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The daily operations of EMS systems focus on providing care and transport to individual patients with (usually) unlimited resources. This approach allows prehospital providers to attempt to maximize the chances of an individual's survival and reduce the morbidity they may experience from their injury or illness. In situations involving multiple/mass casualties incidents and disasters, the principles of “routine” field triage and transport decisions can change significantly, as the goals of patient care shift from doing the most good for a singular patient, to doing the most good for the most patients. Recognizing the regional variability inherent in prehospital emergency care, it is imperative for EMS physicians to understand the concepts in this chapter globally, but also to apply and understand them in the context of their local/regional EMS system(s). Specific aspects of daily operations are discussed elsewhere in the text.


  • Describe the theory behind the need for trauma triage in mass casualty incidents.

  • Describe the major field triage methods, and detail their use.

  • Describe the medical triage, transport, and treatment areas setup during an MCI.

  • Discuss the role of the EMS physician in assisting the triage officer(s) and transport officer(s) in their duties.

  • Discuss the pros and cons of the EMS physician limiting their role to aiding in the treatment area during an MCI.

  • Discuss field triage and retriage in prolonged events, or during times of limited hospital/transportation resources.


Triage, from the French trier meaning to sort, is a term initially ascribed to the process of sorting coffee beans. The transition from an agrarian process to a part of the medical evaluation process began with the efforts of Baron Dominique-Jean Larrey, Chief Surgeon of Napoleon's Army. Baron Larrey is credited with devising a system to identify and sort casualties of war on the battlefield and evacuate them via ambulances volantes to field hospitals.1 In this first use of medical triage, the goal was to identify soldiers with injuries that were survivable, with focus placed on providing the care needed to return the soldier to the battlefield as quickly as possible in order to maintain a sufficient fighting force. Following the Napoleonic wars, the battlefields of subsequent military engagements saw further refinement of the triage processes as the technology of health care and warfare developed. The development of antibiotics and advanced surgical techniques, recognition and treatment of shock, utilization of helicopters, and institution of “buddy care” to initiate immediately lifesaving interventions all had a significant role in the reduction of combat fatalities from a rate as high as 30% during World War II to a rate of less than 10% in the Afghan and Iraqi wars.1

As with much of our present-day trauma care practices, civilian triage methods were subsequently derived from wartime practices that have been adapted to peacetime needs stemming from natural, industrial, and ...

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