TRIAGE

Wg Cdr Ankur Pandya

MBBS, MS, MCh(Plast), Dip.Nat.Board(Gen)(Plast), FRCS(Ed),

FRCS(G), Eur.Dip.Hand.Surg, FRCS(Plast), DMCC, O.St.J.,RAF

Consultant Plastic, Reconstructive & Hand Surgeon

Mountbatten Dept of Plastic & Reconstructive Surgery

Consultant Advisor in Plastic surgery to Head RAF Medical Services

Assoc Dean(S) Defence Deanery

Hon. Senior Clinical LecturerSouthampton Univ. School of Medicine

University of Portsmouth

Vounteer Operation Smile &

The Swinfen Trust

Mass Disaster – Madrid

Bombing

London Tower Fire

London Bombings

Bomb Blast

Refugee camp in Yemen

Ebola in the Congo

ScreeningPatients on a humanitarian mission awaiting

surgery in Ethiopia

What is common amongst all

these slides?

Disaster

• All of these fulfill the definition of a

disaster

• “When any social,care or health system

is overwhelmed” by large numbers of

patients or casualties, either in terms of

• Capacity

• Infrastructure

• Expertise

What is the most important

response when there has

been a disaster?

Timely Response

Timely Aid

Targeted Aid

Do Maximum Good with what

is available, to maximum

people even at the expense of

some

To Whom????

This is the basis of Triage

Considerations

• There should be no considerations in

Triage apart from the basic tenet of

doing as much good to those who need

it with what is available

Considerations

• However there is the scope that being

humans we will bring in

• Human Factors

• Ethical Considerations

• In this equation

This is wrong and has the

potential to do great harm

Triage

• Triage, derived from the French verb

trier, and is the process by which

treatment and transport priorities are

allocated to patients

Triage

• The aim of triage is to get the right

patients to the right care in the right way

at the right time

Triage directed by a priority

system

P1 immediate/life saving

P2 within a few hours

P3 can wait

P4 (expectant or dead)

Triage Systems

• Physiological

• Anatomical

• Both

Triage Variants

• Resuscitation Triage

• Surgical Triage

• Transfer (Evacuation) Triage

Triage

• Multiple casualties

• Mass casualties

Personal factors in medical

management

• Fatigue / hunger / nutrition

• Emotional stress and disruption at work

• Situational awareness

• Teamworking (or lack of it)

• Multi-tasking when doing complex tasks

• Briefing/debriefing

Ethics

These are the moral principles that

govern a person's behavior or the

conducting of an activity.

Ethics should be absolute

Ethics

However

• Ethics are influenced by the morality of

the times

• Religion

• Race

• Nationality

• Ethnicity

• Education

Daily routine….

Child Burns Afghanistan

• She was two years old and beautiful

• 43 % burns

• Also inhalationl injury

She was medically retired

• Pain relief..morphine drip

• Tube removed

• Passed away in 30 minutes

Ethics or Triage

Military and the Taliban were the cause in

this war

Innocent bystander (Collateral Damage)

Ethical Responsibility versus Triage

Ethics or Triage?

Taliban father and son

• Father strapped son with explosives

• Loaded hand cart with explosives

• Later the son approached a check point

and the father remotely exploded the

device

• Taliban father also brought in along with

UK soldiers

Daily routine….

External fixators and the ICRC

Ethics

Ethics or Triage?

Daily Triage

• Rounds in a hospital

• ITU beds

• Who to discharge

• Who gets the one appointment for an

urgent MRI scan

• Who gets the urgent emergency

surgical slot

Medical Retirement

• Who to take off life support?

• Who to provide optimum treatment to?

• What is the interplay here between

human factors, ethics and triage??

Who does one operate on?

• This old man?

• This young child?

Never Too Old

Which of these would you

operate upon first?

Screening

World Health Programme…….Screening

In the Triage of a true disaster

pure triage systems need to

come into play for the

maximum good

Human factors, ethics and

triage require to come

together with a human touch

in cold humanitarian triage

Finally

• Civilian bombing

• 5 victims for a two capacity ambulance

• 1) Pregnant Lady

• 2) A Young immigrant youth

• 3) A poicewoan

• 4) The Bomber

• 5) A Child

Thank You