Triage is the concept that is introduced by Napoleon’s battlefield surgeon. The concept stress on the need for us to treat the most seriously injured to receive the care first. This concept is usually needed in the case of mass disaster. Disaster mentioned here can be natural disaster such as cyclones or manmade disaster such as bombing. In mass disaster, the resources available to provide greatest conventional care for each individual injured usually are not sufficient. So, patient that seriously needs the care must be treated first in order to increase the chance of survival. Basically, triage can be divided into five categories: Immediate, delayed, minimal (walking wounded), expectant and dead. In the initial phases, only two phases are considered important: immediate or non-immediate. Immediate category . Later, more categories can be defined when the casualties influx subsides and nature and extend of injuries and resources are known, and more evaluation are carried out.
Patients who are classified into immediate category must be treated first because they are having life-threatening case. There are many examples of life-threatening case such as open chest wound, tension pneumothorax, airway compromise, unconsciousness with focal signs, hypotension, active external haemorrhage and intermediate burn. These conditions can be treated by simple intervention such as rapid external wound compression, laparotomy for splenectomy, endotracheal intubation, tube thoracostomy that would stabilize patient immediately after the intervention. These interventions are not only life saving but can also give more space for other patients that are belong to the same category to be treated as soon as possible.
Other category is delayed. Patients with extremity vascular compromise, spinal fractures with or without spinal cord injury, pelvic fractures, open or closed extremity fractures, penetrating torso fractures, soft tissue wounds, unconsciousness without airway compromise or lateralizing signs and etc are classified into this group. Continuous monitoring is needed and intervention such as IV infusion, volume repletion, administration of analgesics and antibiotics, covering open wounds are immobilizing fractures can reduce the morbidity. These interventions are included in minimal acceptable care. Patients must be placed in the area in which the immediate patients group are placed to avoid crowding and confusion.
The minimal group is the one who always arrive at the hospital early because of their ability to walk using their own power. Patients in this group are usually do not need intensive treatment but may require first aid treatment. Medical team must monitor these patients for any deteriorating conditions.
Expectant is related to the patients with the conditions that are serious with low chances of survival but are still alive. This condition may confuse us from giving the right treatment to the patient classified into immediate group that are more beneficial. The examples of conditions that classified into expectant condition are serious head injuries with open skull fractures or unconsciousness, extensive and deep burns and imminent cardiac arrect with major torso trauma. They basically need to be monitored for any improvement that may warrant care as well as kept comfortable.
The last but not least is the dead category that is important to be differentiated from other group to prevent unnecessary resuscitation and intervention. Moreover, the process will make later processes of identification as well as communication to the family of the dead person easier.
References:
1. E.R. Frykberg. Triage: Principles and Practice. 2005. [online accessed on November 28rd
2010]
URL: http://www.fimnet.fi/sjs/articles/SJS42005-272.pdf
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