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Casualty TriageCasualty Triage
COMBAT MEDIC ADVANCED SKILLS TRAINING (CMAST)
CMASTCMAST 22
Familiarity with the principles of casualty Familiarity with the principles of casualty triage.triage.
Perform casualty triage in a given situation.Perform casualty triage in a given situation.
Understand patient triage vs. evacuation Understand patient triage vs. evacuation categories.categories.
IntroductionIntroduction
CMASTCMAST 33
Mass casualty (MASCAL) situations occur Mass casualty (MASCAL) situations occur when the number of casualties exceeds the when the number of casualties exceeds the available medical capability to rapidly treat available medical capability to rapidly treat and evacuate them.and evacuate them.
– The actual numbers varies depending on The actual numbers varies depending on available resourcesavailable resources
– May be a soldier medic having to manage May be a soldier medic having to manage more than one casualty at a timemore than one casualty at a time
Casualty TriageCasualty Triage
CMASTCMAST 44
SystemSystem used for categorizing and sorting used for categorizing and sorting casualties according to severity of their casualties according to severity of their injuries and available resources:injuries and available resources:
– Survey and classify Survey and classify casualties for the most casualties for the most efficient use of available efficient use of available medical personnel and medical personnel and suppliessupplies
Casualty TriageCasualty Triage
CMASTCMAST 55
– Treatment first towards the casualties who Treatment first towards the casualties who have the best chance to survivehave the best chance to survive
– Locate troops with Locate troops with minor wounds and minor wounds and return them to dutyreturn them to duty
Casualty TriageCasualty Triage
CMASTCMAST 66
Determine the tactical and environmental Determine the tactical and environmental situation.situation.– Necessity to transport casualties to a more secure Necessity to transport casualties to a more secure
collection point for treatment.collection point for treatment.– Number and location of injured.Number and location of injured.– Severity of injuries.Severity of injuries.– Available assistance: self-aid, CLS, medical Available assistance: self-aid, CLS, medical
personnel.personnel.– Evacuation support capabilities and requirements.Evacuation support capabilities and requirements.
Casualty TriageCasualty Triage
CMASTCMAST 77
Establishing triage, treatment and holding Establishing triage, treatment and holding areas.areas.─ May be established in existing MTF, an May be established in existing MTF, an
available shelter or outdoorsavailable shelter or outdoors
Casualty TriageCasualty Triage
CMASTCMAST 88
Existing MTF for MASCAL stations:Existing MTF for MASCAL stations:– Triage areaTriage area
• Easily accessedEasily accessed• Sufficient spaceSufficient space• Controlled flowControlled flow• Surgical detachmentSurgical detachment
– Holding areas for each triage categoryHolding areas for each triage category– Marking (casualty triage tags) Marking (casualty triage tags)
Casualty TriageCasualty Triage
CMASTCMAST 99
Outdoor MASCAL stations:Outdoor MASCAL stations:– Overhead cover; available shadeOverhead cover; available shade– Triage area accessibleTriage area accessible
• OutdoorsOutdoors• Inclement weather Inclement weather
planned forplanned for
– Improvised sheltersImprovised shelters
– CBRN threat?CBRN threat?
Casualty TriageCasualty Triage
CMASTCMAST 1010
Triage is the process of prioritizing soldiers Triage is the process of prioritizing soldiers on the basis of their individual needs for on the basis of their individual needs for medical intervention.medical intervention.
The likely outcome of the individual casualty The likely outcome of the individual casualty must be factored into the decision process must be factored into the decision process prior to the commitment of limited prior to the commitment of limited resources. resources.
Casualty TriageCasualty Triage
CMASTCMAST 1111
Casualties are generally sorted into the Casualties are generally sorted into the following four categories (or priorities). following four categories (or priorities).
* * Remember:Remember: Triage is an ongoing process Triage is an ongoing process of of reassessmentreassessment which may change the which may change the casualties’ triage category. casualties’ triage category.
