Prolonged Field Care Podcast

Prolonged Field care Podcast 225: Mastering Triage

Apr 14, 2025
Join emergency medicine physician Andrew Shafrina, who brings his experience from multiple deployments, and Rick Hines, a speaker on triage and evacuation tactics. They dive into the chaos of triage during mass casualties, spotlighting the urgency of quick decision-making. Andrew shares hands-on insights, emphasizing clinical judgment and the need for intuitive assessments. The conversation also touches on ethical dilemmas in resource allocation, the integration of security during crises, and the necessity for realistic training to prepare medical teams for real-world challenges.
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ADVICE

Use Binary First-Pass Triage

  • Use the simplest, most intuitive triage method in chaotic point-of-injury mass casualties.
  • Identify who is dying now and treat immediate life threats (massive hemorrhage, airway) first.
ANECDOTE

Helicopter Crash Triage Story

  • Andrew described a helicopter crash with 22 people where he was initially the only medic on scene and had to triage rapidly.
  • He used 10–15 second checks (breath, pulse, visible hemorrhage) to separate who was dying now versus who was not.
INSIGHT

Two-Phase Triage Approach

  • After initial lifesaving interventions and movement, switch to a more deliberate multi-category triage.
  • Use clinical gestalt and mechanism of injury to refine who needs urgent damage-control surgery within the hour.
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