9. Always carry a litter patient feet first so that therear bearer can constantly observe the victim forrespiratory or circulatory distress.TRIAGELEARNING OBJECTIVE:Recognizethe protocols for tactical and nontacticaltriage.Triage, a French word meaning “to sort,” is theprocess of quickly assessing patients in amultiple-casualty incident and assigning patient apriority (or classification) for receiving treatmentaccording to the severity of his illness or injuries. In themilitary, there are two types of triage, tactical andnontactical, and each type uses a different set ofprioritizing criteria. The person in charge is responsiblefor balancing the human lives at stake against the realitiesof the tactical situation, the level of medical stock onhand, and the realistic capabilities of medical personnelon the scene. Triage is a dynamic process, and a patient’spriority is subject to change as the situation progresses.SORTING FOR TREATMENT (TACTICAL)The following discussion refers primarily tobattalion aid stations (BAS) (where neither helicopternor rapid land evacuation is readily available) and toshipboard battle-dressing stations.Immediately upon arrival, sort the casualties intogroups in the order listed below.Class IPatients whose injuries require minorprofessional treatment that can be done onan outpatient or ambulatory basis. Thesepersonnel can be returned to duty in a shortperiod of time.Class IIPatients whose injuries require immediatelife-sustaining measures or are of a moderatenature. Initially, they require a minimumamount of time, personnel, and supplies.Class IIIPatients for whom definitive treatment canbe delayed without jeopardy to life or lossof limb.Class IVPatients whose wounds or injuries wouldrequire extensive treatment beyond theimmediate medical capabilities. Treatmentof these casualties would be to thedetriment of others.SORTING FOR TREATMENT(NONTACTICAL)In civilian or nontactical situations, sorting ofcasualties is not significantly different from combatsituations. There are four basic classes (priorities) ofinjuries, and the order of treatment of each is different.Priority IPatients with correctable life-threateningillnesses or injuries such as respiratoryarrest or obstruction, open chest orabdomen wounds, femur fractures, orcritical or complicated burns.Priority IIPatients with serious but non-life-threatening illnesses or injuries such asmoderate blood loss, open or multiplefractures (open increases priority), or eyeinjuries.Priority IIIPatients with minor injuries such as softtissue injuries, simple fractures, or minorto moderate burns.Priority IVPatients who are dead or fatally injured.Fatal injuries include exposed brainmatter, decapitation, and incineration.As mentioned before, triage is an ongoing process.Depending on the treatment rendered, the amount oftime elapsed, and the constitution of the casualty, youmay have to reassign priorities. What may appear to bea minor wound on initial evaluation could develop intoa case of profound shock. Or a casualty who requiredinitial immediate treatment may be stabilized anddowngraded to a delayed status.SORTING FOR EVACUATIONDuring the Vietnam war, the techniques forhelicopter medical evacuation (MEDEVAC) were soeffective that most casualties could be evacuated to amajor medical facility within minutes of their injury.This considerably lightened the load of the HospitalCorpsman in the field, since provision for long-termcare before the evacuation was not normally required.However, rapid aeromedical response did not relievethe Corpsman of the responsibility for giving the bestemergency care within the field limitations to stabilizethe victim before the helicopter arrived. Triage wasseldom needed since most of the injured could beevacuated quickly.New developments in warfare, along with changesin the theaters of deployment, indicate that thehelicopter evacuation system may no longer be viable4-2
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