1. Casualty TriageCasualty Triage
COMBAT MEDIC ADVANCED SKILLS TRAINING (CMAST)

2. CMAST 2
 Familiarity with the principles of casualtyFamiliarity with the principles of casualty
triage.triage.
 Perform casualty triage in a givenPerform casualty triage in a given
situation.situation.
 Understand patient triage vs. evacuationUnderstand patient triage vs. evacuation
categories.categories.
IntroductionIntroduction

3. CMAST 3
 Mass casualty (MASCAL) situations occurMass casualty (MASCAL) situations occur
when the number of casualties exceeds thewhen the number of casualties exceeds the
available medical capability to rapidly treatavailable medical capability to rapidly treat
and evacuate them.and evacuate them.
– The actual numbers varies depending onThe actual numbers varies depending on
available resourcesavailable resources
– May be a soldier medic having to manageMay be a soldier medic having to manage
more than one casualty at a timemore than one casualty at a time
Casualty TriageCasualty Triage

4. CMAST 4
 SystemSystem used for categorizing and sortingused for categorizing and sorting
casualties according to severity of theircasualties according to severity of their
injuries and available resources:injuries and available resources:
– Survey and classifySurvey and classify
casualties for the mostcasualties for the most
efficient use of availableefficient use of available
medical personnel andmedical personnel and
suppliessupplies
Casualty TriageCasualty Triage

5. CMAST 5
– Treatment first towards the casualties whoTreatment first towards the casualties who
have the best chance to survivehave the best chance to survive
– Locate troops withLocate troops with
minor wounds andminor wounds and
return them to dutyreturn them to duty
Casualty TriageCasualty Triage

6. CMAST 6
 Determine the tactical and environmentalDetermine the tactical and environmental
situation.situation.
– Necessity to transport casualties to a moreNecessity to transport casualties to a more
secure collection point for treatment.secure collection point for treatment.
– Number and location of injured.Number and location of injured.
– Severity of injuries.Severity of injuries.
– Available assistance: self-aid, CLS, medicalAvailable assistance: self-aid, CLS, medical
personnel.personnel.
– Evacuation support capabilities andEvacuation support capabilities and
requirements.requirements.
Casualty TriageCasualty Triage

7. CMAST 7
 Establishing triage, treatment and holdingEstablishing triage, treatment and holding
areas.areas.
─May be established in existing MTF, anMay be established in existing MTF, an
available shelter or outdoorsavailable shelter or outdoors
Casualty TriageCasualty Triage

8. CMAST 8
 Existing MTF for MASCAL stations:Existing MTF for MASCAL stations:
– Triage areaTriage area
• Easily accessedEasily accessed
• Sufficient spaceSufficient space
• Controlled flowControlled flow
• Surgical detachmentSurgical detachment
– Holding areas for each triage categoryHolding areas for each triage category
– Marking (casualty triage tags)Marking (casualty triage tags)
Casualty TriageCasualty Triage

9. CMAST 9
 Outdoor MASCAL stations:Outdoor MASCAL stations:
– Overhead cover; available shadeOverhead cover; available shade
– Triage area accessibleTriage area accessible
• OutdoorsOutdoors
• Inclement weatherInclement weather
planned forplanned for
– Improvised sheltersImprovised shelters
– CBRN threat?CBRN threat?
Casualty TriageCasualty Triage

10. CMAST 10
 Triage is the process of prioritizing soldiersTriage is the process of prioritizing soldiers
on the basis of their individual needs foron the basis of their individual needs for
medical intervention.medical intervention.
 The likely outcome of the individualThe likely outcome of the individual
casualty must be factored into the decisioncasualty must be factored into the decision
process prior to the commitment of limitedprocess prior to the commitment of limited
resources.resources.
Casualty TriageCasualty Triage

11. CMAST 11
 Casualties are generally sorted into theCasualties are generally sorted into the
following four categories (or priorities).following four categories (or priorities).
** Remember:Remember: Triage is an ongoing processTriage is an ongoing process
ofof reassessmentreassessment which may change thewhich may change the
casualties’ triage category.casualties’ triage category.
Casualty TriageCasualty Triage

