Disaster triage is a critical medical process used in mass casualty incidents or large-scale emergencies to rapidly categorize injured individuals based on the severity of their injuries and the likelihood of their survival, ensuring the most effective use of limited resources. Unlike everyday medical triage, which often focuses on the best outcome for an individual, disaster triage prioritizes saving the greatest number of lives within the affected community.
In these challenging circumstances, the primary goal shifts from individual well-being to maximizing overall community survival. Speed is paramount in disaster triage, as delays in assessment and initial treatment can lead to fatal outcomes for many victims.
Core Principles of Disaster Triage
Disaster triage operates on several key principles that differentiate it from standard emergency department triage:
- Community Survival Focus: The ultimate aim is to benefit the largest number of people, even if it means some individuals with severe injuries, who would require extensive resources with a low chance of survival, might be categorized lower.
- Rapid Assessment: Triage must be conducted quickly and efficiently, often in chaotic environments, to identify and prioritize those who can be saved with immediate intervention.
- Resource Optimization: Given the scarcity of medical personnel, equipment, and facilities in a disaster, triage guides the allocation of these limited resources to achieve the broadest positive impact.
- Dynamic Process: Triage is not a one-time event; patients may need to be re-triaged as their condition changes or as more resources become available.
Common Triage Systems
Several standardized systems are employed globally to facilitate rapid and consistent assessment in disaster settings. One of the most widely recognized is the START (Simple Triage and Rapid Treatment) method, often adapted with the JumpSTART system for pediatric victims. These systems typically use color-coded tags to denote priority levels:
| Category | Color Tag | Description | Example |
|---|---|---|---|
| Immediate | Red | Patients with life-threatening injuries who can survive if treated immediately. Requires urgent intervention within minutes to an hour. | Airway obstruction, severe bleeding, tension pneumothorax, shock. |
| Delayed | Yellow | Patients with significant injuries that require medical attention but are not immediately life-threatening. They can wait for treatment for several hours without significant risk. | Stable fractures, moderate burns, significant lacerations without uncontrolled bleeding, most abdominal injuries. |
| Minor | Green | "Walking wounded" – patients with minor injuries who can self-care or wait for treatment for an extended period. They are often asked to move to a designated area to help clear the scene. | Minor cuts and abrasions, sprains, small contusions, minor psychological trauma. |
| Deceased/Expectant | Black | Patients who are either deceased or have injuries so severe that survival is unlikely even with extensive medical intervention, or their survival would consume resources that could save multiple other lives. | Obvious signs of death (e.g., decapitation), massive head trauma with brain matter exposed, extensive burns covering most of the body, injuries incompatible with life, or those who fail to respond to immediate, basic life-saving measures (e.g., opening an airway and controlling severe bleeding). |
(Source for categories: CDC - Mass Casualty Incident Triage)
Practical Application
In a disaster scenario, first responders, often firefighters, paramedics, or even trained volunteers, are typically the first to initiate triage. They quickly assess vital signs, mental status, and obvious injuries to assign a color category. For example, during an earthquake or a large vehicle collision, initial responders would quickly move through the scene, performing a rapid assessment (e.g., checking for breathing, presence of a pulse, and ability to follow commands) and tagging victims. This initial tagging then guides subsequent medical teams on who to transport first and to which level of care facility.
This systematic approach ensures that medical resources are directed where they can do the most good, maximizing the number of survivors in the face of overwhelming demand.
