Triage

[7][8] This is because triage needs to balance multiple and sometimes contradictory objectives simultaneously, most of them being fundamental to personhood: likelihood of death, efficacy of treatment, patients' remaining lifespan, ethics, and religion.The term triage comes directly from French, where the term means to pick or to sort,[9] it itself coming from the Old French verb trier, meaning to separate, sort, shift, or select; with trier in turn came from late Latin tritare, to grind.

[10] Although the concept existed much earlier, at least as far back as the reign of Maximillian I,[11] it was not until the 1800s that the Old French trier was used to describe the practice of triage.

[12] That year, Baron Dominique-Jean Larrey, the Surgeon in Chief of Napoleon's Imperial Guard laid the groundwork for what would eventually become modern triage[1] introducing the concept of "treat[ing] the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of their rank or nationality".

[31] The second concept of Reverse Triage is utilized for certain conditions such as lightning injuries, where those appearing to be dead may be treated ahead of other patients, as they can typically be resuscitated successfully.

[34] In triage, palliative care takes on a wider applicability, as some conditions which may be survivable outside of extreme circumstances become unsurvivable due to the nature of a mass casualty incident.

Additional considerations must be made to avoid overwhelming local resources,[39] and in some extreme cases, this can mean evacuating some patients to other countries.

[40] Such improvised facilities are generally developed in cooperation with the local hospital, which sees them as a strategy for creating surge capacity.

[41] Discovered in 1862, outside of modern-day Luxor, Egypt,[42] the Edwin Smith Papyrus contains descriptions of the assessment and treatment of a multitude of medical conditions, and divides injuries into three categories: During the reign of Emperor Maximilian I, during wartime, a policy was implemented where soldiers were prioritized over all others in hospitals, and the sickest soldiers received treatment first.

[43][44] French and Belgian doctors began using these concepts to inform the treatment of casualties at aid stations behind the front.

[44] Ambulances, driven by YMCA and American Red Cross trained drivers then removed the casualties to mobile surgical centers, called postes avances des hospitaux du front or outposts of the frontline hospitals.

[44][47] By the onset of World War II, American and British forces had adopted and adapted triage, with other global powers doing the same.

As the city has no hospital, they had to evacuate casualties to area facilities, including those in Galveston and Houston,[53] with at least one doctor relying on skills he had learned in World War II to inform care decisions.

[54] The Korean War saw the advent of the tiered triage, wherein care providers sorted people into categories defined ahead of time.

[23] In 1993, the north tower of the World Trade Center was bombed, in a plot with a similar intended outcome as the later September 11th attacks.

[58] In June 1994, emergency crews began responding to calls related to symptoms of toxic gas exposure in a neighborhood.

[62] Most simply, the general purpose of triage is to sort patients by level of acuity to inform care decisions; so that the most people possible can be saved.

[63] Although a multitude of systems, color codes, codewords, and categories exist to help direct it, in all cases, triage follows the same basic process.

[95] The tool allows for rapid assessment by removing the need to measure physiological vital signs focusing on what the emergency responder can see.

Poor assessments, invalid categories, no objective methodology and tools for prioritizing casualties and allocating resources, and a protocol of worst first triage provide some challenges for emergency and disaster preparedness and response.

These are clear obstacles for efficient triage and resource rationing, for maximizing savings of lives, for best practices and National Incident Management System (NIMS) compatibilities,[104][105][106] and for effective response planning and training.

Such analyses are often required for healthcare grants funded by taxpayers, and represent normal engineering and management science practice.

These inefficiencies relate to the following cost areas: Because treatment is intentionally delayed or withheld from individuals under this system, triage has ethical implications that complicate the decision-making process.

Individuals involved in triage must take a comprehensive view of the process to ensure fidelity, veracity, justice, autonomy, and beneficence are safeguarded.

Emergency departments are advised to preemptively plan strategies in attempts to mitigate the emotional burden on these triage responders.

Some ethicists argue the utilitarian approach to triage is not an impartial mechanism, but rather a partial one that fails to address the social conditions that prevent optimal outcomes in marginalized communities, rendering it a practical but inadequate means of distributing health resources.

It is generally argued that giving special considerations or deviating from the standard medical protocol for VIPs or celebrities is unethical due to the cost to others.

However, others argue that it may be morally justifiable as long as their treatment does not hinder the needs of others after assessing overall fairness, quality of care, privacy, and other ethical implications.

[114] The logistical realities of humanitarian emergencies and conflict situations threatens the bioethical principle of beneficence, the obligation to act for the benefit of others.

Scholars have argued that new frameworks must prioritize informed consent and rely on established medical criteria only in order to respect the human rights considerations set forth by the Geneva Convention of 1864 and the Universal Declaration of Human Rights,[115] but no comprehensive triage model has been adopted by international bodies.

She said that pressures on veterinarians having been exacerbated by staffing shortages that resulted from the Covid pandemic, coupled with growth in spending on veterinary care and on pet insurance.