Casualty TriageCasualty Triage
CMASTCMAST 1212
Sort multiple casualties into Sort multiple casualties into prioritiespriorities. . ConventionalConventional battlefield casualties. battlefield casualties.
– ImmediateImmediate: immediate treatment to save life, limb : immediate treatment to save life, limb or eyesight or eyesight
– DelayedDelayed: casualties who have less risk of losing life : casualties who have less risk of losing life or limbor limb
– MinimalMinimal: “walking wounded", self-aid or buddy-aid : “walking wounded", self-aid or buddy-aid
– ExpectantExpectant: casualty so critically injured that only : casualty so critically injured that only complicated and prolonged treatment offers any hope complicated and prolonged treatment offers any hope of improving life expectancyof improving life expectancy
Casualty TriageCasualty Triage
CMASTCMAST 1313
IntegratedIntegrated battlefield casualties. battlefield casualties. – ImmediateImmediate: conventional life threats; no CBRN: conventional life threats; no CBRN
– Chemical ImmediateChemical Immediate: severe chemical life threats; : severe chemical life threats; no conventional threatno conventional threat
– DelayedDelayed: no conventional life threats; mild chemical : no conventional life threats; mild chemical threatthreat
– MinimalMinimal: minor conventional injuries; no chemical : minor conventional injuries; no chemical
– ExpectantExpectant: conventional life threats; severe chemical : conventional life threats; severe chemical threatthreat
Casualty TriageCasualty Triage
CMASTCMAST 1414
Evacuation – Evacuation – UrgentUrgent.. Evacuation required as soon as possible; no Evacuation required as soon as possible; no
later than later than 2 hours2 hours to save life, limb or eyesight. to save life, limb or eyesight. – Casualties condition(s) cannot be controlled Casualties condition(s) cannot be controlled
and have the greatest opportunity for survival and have the greatest opportunity for survival – Cardiorespiratory distressCardiorespiratory distress– Shock not responding to IV therapyShock not responding to IV therapy
Evacuation Categories Evacuation Categories
CMASTCMAST 1515
Evacuation – Evacuation – UrgentUrgent (cont’d). (cont’d).– Prolonged unconsciousnessProlonged unconsciousness– Head injuries with signs of increasing ICPHead injuries with signs of increasing ICP– Burns covering 20% to 85% of TBSABurns covering 20% to 85% of TBSA
Evacuation Categories Evacuation Categories
CMASTCMAST 1616
Evacuation – Evacuation – Urgent SurgicalUrgent Surgical.. Evacuation required for casualties who must Evacuation required for casualties who must
receive far forward surgical intervention to save receive far forward surgical intervention to save life and stabilize for further evacuation. life and stabilize for further evacuation. – Decreased circulation in the extremitiesDecreased circulation in the extremities– Open chest and/or abdominal wounds with Open chest and/or abdominal wounds with
decreased blood pressuredecreased blood pressure– Penetrating woundsPenetrating wounds
Evacuation Categories Evacuation Categories
CMASTCMAST 1717
Evacuation – Evacuation – Urgent SurgicalUrgent Surgical (cont’d). (cont’d).– Uncontrollable bleeding or open fractures with Uncontrollable bleeding or open fractures with
severe bleedingsevere bleeding– Severe facial injuriesSevere facial injuries– Burns on hands, feet, face, genitalia or Burns on hands, feet, face, genitalia or
perineum, even if under 20% TBSAperineum, even if under 20% TBSA
Evacuation Categories Evacuation Categories
CMASTCMAST 1818
Evacuation – Evacuation – PriorityPriority.. Evacuation is required within 4 hours or Evacuation is required within 4 hours or
casualty’s condition could become worse casualty’s condition could become worse and become an "urgent" or "urgent surgical" and become an "urgent" or "urgent surgical" category condition.category condition.– Closed-chest injuriesClosed-chest injuries– Brief periods of unconsciousnessBrief periods of unconsciousness– Soft tissue injuries and open or closed Soft tissue injuries and open or closed
