Page 11 - 2026 SMOG

MASCAL TRIAGE
Triage Principles
• Priorities change based on the time since the injury
• Activities in the first hour are CRITICAL
• Don’t waste time with formal triage tools
• Extricate/stop threat, stop external bleeding, clear airway
• Need for transfusion and ventilator support within the first hour identifies a resource-
intensive patient
• Damage control surgery has little impact after the first hour
• (COMBAT) Assume minimal will stay armed/engaged if no mental status-altering meds are
given for pain
• The expectant category is used ONLY in combat operations and/or when the requirements to
treat these patients adequately exceed available resources. In peacetime, it is generally assumed
that all patients have a chance of survival.
METHOD 1
**Complete Each Patient Triage Assessment in Less Than 60 Seconds**
Category Examples
Category I: • Any MARCH issue
Immediate (red chemlite) • Airway obstruction
• Flail/open chest wound
• Tension pneumothorax/hemothorax
• Massive hemorrhage
• 20–70% Burns
• Unstable vital signs
• Severe TBI (unconscious alive patient)
Category II: • Open fractures with PMS intact
Delayed (green chemlite) • Soft tissue injuries
• Moderate TBI (stable vital signs)
• Open abdominal wounds
Category III: • Minor abrasions, burns, sprains, lacerations
Minimal (no chemlite) • Moderate/mild anxiety
*remain armed, continue • Fractures/dislocations with PMS
to engage • Mild TBI
Category IV: • Massive head or spinal injury
Expectant (blue chemlite) • Third-degree burns >70% TBSA
• Injuries incompatible with life
(continues)

2026 Standard Medical Operating Guidelines (SMOG) • 3