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European Journal of Trauma and Emergency Surgery Focus on Disaster Medicine
Triage: Principles and Pressures
James M. Ryan1,2
Abstract The aim of this paper is to review the art and science underpinning the application of effective triage. The paper also attempts to cut through the fog of confusion surrounding the topic and to point a way towards a generally-agreed unied approach. Triage needs to be understood in the context of the environment in which it is applied, and the paper deals with this in some detail.
Key Words Multiple casualties Mass Casualties Triage sieve Triage sort
Eur J Trauma Emerg Surg 2008;34:42732 DOI 10.1007/s00068-008-8804-3
Introduction Triage is a widely used term that was initially used in relation to the care of war injured but is now ubiquitous in civilian trauma practice. The word triage is derived from the French verb trier, meaning to sift or to sort [1]. In practice it is the method used to identify those in greatest need when faced with multiple or mass casualties. It is the process used throughout all management phases and allows the allocation of priorities for initial treatment, transport and in-hospital management, including access to operating rooms and intensive therapy unit (ITU) bed-space.
Credit for initiating triage is attributed to Baron Dominique Jean Larrey, Chief Surgeon to Napoleon Bonaparte. He applied triage as a means of sorting casualties into priority groups for evacuation from the battleeld by horse-drawn ambulances to rear areas for treatment. It is interesting to note that he initially used the method to identify the lightly injured that would most likely survive and could then be returned to the ghting.
Today the aim of triage is different: it is used to identify, manage and evacuate the most severely
injured ahead of the more lightly injured. In short, it is a method that is applied to get the right patient to the right care at the right time. In US parlance, it aims to do the most for the most when faced with multiple or mass casualties. It is thus most suited to conict and catastrophe settings.
Principles of Care in Conict and Catastrophes It is important to place triage in context when considering the overall care of the injured in these settings. Conict...