Limitations of Triage in Military Mass Casualty Response: A Case Series.
Journal of Special Operations Medicine · 2024-08-22 · Observational study
Abstract
INTRODUCTION: Mass casualty events (MASCALs) in the combat environment, which involve large numbers of casualties that overwhelm immediately available resources, are fundamentally chaotic and dynamic and inherently dangerous. Formal triage systems use diagnostic algorithms, colored markers, and four or more named categories. We hypothesized that formal triage systems are inadequately trained and practiced and too complex to successfully implement in true MASCAL events. This retrospective analysis evaluates the real-world application of triage systems in prehospital military MASCALs and other aspects of MASCAL management. METHODS: We surveyed Special Operations Forces (SOF) medics known to us who have participated in military prehospital MASCALs and analyzed them. Aggregated data describing the scope of the incidents, the use of formal triage algorithms and colored markers, the number of categories, and the interventions on scene were analyzed using descriptive statistics, and lessons learned were consolidated. RESULTS: From 1996 to 2022 we identified 29 MASCALs that were managed by military medics in the prehospital setting. There was a median of three providers (range 1-85) and 15 casualties (range 6-519) per event. Four or more formal triage categories were used in only one event. Colored markers and formal algorithms were not used. Life-saving interventions were performed in 27 of 29 (93%) missions and blood transfusions were performed in four (17%) MASCALs. The top lessons learned were: 1) security and accountability are cornerstones of MASCAL management; 2) casualty movement is a priority; 3) intuitive triage categories are the default; 4) life-saving interventions are performed as time and tactics permit. CONCLUSION: Formal triage systems requiring the use ofdiagnostic algorithms, colored tags, and four or five categories are seldom implemented in real-world military prehospital MASCAL management. The training of field triage should be simplified and pragmatic, as exemplified by these instances.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Blood products · Fluids & blood · Mass casualty triage · Military & tactical
Related articles
- Optimizing Mass Casualty Triage: Using Discrete Event Simulation to Minimize Time to Resuscitation. (J Am Coll Surg, 2024)
- A Case Report of Combat Blast Injury Requiring Combat Casualty Care, Far-Forward ECMO, Air Transport, and All Levels of Military Critical Care. (Mil Med, 2023)
- Case-control analysis of prehospital death and prolonged field care survival during recent US military combat operations. (J Trauma Acute Care Surg, 2021)
- Red tides: Mass casualty and whole blood at sea. (J Trauma Acute Care Surg, 2018)
- Blood supply continuity and emergency preparedness in natural and man-made disasters and in armed conflicts-The Nordic perspectives. (Vox Sang, 2026)
- Far Forward Anesthesia and Massive Blood Transfusion: Two Cases Revealing the Challenge of Damage Control Resuscitation in an Austere Environment. (AANA J, 2015)