MILITARY TRIAGE AND
EVACUATION: PARALLELS TO
CIVILIAN SYSTEMS
CDR JOHN P. WEI, USN MC MD
4th Medical Battallion, 4th MLG,
BSRF-12
MILITARY MASS CASUALTIES
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Long protracted event
Extensive locally or at battlefield
Variable number of injured or dead
Health facilities always ready to receive injured
Resources potentially unlimited
Natural and geographic limitations
Usually occurs on foreign soil
MILITARY CARE FOR
BATTLEFIELD CASUALTIES
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Save lives
Reduce permanent morbidity and deficits
Return fighting force to battlefront
Evacuate casualties for definitive care
STANDARD TRIAGE
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Provide orderly care to those who need most
urgently
Save most number of lives
Coded system:
Green: minor injuries
Yellow: major injuries, acceptable for delayed
care
Red: major injuries, require immediate
treatment
Black: expectant
MILITARY CARE FOR
BATTLEFIELD CASUALTIES
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Depend upon battlefield conditions
Urban vs rural mountainous terrain
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Small arms fire vs. explosive
devices
Geography of battlefield
Dedicated resources available on
site
Health care system primary mission
is treatment of casualties
CARE OF BATTLEFIELD
CASUALTIES
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Stratified to provide immediate
access to basic care
Stabilization in the battle field
Progressive levels of evacuation to
advanced care in rear
Evacuation to homeland for
definitive care & recovery
DIFFERENTIATED LEVELS OF
CARE
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Echelon I: Buddy-aid,
corpsman/medic, First-Aid Station
Echelon II: FST / FRSS field support
hospital with surgical capacity
Echelon III: fixed base advanced
care hospital
Echelon IV: complex advanced
stabilization and care
Echelon V: definitive CONUS hospital
ECHELON I
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Buddy-aid: every soldier carries
tourniquet, QuikClot pack
Medic/Corpsman – first aid pack
with I.V.'s RL, bandages, needles
First Aid Station: if available, GMO
/ ER physician
CASUALTY EVACUATION
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Casualty evacuation via ground
ambulance CASEVAC
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–
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Difficult terrain
Remote location
Medical evacuation MEDEVAC
–
Air rescue by Blackhawk/Seahawk
or Chinook helicopter
ECHELON II
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Forward
surgical
capability
Mobile combat
support
hospital
Basic surgical
capacity to
save lives
ECHELON III
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Fixed brick/mortar hospital with
ICU capacity, advanced radiology,
neurosurgical & orthopedic
capability
AEROMEDICAL EVACUATION
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Critical care transport in air
Transcontinental evacuation
Transport of mass casualties
Provision of sophisticated ICU care while
en route
ECHELON IV
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Landstuhl Regional Medical Center,
Germany
Intermediate advanced surgical
care for stabilization
Intensive care unit provisions
ECHELON V
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Definitive care for battle injuries
Recuperation in CONUS
Walter Reed MC, Bethesda NMC,
Brooke AMC
CIVILIAN MASS CASUALTIES
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Acute isolated event
Extensive destruction
Large number of ill, injured, or dead
Health facilities overwhelmed by ill or injured
Resources damaged or limited
Natural and Geologic
Weather and Atmospheric
Biologic and Infectious
Terrorist Acts
Man-made Accidents
Catastrophes
CIVILIAN HOSPITAL PREPAREDNESS
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Emergency practice drills
Hospital planning
Variability
In trained personnel
Integration with local EMS
Liason with municipalities
CIVILIAN TRAUMA SYSTEMS
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American College of Surgeons
Committee on Trauma
Training of personnel
Physical capacity and capability
Triage of patients by severity of
injuries to designated centers:
Level I, II, III
CIVILIAN TRAUMA SYSTEM
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Geographically dependent on
resources
No dedicated resources at all levels
Not all hospital facilities are trauma
capable
No dedicated trauma/critical care
personnel
CIVILIAN TRAUMA SYSTEM
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Emergency first responders:
variable ambulance services
dependent on municipality, private
services, hospital
BLS/EMT vs. advanced care with
paramedics
CIVILIAN TRAUMA SYSTEM
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Air evacuation via helicopter limited
to Level I centers with air services
Limitations of time and distance
Severity of injuries
Access to Level I care
SUMMARY
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Current civilian trauma system
takes origin from military
experience
Battlefield mass casualties demand
different resources and capabilities
Principles of triage and evacuation
similar between military and
civilian systems
Military system dedicated to
trauma care as primary mission