Tactical emergency care for law enforcement: Effective triage in mass casualty incidents By:

In the final part of this series, Robert Carlson from Brave Defender Training Group discusses the critical role of triage in Tactical Emergency Casualty Care (TECC).

In mass casualty situations where the number of injured exceeds available resources, triage ensures that medical attention is prioritized for patients with the highest chance of survival. This approach helps responders efficiently use limited time, manpower and equipment to save as many lives as possible.

Key learning points

1. Definition of mass casualty events: A mass casualty event is any scenario where the number of patients overwhelms the available resources, including personnel and equipment.
2. The purpose of triage: Triage is a sorting tool that helps responders identify and prioritize patients based on injury severity, ensuring that those most in need receive timely care.
3. Color-coding system for triage: TECC employs a standard color-coded system — red (immediate), yellow (delayed), green (minimal) and black (expectant/deceased) — to classify patients and guide treatment.
4. The MARCH algorithm: By applying the MARCH algorithm (Massive bleeding, Airway, Respiration, Circulation, Hypothermia/Head injury) across the entire scene, responders ensure the most critical injuries are addressed first.
5. CPR in mass casualty scenarios: Due to the low effectiveness of CPR in trauma cases and the high demand on personnel, patients requiring CPR are often classified under the black (expectant) category, prioritizing other critical patients with higher survival chances.

Discussion questions

1. How does the triage color-coding system help responders make quick decisions during high-stress situations?
2. Why is it important to use the MARCH algorithm across the entire scene rather than focusing on individual patients?
3. What are the advantages of establishing a Casualty Collection Point (CCP) in a mass casualty scenario?
4. In what situations might CPR be deprioritized, and why is this an important decision in tactical scenarios?
5. How might the triage process differ in tactical versus conventional mass casualty events, such as an active shooter compared to a large-scale vehicle accident?