Mass casualties, triage and war wounds

1Mass casualty incident: organise before treating

When the number of injured exceeds the resources on hand, the objective changes: it becomes doing the greatest good for the greatest number. The team leader does not treat: they organise. They check safety (second explosion, shooting, collapse), call for help, designate a safe gathering area, deploy the first aiders and keep a register of casualties.

Organisations working in conflict zones prepare a mass casualty plan with local health facilities: roles, extra kits (tourniquets, pressure dressings, blankets), means of transport, contacts for the Red Crescent or Red Cross and the ICRC.

2START triage

START triage classifies each casualty in less than a minute:

• Green: the casualty can walk. They are gathered in a safe area and will be reassessed.
• Black: not breathing, even after the airway is opened.
• Red (immediate): breathing more than 30 times a minute, or no radial pulse (or capillary refill over 2 seconds), or unable to follow simple commands.
• Yellow: all other casualties who cannot walk.

During triage, only two actions are performed: stopping catastrophic bleeding (tourniquet) and placing an unconscious casualty who is breathing in the recovery position. Triage is repeated, as casualties' condition changes.

3War wounds while awaiting evacuation

In war trauma, catastrophic bleeding is treated first, even before the airway: tourniquet on limbs, firm pressure and packing the wound with gauze for junctional wounds (groin, armpit, neck). Then come the airway, breathing, circulation and the prevention of hypothermia (survival blanket, even in hot weather, because a bleeding casualty cools quickly).

A chest wound that is bubbling is left open or covered with a non-occlusive dressing. An abdominal wound with protruding organs is covered with a clean damp cloth, without pushing anything back in. An embedded object is never removed. Nothing is given to drink to an injured person who will need surgery.

4After the event: the team and the witnesses

Responders are exposed to traumatic scenes. In the following days, offer a voluntary discussion focused on practical needs, without forcing anyone to talk. Lighten the workload, watch for signs that persist beyond a few weeks (sleep problems, avoidance, irritability) and refer to professional psychological support.

Also hold an operational lessons-learned review: what worked, the missing equipment, the contacts to update. Restock the kits used immediately.