9. Always carry a litter patient feet first so that the rear bearer can constantly observe the victim for respiratory or circulatory distress. TRIAGE LEARNING OBJECTIVE: Recognize the protocols for tactical and nontactical triage. Triage, a French word meaning “to sort,” is the process of quickly assessing patients in a multiple-casualty incident and assigning patient a priority (or classification) for receiving treatment according to the severity of his illness or injuries. In the military, there are two types of triage, tactical and nontactical, and each type uses a different set of prioritizing criteria. The person in charge is responsible for balancing the human lives at stake against the realities of the tactical situation, the level of medical stock on hand, and the realistic capabilities of medical personnel on the scene. Triage is a dynamic process, and a patient’s priority is subject to change as the situation progresses. SORTING FOR TREATMENT (TACTICAL) The following discussion refers primarily to battalion aid stations (BAS) (where neither helicopter nor rapid land evacuation is readily available) and to shipboard battle-dressing stations. Immediately upon arrival, sort the casualties into groups in the order listed below. Class I Patients whose injuries require minor professional treatment that can be done on an outpatient or ambulatory basis. These personnel can be returned to duty in a short period of time. Class II Patients whose injuries require immediate life-sustaining measures or are of a moderate nature. Initially, they require a minimum amount of time, personnel, and supplies. Class III Patients for whom definitive treatment can be delayed without jeopardy to life or loss of limb. Class IV Patients whose wounds or injuries would require extensive treatment beyond the immediate medical capabilities. Treatment of these casualties would be to the detriment of others. SORTING FOR TREATMENT (NONTACTICAL) In civilian or nontactical situations, sorting of casualties is not significantly different from combat situations. There are four basic classes (priorities) of injuries, and the order of treatment of each is different. Priority I Patients with correctable life-threatening illnesses or injuries such as respiratory arrest or obstruction, open chest or abdomen wounds, femur fractures, or critical or complicated burns. Priority II Patients with serious but non-life- threatening illnesses or injuries such as moderate blood loss, open or multiple fractures (open increases priority), or eye injuries. Priority III Patients with minor injuries such as soft tissue injuries, simple fractures, or minor to moderate burns. Priority IV Patients who are dead or fatally injured. Fatal injuries include exposed brain matter, decapitation, and incineration. As mentioned before, triage is an ongoing process. Depending on the treatment rendered, the amount of time elapsed, and the constitution of the casualty, you may have to reassign priorities. What may appear to be a minor wound on initial evaluation could develop into a case of profound shock. Or a casualty who required initial immediate treatment may be stabilized and downgraded to a delayed status. SORTING FOR EVACUATION During the Vietnam war, the techniques for helicopter medical evacuation (MEDEVAC) were so effective that most casualties could be evacuated to a major medical facility within minutes of their injury. This considerably lightened the load of the Hospital Corpsman in the field, since provision for long-term care before the evacuation was not normally required. However, rapid aeromedical response did not relieve the Corpsman of the responsibility for giving the best emergency care within the field limitations to stabilize the victim before the helicopter arrived. Triage was seldom needed since most of the injured could be evacuated quickly. New developments in warfare, along with changes in the theaters of deployment, indicate that the helicopter evacuation system may no longer be viable 4-2