Triage in the Defence Medical Services

Abstract

Triage of patients into categories according to their need for intervention is a core part of military medical practice. This article reviews how triage has evolved in the Defence Medical Services and how it might develop in the context of recent research. In particular, a simple model demonstrates that the ideal sensitivity and specificity of a triage system depends upon the availability of transport and the capacity of the receiving units. As a result, we may need to fundamentally change the way we approach triage in order to optimise outcomes-especially if casualty evacuation timelines become longer and smaller medical units more prevalent on future operations. Some pragmatic options for change are discussed. Finally, other areas of current research around triage are highlighted, perhaps showing where triage may go next.

Assessment of the mass casualty triage during the November 2015 Paris area terrorist attacks: towards a simple triage rule

“…Wartime triage was initially meant to establish surgical priority at a time when this process was the only decisive factor in the prognosis of war casualties. 6 The evolution of war medicine has given rise to the need to prioritize access to other scarce resources such as blood products, diagnostic methods and life-saving interventions prior to surgery. As a result, preoperative and pre-hospital categorization tools have been added to classic surgical triage without replacing it.…”

“…Since prospective research in this area is difficult to conduct, and probably unethical, most information has been obtained during simulation research which may not apply to real conditions. [6][7][8] Analysis of the triage during major incidents may also be difficult because of either small sample size, study heterogeneity, and/or biased selection of studied casualties. 9,10 A systematic review concluded that field triage systems do not perform consistently during mass casualty events.…”