Page 131 - JSOM Fall 2025

FIGURE 3 TCCC Triage 2025. Discussion
The triage process should be simple and applicable across the
range of military operations, all-hazards emergencies, and
all-hazard MASCAL incidents. Terminology should align with
commonly used operational language to ensure clarity and
ease of adoption. Time is the ultimate triage tool, as such triage
and categories may change when an injury worsens over time
or improves with medical care. Accordingly, there are three
groups of casualties based on the current DoD medical evac-
uation doctrine:
1. Casualties who are dying now and require immediate life-
saving care (urgent)
2. Casualties who will die later without medical care (priority)
3. Casualties who will survive and require non-critical medi-
cal care or who are expected to die due to their clinical sta-
tus or due to medical, operational, or logistical constraints
(routine)
First Pass Triage
Prehospital triage must categorize and prioritize casualties not
First pass triage is defined as the initial sorting of casualties into only for treatment but also for evacuation to a higher role of
urgent and non-urgent categories while moving the casualties care. To rapidly facilitate this, the principles-based approach
out of danger and providing life-saving care as able. As soon to triage in TCCC combines existing medical, evacuation, and
as tactically feasible, responders should rapidly conduct first international triage terminology with common terms of ref-
pass triage to provide immediate life-saving care and identify erence. This simplification improves communication between
urgent and non-urgent categories. Simply put, during the first nonmedical and medical responders since it is no longer nec-
pass triage, casualties who are dying now and require immedi- essary to translate medical triage terminology into evacuation
ate life-saving interventions to survive should be categorized as terminology, resulting in expedited triage decision-making and
urgent. Remaining casualties who do not need immediate life- driving actions that result in improved operations and casualty
saving interventions but require medical care or are unlikely care.
to benefit from further intervention, should be categorized as
non-urgent. The goals of first pass triage are to identify urgent To illustrate this point, upon hearing that there is an urgent
casualties and treat immediate life threats, primarily extremity casualty, a medical responder will interpret this as a casualty
or junctional bleeding and airway compromise. The focus is who is suffering from life-threatening trauma. Timely life-sav-
on efficiency to enable providers to evaluate all casualties as ing medical interventions, such as applying limb tourniquets
quickly as possible and not become overwhelmed in treatment to control massive external bleeding and clearing the airway,
of any individual casualty. It is also important to obtain an may significantly improve the casualty’s chances of survival.
initial understanding of the magnitude of the casualty situa- These interventions may be provided expeditiously during first
tion. First pass triage provides the information necessary for pass triage, with the casualty being categorized as urgent. If the
immediate evacuation coordination, communication, and sub- patient is stabilized following these interventions, they may be
sequent actions during second pass triage. recategorized as priority during second pass triage. In contrast,
another casualty may have non-compressible hemorrhage and
Second Pass Triage may survive only if blood transfusion is initiated within 36
minutes and handoff to a surgical team occurs by 60 min-
Second pass triage is defined as the overarching plan for sort- utes. This casualty may require an excessive amount of time
4,8
ing casualties based on the priority of medical and evacuation and resources that may be required for other, potentially more
needs into urgent, priority, and routine (UPR) categories. Sec- survivable cases in this MASCAL event. This casualty may be
ond pass triage is a more deliberate process that supports casu- categorized as urgent during first pass triage, or perhaps (if
alty evacuation while allowing continued care during ongoing the injuries are clearly non-survivable) may be initially cate-
MCM. These categories are defined as follows: gorized as non-urgent. During the second pass triage, a more
detailed assessment will occur, and, depending on the resource
• Urgent: High priority casualty with severe or critical life- allocation, the patient may be categorized as urgent (resources
threatening injury or illness who will only survive with im- available) or routine (resources not available, expected to die)
mediate surgery, rapid damage control resuscitation, or ad- (Figure 4).
vanced medical treatment.
• Priority: Medium priority casualty with serious injury However, receiving the same report of an urgent casualty, a
or illness who will require surgery or advanced medical nonmedical leader will interpret the casualty in a different way
treatment at a delayed time (may include limb- and eyesight- and begin driving nonmedical actions to provide aid and litter
threatening injuries). team, security, and casualty evacuation to the next role of care
• Routine: Low priority casualty with minimal injury or ill- as soon as tactically feasible, prior to completing the mission.
ness who will require additional medical treatment, or ex- Further, a nonmedical leader upon hearing a casualty is cate-
pectant casualty for whom life-saving interventions will be gorized as routine will understand they may be evacuated at
minimized. a later time and may or may not require a litter. Additionally,

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