BharatNotes What is Triage (Disaster Medicine)?
Triage is the systematic sorting of casualties in a mass-casualty incident (MCI) to decide the order and priority of treatment and evacuation when medical resources are insufficient for everyone at once. The aim is utilitarian — to maximise the number of survivors rather than to treat patients in order of arrival or in order of who is most critically ill. The word derives from the French "trier" (to sort), and the modern military-medical system is credited to Baron Dominique-Jean Larrey, surgeon to Napoleon's Imperial Guard, who in the 1790s sorted the wounded by severity of injury rather than by rank.
The Colour-Tag Categories
Triage assigns each casualty a colour-coded priority tag. The four widely used categories are:
| Tag | Priority | Meaning |
|---|---|---|
| Red | Immediate (P1) | Life-threatening injuries; cannot survive without urgent treatment but has a realistic chance of survival |
| Yellow | Delayed (P2) | Serious injuries, currently stable; treatment can wait a short while |
| Green | Minor (P3) | "Walking wounded"; can wait or self-transport |
| Black | Deceased / Expectant | Dead, or injuries so severe that survival is improbable given available resources |
Some evidence-based systems (such as SALT) add a separate "expectant" (often grey) category for the still-living whose injuries are almost certainly fatal, distinguishing them from the already deceased.
Common Triage Methods
The most widely used field method is START (Simple Triage And Rapid Treatment), designed to sort each casualty in about 30 seconds using three observations — RPM: Respiration, Perfusion and Mental status. A casualty breathing faster than 30 breaths/minute, with absent radial pulse or capillary refill over 2 seconds, or unable to follow simple commands, is tagged Red (Immediate).
SALT (Sort, Assess, Lifesaving interventions, Treatment/transport) is an evidence-based, non-proprietary system developed in 2008 to standardise all-hazards MCI triage, and is supported by the US CDC as a scientifically designed method. A paediatric variant, JumpSTART, adapts the criteria for children.
Significance and Indian Context
Triage is the operational backbone of medical preparedness during earthquakes, stampedes, industrial accidents, terror strikes and pandemics. In India, it is embedded in the NDMA's National Disaster Management Guidelines for Medical Preparedness and Mass Casualty Management. The NDMA, chaired by the Prime Minister, is the apex body for disaster management under the Disaster Management Act, 2005. Triage typically operates in stages — primary (field) triage by first responders and secondary triage by emergency physicians on hospital arrival — with the immediate goal of basic ABC (Airway, Breathing, Circulation) interventions rather than full resuscitation.
UPSC Angle
For GS3, triage anchors answers on disaster medical response, hospital surge preparedness and the role of NDMA/NDRF/State authorities. For GS4 ethics, it is a powerful real-world illustration of utilitarian decision-making, allocation of scarce resources, and the moral weight of "expectant" categorisation. Knowing the colour codes and the START/SALT logic adds factual precision to both Mains answers and Prelims-style recall.