12. CMAST 12
 Sort multiple casualties intoSort multiple casualties into prioritiespriorities..
 ConventionalConventional battlefield casualties.battlefield casualties.
– ImmediateImmediate: immediate treatment to save life, limb: immediate treatment to save life, limb
or eyesightor eyesight
– DelayedDelayed: casualties who have less risk of losing life: casualties who have less risk of losing life
or limbor limb
– MinimalMinimal: “walking wounded", self-aid or buddy-aid: “walking wounded", self-aid or buddy-aid
– ExpectantExpectant: casualty so critically injured that only: casualty so critically injured that only
complicated and prolonged treatment offers any hopecomplicated and prolonged treatment offers any hope
of improving life expectancyof improving life expectancy
Casualty TriageCasualty Triage

13. CMAST 13
 IntegratedIntegrated battlefield casualties.battlefield casualties.
– ImmediateImmediate: conventional life threats; no CBRN: conventional life threats; no CBRN
– Chemical ImmediateChemical Immediate: severe chemical life threats;: severe chemical life threats;
no conventional threatno conventional threat
– DelayedDelayed: no conventional life threats; mild chemical: no conventional life threats; mild chemical
threatthreat
– MinimalMinimal: minor conventional injuries; no chemical: minor conventional injuries; no chemical
– ExpectantExpectant: conventional life threats; severe chemical: conventional life threats; severe chemical
threatthreat
Casualty TriageCasualty Triage

14. CMAST 14
 Evacuation –Evacuation – UrgentUrgent..
 Evacuation required as soon as possible; noEvacuation required as soon as possible; no
later thanlater than 2 hours2 hours to save life, limb or eyesight.to save life, limb or eyesight.
– Casualties condition(s) cannot be controlledCasualties condition(s) cannot be controlled
and have the greatest opportunity for survivaland have the greatest opportunity for survival
– Cardiorespiratory distressCardiorespiratory distress
– Shock not responding to IV therapyShock not responding to IV therapy
Evacuation CategoriesEvacuation Categories

15. CMAST 15
 Evacuation –Evacuation – UrgentUrgent (cont’d).(cont’d).
– Prolonged unconsciousnessProlonged unconsciousness
– Head injuries with signs of increasing ICPHead injuries with signs of increasing ICP
– Burns covering 20% to 85% of TBSABurns covering 20% to 85% of TBSA
Evacuation CategoriesEvacuation Categories

16. CMAST 16
 Evacuation –Evacuation – Urgent SurgicalUrgent Surgical..
 Evacuation required for casualties who mustEvacuation required for casualties who must
receive far forward surgical intervention to savereceive far forward surgical intervention to save
life and stabilize for further evacuation.life and stabilize for further evacuation.
– Decreased circulation in the extremitiesDecreased circulation in the extremities
– Open chest and/or abdominal wounds withOpen chest and/or abdominal wounds with
decreased blood pressuredecreased blood pressure
– Penetrating woundsPenetrating wounds
Evacuation CategoriesEvacuation Categories

17. CMAST 17
 Evacuation –Evacuation – Urgent SurgicalUrgent Surgical (cont’d).(cont’d).
– Uncontrollable bleeding or open fractures withUncontrollable bleeding or open fractures with
severe bleedingsevere bleeding
– Severe facial injuriesSevere facial injuries
– Burns on hands, feet, face, genitalia orBurns on hands, feet, face, genitalia or
perineum, even if under 20% TBSAperineum, even if under 20% TBSA
Evacuation CategoriesEvacuation Categories

18. CMAST 18
 Evacuation –Evacuation – PriorityPriority..
 Evacuation is required within 4 hours orEvacuation is required within 4 hours or
casualty’s condition could become worsecasualty’s condition could become worse
and become an "urgent" or "urgent surgical"and become an "urgent" or "urgent surgical"
category condition.category condition.
– Closed-chest injuriesClosed-chest injuries
– Brief periods of unconsciousnessBrief periods of unconsciousness
– Soft tissue injuries and open or closedSoft tissue injuries and open or closed
fracturesfractures
Evacuation CategoriesEvacuation Categories

