Emergency and disaster triage
A top-down decision tree opening with CAN THEY WALK, branching through diamond nodes to four luggage-tag cards for immediate, delayed, minor, and expectant.
Two different questions
Day-to-day triage asks who is sickest, and treats that patient first. Mass-casualty triage asks a different question entirely: how are the most lives saved with the people and supplies actually present? The same patient can be first in one system and last in the other, and nothing about the patient changed.
The four tags
- Immediate — life-threatening injury that is survivable with prompt, available intervention. These patients are the reason the system exists.
- Delayed — serious injury that can safely wait without losing life or limb.
- Minor — walking wounded, able to self-report and often able to help.
- Expectant — injuries incompatible with survival given the resources on hand. Comfort measures are given. Reassignment happens if resources later expand.
The field sort
Ask in order: Can they walk to the collection area? Are they breathing at all, and does a simple airway maneuver start breathing? Is the breathing fast and labored, or settled? Is peripheral perfusion intact? Can they follow a simple command? Each answer moves you down the tree; you never skip ahead because the injury looks dramatic.
After the sort
Categories are reassessed, not assigned once. A delayed patient who deteriorates is retagged as immediate, and retagging is an expected event in a working system rather than evidence that someone made a mistake.
Margin notemost lives, not the worst patient.
Watch outa silent, still casualty may already be expectant, while the walking casualty who is shouting at you is usually minor.
Takeawayin a disaster the resource, not the patient, sets the priority.
Priority frameworks → BOOK 03 · P4. Disaster staffing and evacuation → BOOK 03 · P12.