fracturesfractures
Evacuation CategoriesEvacuation Categories
CMASTCMAST 1919
Evacuation – Evacuation – PriorityPriority (cont’d). (cont’d).– Abdominal injuries with no decreased blood Abdominal injuries with no decreased blood
pressurepressure– Eye injuries that do not threaten eyesightEye injuries that do not threaten eyesight– Spinal injuriesSpinal injuries
Evacuation CategoriesEvacuation Categories
CMASTCMAST 2020
Evacuation – Evacuation – RoutineRoutine.. Evacuation required within Evacuation required within 24 hours24 hours for for
casualties requiring additional care.casualties requiring additional care.– Simple fracturesSimple fractures– Open wounds including chest injuries without Open wounds including chest injuries without
respiratory distressrespiratory distress– Psychiatric casesPsychiatric cases
– Terminal casesTerminal cases
Evacuation CategoriesEvacuation Categories
CMASTCMAST 2121
Evacuation – Evacuation – ConvenienceConvenience.. Evacuation of casualties by medical vehicle is a Evacuation of casualties by medical vehicle is a
matter of convenience rather than necessity.matter of convenience rather than necessity.– Minor open woundsMinor open wounds– Sprains and strainsSprains and strains– Minor burns under 20% of TBSA Minor burns under 20% of TBSA
Evacuation CategoriesEvacuation Categories
CMASTCMAST 2222
Medical Evacuation Request Medical Evacuation Request
CMASTCMAST 2323
Prepare a standard nine-line Medevac request.Prepare a standard nine-line Medevac request.– Line 1Line 1: Pickup location: Pickup location– Line 2Line 2: Radio frequency, call sign and suffix : Radio frequency, call sign and suffix – Line 3Line 3: Number of casualties by precedence : Number of casualties by precedence
((evacuationevacuation) category ) category – Line 4Line 4: Special equipment : Special equipment
requiredrequired– Line 5Line 5: Number of casualties : Number of casualties
by type (by type (ambulatory vs. litterambulatory vs. litter))
Medical Evacuation RequestMedical Evacuation Request
CMASTCMAST 2424
Prepare a standard nine-line Medevac request.Prepare a standard nine-line Medevac request.– Line 6Line 6: Security of pickup site (: Security of pickup site (wartimewartime) or ) or
number/type of wounded, injured, illness number/type of wounded, injured, illness ((peacetimepeacetime))
– Line 7Line 7: Method of : Method of marking pickup sitemarking pickup site
– Line 8Line 8: Casualty‘s : Casualty‘s nationality and nationality and status status
Medical Evacuation RequestMedical Evacuation Request
CMASTCMAST 2525
Prepare a standard nine-line Medevac request.Prepare a standard nine-line Medevac request.– Line 9Line 9: NBC contamination (wartime) or : NBC contamination (wartime) or
terrain description (peacetime)terrain description (peacetime)• NBC contamination, if any - NBC contamination, if any - otherwise omit otherwise omit
this linethis line• Terrain description including details of Terrain description including details of
terrain features in and around proposed terrain features in and around proposed landing sitelanding site
*As *As a minimuma minimum, the first five items , the first five items mustmust be provided in be provided in the exact sequence listed. the exact sequence listed.
Medical Evacuation RequestMedical Evacuation Request
CMASTCMAST 2626
A firm understanding of triage will help A firm understanding of triage will help the soldier medic maximize resources the soldier medic maximize resources and reduce complications.and reduce complications.
Identify steps in performing triage.Identify steps in performing triage. Perform a triage in a given situation.Perform a triage in a given situation. Identify triage categories.Identify triage categories. Identify evacuation categories.Identify evacuation categories.
Summary
CMASTCMAST 2727
Questions?Questions?