Citation

Shackelford SA, Remley MA, Keenan S, Kotwal RS, Baker JB, Gurney J, Rush S, Friedrichs P. J. Trauma Acute Care Surg. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000003699

PMID

35583968

Abstract

BACKGROUND: The overall approach to massive casualty triage has changed little in the past 200 years. As the military and civilian organizations prepare for the possibility of future large scale combat operations, terrorist attacks and natural disasters, potentially involving hundreds or even thousands of casualties, a modified approach is needed to conduct effective triage, initiate treatment and save as many lives as possible.

METHODS: Military experience and review of analyses from the Department of Defense Trauma Registry are combined to introduce new concepts in triage and initial casualty management.

FINDINGS: The classification of the scale of MASCAL, timeline of lifesaving interventions, immediate first pass actions prior to formal triage decisions during the first hour after injury, simplification of triage decisions, and the understanding that ultra-MASCAL will primarily require casualty movement and survival needs with few prehospital life-saving medical interventions are discussed.

CONCLUSION: Self-aid, bystander and first responder interventions are paramount and should be trained and planned extensively. Military and disaster planning should not only train these concepts, but should seek innovations to extend the timelines of effectiveness and to deliver novel capabilities within the timelines to the greatest extent possible.

LEVEL OF EVIDENCE: Level III, Prognostic and Epidemiological.

Language: en