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

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

Save lives
Reduce permanent morbidity and deficits
Return fighting force to battlefront
Evacuate casualties for definitive care
 STANDARD TRIAGE
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
Depend upon battlefield conditions
Urban vs rural mountainous terrain
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
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
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
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
Casualty evacuation via ground
ambulance CASEVAC
Difficult terrain
Remote location
Medical evacuation MEDEVAC
Air rescue by Blackhawk/Seahawk
or Chinook helicopter
 ECHELON II
Forward
surgical
capability
Mobile combat
support
hospital
Basic surgical
capacity to
save lives
 ECHELON III
Fixed brick/mortar hospital with
ICU capacity, advanced radiology,
neurosurgical & orthopedic
capability
AEROMEDICAL EVACUATION
Critical care transport in air
Transcontinental evacuation
Transport of mass casualties
Provision of sophisticated ICU care while
en route
 ECHELON IV
Landstuhl Regional Medical Center,
Germany
Intermediate advanced surgical
care for stabilization
Intensive care unit provisions
 ECHELON V
Definitive care for battle injuries
Recuperation in CONUS
Walter Reed MC, Bethesda NMC,
Brooke AMC
 CIVILIAN MASS CASUALTIES
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

Emergency practice drills

Hospital planning
Variability
In trained personnel
Integration with local EMS
Liason with municipalities
 CIVILIAN TRAUMA SYSTEMS

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
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
Emergency first responders:
variable ambulance services
dependent on municipality, private
services, hospital
BLS/EMT vs. advanced care with
paramedics
 CIVILIAN TRAUMA SYSTEM
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
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