During mass disasters, first aiders and emergency personnel can easily be overwhelmed by the number of people needing first aid treatment. Triage is the rapid classification and sorting of victims requiring emergency treatment. It sorts the victims depending on the severity of illness or injury so that first aid resources and manpower can be more efficiently distributed. The goal is to do the most good for the greater number of people, prioritizing those who will most likely survive if given immediate first aid. It is also used to maximize the number of people who will survive the disaster.
The basic principles in dividing victims into groups include:
- Those who will survive if given immediate emergency treatment;
- Those who will survive regardless of whether they receive emergency treatment or not;
- Those who will die regardless of whether they receive emergency treatment or not.
Although triage is most commonly used in disasters involving a large number of victims, it can also be applied in any emergency situation with more than two casualties. In fact, the system is normally used in classifying patients in the emergency department of health facilities. Advanced first aid courses offered by organizations such as the Red Cross often include triage in the training.
What is S.T.A.R.T?
S.T.A.R.T. stands for Simple Triage And Rapid Treatment/Transport. It is a system used by first responders at the scene of a disaster. It is designed to: 1) sort victims depending on assessed needs for emergency care, 2) provide brief essential life saving treatments, and 3) recognize futility. By using this START triage, the limited number of first aiders can identify and act upon those victims and conditions which will benefit most from the use of available resources.
It is important to note that while each injured person is being triaged, the “triager” provides critical life-saving procedures (such as opening the airway, stopping bleeding, and positioning victim). The “triager” quickly assesses each victim, moving quickly from one victim to another (usually 10 to 30 seconds each) until all injured persons are checked.
Injured persons are classified and tagged using the colour coding scheme that the emergency team uses. Here is a triage category:
Priority 1 (RED) – first priority for treatment or transport; serious but salvageable life-threatening injuries and illnesses
- Head injuries
- Severe bleeding
- Severe burns
- Severe breathing problems
- Heart attack
- Internal injuries
Priority 2 (YELLOW) – second priority for treatment/transport; moderate to serious injuries but not immediately life-threatening
- Moderate burns
- Moderate bleeding
Priority 3 (GREEN) –also called “walking wounded”; non-life-threatening injuries and illnesses; treatment or transportation may be delayed and can be guided to a holding area
- Wounds, cuts and bruises
Priority 4 (BLUE) – victims with potentially fatal illness or injuries but are not salvageable; Remember that in cases of mass casualty incidents, not all injured persons can be given treatment so even if a person still has some vital signs but the injuries are not salvageable, they may be tagged as “un-salvageable” by the triage officer. However, this category is only given if available resources are very limited compared to the needs of the casualties.
Priority 5 (BLACK) – victims who have no signs of life and/or sustained obviously fatal injuries
Take note that the colour coding system may differ depending on the scheme used by the first responders. Triage officers play an essential role in disaster response as they make huge decisions. Ideally, triage officers are healthcare professionals or EMTs who have extensive training in emergency response.