Page 65 - JSOM Fall 2024

adherence to triage methods and the importance of time in and analyzed using sums, medians, and ranges. Lessons learned
triage. 26–34 were summarized across the variety of events. When clarifica-
tion was needed, it was obtained via direct telephone call or
Based on the observations of the authors, during real-world email exchange with the responder.
and casualty exercise events, it was clear that formal triage
systems are infrequently used, or when used, are slow and not Results
practical for large numbers of casualties. Additionally, there is
a paucity of data on military MASCALs and therefore the po- We identified 29 MASCALs involving 1,075 casualties from
tential to lose insight from these relatively rare events as those 1996 to 2022. There was a median of three medics (range
with experience leave military service. 1–85) and a median of 15 casualties (range 6–519) per event.
Response and times on scene are also presented in Table 1.
We hypothesized that formal triage systems are infrequently Other data including nation, temperature, and terrain are pre-
used in real events. We undertook this survey to document sented in Table 2. Most of the respondents were PJs (Table 3)
which triage methods were used in the prehospital environ- and in 11 (38%) missions there was a mix of different medic
ment during military MASCALs and other details of the re- types (e.g., PJ and 18D).
sponse, with the intent to inform future tactics and training.
TABLE 1 Military Prehospital Mass Casualty Event Characteristics
(N = 29)
Methods
Characteristics Median (range)
This study was approved by the institutional review board at No. of medics per incident 3 (1–85)
the Naval Medical Center San Diego. A network of Special No. of casualties per incident 15 (6–519)
Operations Forces (SOF) relationships was used to identify Time to medic arrival, min 5 (0–180)
medics (Air Force Pararescuemen [PJs], medics, and Corps-
men) with real-world MASCAL experience across the Depart- Time spent on scene, hr 1.5 (0.25–48)
ment of Defense (DoD) SOF community. Survey questions
were generated to address the question of the use of formal TABLE 2 Nation and Environment
triage during military MASCALs and other pertinent informa- Factor No. of MASCAL
tion (Box 1). Respondents completed data collection forms, Nation
which excluded sensitive personally identifiable information Afghanistan 21
and operational security data. Triage information was col- Iraq 2
lected on the use of any formal triage algorithms, the use of
colored markers, and the number of triage categories. Formal Other 6
triage algorithms were defined as named triage tools used to Temperature
assess specific physiologic parameters in a specific order, fol- Hot 15
lowed by assignment of a category name or label (e.g., color Temperate 12
designation, colored markers). Finally, the respondents were Cold 2
asked to share lessons learned. Terrain
Urban 7
BOX 1 Survey Questions Village 7
Nation (location of event), withhold if classified Mountain 4
Weather Roadside 3
Terrain Compound 3
Number of medics Desert 2
Approximate or exact number of casualties – total, live, dead
Jungle 2
Time from incident to on scene (approximate) Forward base 1
Time spent on scene (approximate) MASCAL = mass casualty event.
Overwhelming YES NO
Formal triage algorithm performed. YES NO TABLE 3 Respondents to Survey
How many triage categories did you use? Designation No. of MASCAL
Did you use colored markers? YES NO PJ 16
LSA (lifesaving actions – stop bleeding, open airway) taken?
YES NO 18 Delta 7
Other medical interventions performed NO SOCM – NOS 1
Blood transfusions? YES Ranger medic 1
Medications, wounds, splinting? YES NO 69 Whiskey* 1
Exfil: in stages or immediate as able NOS 2
Exfil by ground or air Corpsman 1
List lessons learned MASCAL = mass casualty event; PJ = Air Force Pararescueman; NOS =
not otherwise specified; SOCM = Special Operations Combat Medic.
*68 Whiskey present in support of a SOF unit.
Responses were consolidated and analyzed using descriptive
statistics. Categorical and nominal data were entered into an Formal triage algorithms were not used in any event (0/29).
Excel spreadsheet (Microsoft, Redmond, WA) for tabulation Formal triage categories were used only once in 29 (3%)

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