Triage shouldn’t be needed in this world. We should be able to help everybody. Just hearing the word makes me feel helpless.
nod
I heard the term “cadaver dogs” more times on Tuesday than one should hear in a lifetime.
The word of course is old, and used (in English) at least since the Napoleanic campaigns.
There was a revival in the common usage when MASH was popular. It is now mainly used by medical personnel.
I guess that’s why it’s all the more disturbing when you have to hear it all of the sudden and a lot. I’ll just be glad when my coworkers can talk about something else over lunch again.
It’s just a word to many people who hear it. At best they think of it as “prioritizing,” which it is. But once you start thinking deeper about what is being prioritized its real meaning starts to sink in.
It’s one of those few terms that do not sugar-coat what reality is–that in this world, suffering is prodigal, and surges beyond our capacity to directly treat all of it.
“To harrow” is an interesting word, its archaic roots meaning to pillage, plunder. There is a common narrative, sometimes explicit and more often implicit, that humanity is powerful. Look at the works we have wrought; look at our cities, look at the strides we have made against disease, against death. In our developed corner of the world, counter-examples are usually scattered, minor, not intruding on the lives of the vast majority more than fleetingly–and make no mistake, that itself is evidence of power. But that is harrowed by situations when triage is necessary–pointing up, in spades, that our power only goes so far. Our works can turn to dust in an instant, as can our ability to combat suffering.
Triage is actually a French word. I think the French teacher said it means “one after another”.
Everybody seems to think that triage principally means letting some terribly injured people die while treating other critically injured patients who can still be saved. That’s hardly ever how it works!
99.9% of all triage is the simple act of treating the worst injured first. You let the guy with the broken leg wait while you save the life of the guy with the head injury, because if you treat the guy with the broken leg first, the guy with the head injury who needs immediate life-saving treatment dies. With proper triage, they both get helped.
So don’t despair just because you hear the word “triage.” Once in a great while, triage means choosing who lives and who doesn’t, but almost always it means making sure that everybody lives.
So true… do not despair… my “gf” is an ER nurse and sometimes takes her turn in Triage… it is exactly what is described above… Triage is in every emergency room… the worst injured get treated first no matter time of entry.
…in the case of the terrorism though… it could mean the treatable get treated before the untreatable… so sad.
Triage is a bit more difficult than that…yes it is the treatment of who is injured the worst, to a point. As soon as there is more patients than caretakers, you have to decide who will wait. One of those difficult decisions is to actually let someone die. Triage properly done may very well let someone die. If there are 10 people injured, and only 3 caretakers, and one of those injured is near death, I would not treat that person. I would have 9 other patients to care for. If I divert all my resources to that one person, I may loose other patients who I would have been able to save if I gave that patient even some basic attention…
It is a very hard decision to look at someone and let them die, but in triage, it does happen…
I know. Wife did her time in the ER, fending off the guy whose tummy aches wasn’t being treated since the car crash was brought in, even though he got there first. :rolleyes:
This week was different. Or it would have been different if more had survived. As it was, it doesn’t look like triage was needed much.
Re: Cadaver dogs
Yeah, that is what we call them. I personally use different terminology, mostly because of the impact on people - the minute I arrive on a scene, they know it’s because people are dead - my dogs are cadaver dogs.
I use “Search Dog” for live finds, and “Recovery Dog” for cadaver.
Technical term is “cadaver” - we train on “cadaver scent”… that kind of thing.
I much prefer recovery.
Muchly.
I think triage is also used in maternity wards. I’m pretty sure that’s what they called it when I went in, once when I was having contractions too early and needed to be monitored, and once when I was finally in labor. I thought it was where they checked you out before they figured out if you had to be admitted as a regular patient or not.
I can recall thinking it made the process sound terribly serious (Triage?!?! Isn’t that for people who are seriously hurt?!?!) but it must have a broader meaning.
Triage is a horrible necessity during wartime, and SOMETIMES a horrible necessity during a peacetime disaster.
Look, in an Army hospital (sorry to use “MASH” as an illustration, but it helps), when a hundred wounded men are rushed in, and you’ve only got X amount of blood, X number of doctors, and X amount of anaesthetic, some very tough choices have to be made. Nobody WANTS to be cold or hertless, and nobody WANTS soldiers to die, but if you want to save the greatest number of men possible, you have to spend your time and resources in the most efficient way possible.
“Triage” means separating the wounded into three groups:
- Those who will almost certainly die no matter what you do.
- Those who are in mortal danger, but who can be saved with immediate treatment.
- Those who will probably survive for quite a while without treatment.
IF your resources, time and manpower are VERY limited… the sad reality is, doctors must let the first group die.
It may sound cruel, but you can’t expend plasma and a surgeon’s time/skill on a man who’s not going to survive anyway. That blood and that surgeon’s time could be better used on someone who has a chance at survival.
Now, as said earlier, in MOST ordinary hospital emergency rooms, “triage” is a lot less grim than this. MOST of the time, it means simply that the guy with the sprained ankle waits, while the guy with the head trauma is treated.
But in the RARE cases, like the WTC bombing, when hospitals are packed to the rafters with injured people, and resources are in short supply (you don’t really expect ANY hospital to be fully ready for something as horrible as this, do you?)… “MASH”-style triage may be appropriate.
Please note this post is not for the faint of heart or stomach.
In a perfect world yes everyone would be helped, in reality things like response times, number of personell available and amount of equipment available will determine who gets help first. I have been through this. I was an EMT that was part of the response to a 74 car pileup on a rural section of freeway. Visibility was only about 100 feet in some patches and at 65 mph thats less than a second to stop. The first 20-30 vehicles were messy enough, many of the fatalitiies occurred when a small propane tanker plowed into the mess rupturing its tank. Several of the first few ambulances to arrive were struck by other vehicles who were
unaware of the problem yet. we had I believe 128 patients many critical and lots of burns from the propane blast.
In many cases people are “beyond help”
Examples being:
over 90% of body surface 2nd and 3rd degree burns. These people even if recieved alive at a burn unit they rarely survive their injuries.
Many cardiac/respiratory arrests are let go under these circumstances, it takes 3-4 people to effectively work these patients. If they attempted to revive every arrested person it would take 70-80 personel just to handle those 20 patients. I don’t think we ever had many more EMS folk on scene at once.
Massive multi-trauma like people who have been ejected from vehicles and had arms, legs, etc ripped away and have pretty much bled out by the time EMS arrives. No blood = No patient.
Triage is not about treating everyone equally, its making the best of a horrible situation. You fix what you can the rest don’t make it. Simple numbers, if you have 20 ambulances and 80 patients you don’t bother transporting someone who won’t survive the ride. It isn’t easy for anyone to put a black triage tag (dead or unsalvageable) on someone who isn’t dead yet but it has to happen sometimes.