Page 188 - PJ MED OPS Handbook 8th Ed

14. Triage and Mass Casualty Management

Mass casualty management focuses on:
1. security
2. accountability
3. triage and patient movement
4. CCP with or without treatment based on time and to tactics
5. exfil

An immediate determination should be made by the leadership if the MCI is a scenario with mul-
tiple casualties well within the scope of the team and resources, if it is a mass casualty scenario
and is safe for which traditional triage and CCP management and treatment can occur, or if it is an
overwhelming or non-secure situation where you simply need to move the live patients and have
them set for exfil and then later collect the dead patients and move them.

In some instances, survival management (shelter, warmth, food, water) take precedence over med-
icine as medicine is impractical in certain environments and situations.

Triage, French for sorting, is the screening and classification of sick, wounded or injured persons
during combat or other disasters. The goal is to determine the priority of needs and direct medical
treatment where it will do the most good for the greatest number of patients. Triage is a dynamic
process that is conducted whenever the number of patients exceeds the available medical resources
(i.e., medical materials and/or number of providers), and/or the capacity for evacuation. Each pa-
tient is initially triaged and categorized, then re-triaged at each level of care. Individual patients are
re-evaluated periodically and may be re-categorized as their condition changes and/or resource
availability changes. Pararescuemen dealing with personnel recovery utilize 3 basic types of staging:
1. Initial Patient Contact
2. Patient Transfer Points
3. Casualty Collection Points

When a Team Commander is present on an MCI, his interaction with the Team Leader is key to the
successful mission prosecution. A good Team Commander/Lead working relationship provides a
synergistic mission leadership function.

Team Commander (TC) Responsibilities and Considerations:
The TC provides command and control for the overall mission, the TC’s ‘Up-and-out’ interface for
the team with outside forces, ensuring security, air traffic flow, reach-back, resupply, and comms
with higher headquarters is key to keeping the TL and Team focused ‘down and in’.

Team Leader (TL) Responsibilities and Considerations:
The ultimate success of a MCI is determined by the proper actions of the TL. During a MCI the TL
provides all command and control to include on-scene medical direction. When a TC is present, the
TL handles all the ‘down-and-in’ control functions. The TL is the “center of authority and direction,”
to whom all team members report their findings and requirements. The team leader then deter-
mines which patients have priority for transportation and allocates further resources to areas of
greatest need. Responsibilities and considerations include, but are not limited to:

186 n Pararescue Medical Operations Handbook / 8th Edition