19. CMAST 19
 Evacuation –Evacuation – PriorityPriority (cont’d).(cont’d).
– Abdominal injuries with no decreased bloodAbdominal injuries with no decreased blood
pressurepressure
– Eye injuries that do not threaten eyesightEye injuries that do not threaten eyesight
– Spinal injuriesSpinal injuries
Evacuation CategoriesEvacuation Categories

20. CMAST 20
 Evacuation –Evacuation – RoutineRoutine..
 Evacuation required withinEvacuation required within 24 hours24 hours forfor
casualties requiring additional care.casualties requiring additional care.
– Simple fracturesSimple fractures
– Open wounds including chest injuries withoutOpen wounds including chest injuries without
respiratory distressrespiratory distress
– Psychiatric casesPsychiatric cases
– Terminal casesTerminal cases
Evacuation CategoriesEvacuation Categories

21. CMAST 21
 Evacuation –Evacuation – ConvenienceConvenience..
 Evacuation of casualties by medical vehicle is aEvacuation of casualties by medical vehicle is a
matter of convenience rather than necessity.matter of convenience rather than necessity.
– Minor open woundsMinor open wounds
– Sprains and strainsSprains and strains
– Minor burns under 20% of TBSAMinor burns under 20% of TBSA
Evacuation CategoriesEvacuation Categories

22. CMAST 22
Medical Evacuation RequestMedical Evacuation Request

23. CMAST 23
 Prepare a standard nine-line Medevac request.Prepare a standard nine-line Medevac request.
– Line 1Line 1: Pickup location: Pickup location
– Line 2Line 2: Radio frequency, call sign and suffix: Radio frequency, call sign and suffix
– Line 3Line 3: Number of casualties by precedence: Number of casualties by precedence
((evacuationevacuation) category) category
– Line 4Line 4: Special equipment: Special equipment
requiredrequired
– Line 5Line 5: Number of casualties: Number of casualties
by type (by type (ambulatory vs. litterambulatory vs. litter))
Medical Evacuation RequestMedical Evacuation Request

24. CMAST 24
 Prepare a standard nine-line Medevac request.Prepare a standard nine-line Medevac request.
– Line 6Line 6: Security of pickup site (: Security of pickup site (wartimewartime) or) or
number/type of wounded, injured, illnessnumber/type of wounded, injured, illness
((peacetimepeacetime))
– Line 7Line 7: Method of: Method of
marking pickup sitemarking pickup site
– Line 8Line 8: Casualty‘s: Casualty‘s
nationality andnationality and
statusstatus
Medical Evacuation RequestMedical Evacuation Request

25. CMAST 25
 Prepare a standard nine-line Medevac request.Prepare a standard nine-line Medevac request.
– Line 9Line 9: NBC contamination (wartime) or: NBC contamination (wartime) or
terrain description (peacetime)terrain description (peacetime)
• NBC contamination, if any -NBC contamination, if any - otherwise omitotherwise omit
this linethis line
• Terrain description including details ofTerrain description including details of
terrain features in and around proposedterrain features in and around proposed
landing sitelanding site
*As*As a minimuma minimum, the first five items, the first five items mustmust be provided inbe provided in
the exact sequence listed.the exact sequence listed.
Medical Evacuation RequestMedical Evacuation Request

26. CMAST 26
 A firm understanding of triage will helpA firm understanding of triage will help
the soldier medic maximize resourcesthe soldier medic maximize resources
and reduce complications.and reduce complications.
 Identify steps in performing triage.Identify steps in performing triage.
 Perform a triage in a given situation.Perform a triage in a given situation.
 Identify triage categories.Identify triage categories.
 Identify evacuation categories.Identify evacuation categories.
Summary

27. CMAST 27
Questions?Questions?