Triage vs. Treatment

Triage vs. Treatment

If you have ever been involved with a full scale disaster drill, you've seen it. The biggest hang up for participants is being able to triage all patients in a timeline manner. Why? Because they're doing treatment, not triage.

What's the difference?

Triage comes from the French word trier which means "separate out". Of course that's not our entire scope when performing triage in a mass casualty incident but it is certainly the objective. Couple that with the overarching CERT mission to do "the greatest good for the greatest number" and we must perform this "separating out" with expediency.

Simple Triage and Rapid Treatment (START) is the most widely used acronym to abbreviate the act of triage in an MCI. But wait, it says "treatment"! Actually it says rapid treatment. Why rapid? Objectively, we are trying to do the great good for the greatest number. Tactically, we are up against the clock so we are only providing the minimum treatment necessary to keep the patient alive long enough to be extricated. More often than not, this rapid treatment is only performed on Immediate patients who are at severe risk of death if no intervention is immediately given.

Treatment, on the other hand, is the more laborious act of tending to injuries. Our objective is to treat the injury for pain relieve and to mitigate long term or permanent damage. Expediency cannot be guaranteed with this objective because most injuries cannot be treated in less than two minutes.

Simply put, triage is sorting and treatment is curing.

Why do we struggle with this?

Because we're good people. We signed up for this gig - and stick with it - because we care for our fellow citizen. We don't want to leave anyone in distress, even if it's a sprained ankle. The screams of agony are a strong gravitational pull on us. However, we need to continually (every second) remind ourselves that there are others that need help - at least we have to assume that. Speed is key.

How can we improve?

Practice Simple Triage. Organizing a disaster drill every month is not tenable for most CERT programs so we can't reasonably expect everyone to practice triage on real people with fancy moulage. You can however use flash cards or PowerPoint slides to create a variety of patient scenarios and time yourself on assigning a triage category.

Another idea is to do a pop quiz at your next team event. If your program has a recurring meeting, carve out five minutes to do 10 scenarios and talk about them afterwards.

Have ready-to-go responses. Patients don't want you to leave but if you say the right thing, they will be more amenable letting you go. Have a short list of phrases in your head such as "someone is coming right behind me" or "I'm not going very far".

Follow a consistent process and have defined roles and responsibilities in your triage crew. Who is responsible for documenting? Tagging? Providing rapid treatment? Define it before you go so that everyone knows exactly what they are doing. Each person will get into a rhythm and speed up as they go.

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