Author Topic: Triage when the SHTF  (Read 3385 times)

Offline Tennessee Mountaineer

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Triage when the SHTF
« on: June 09, 2009, 07:02:42 PM »
Hi ya'll, Any thoughts on triage in a SHTF fan scenario?
We won't have EMS to haul us to the ER, we are going to lose a lot of folks from the git go no matter how we prep.
What protocols do you think would work the best regarding Triage in a SHTF. Say 3 months without essential services or community infrastructure.
Would a broken Femur be a death sentence? Without some ALS that box of band aids and aspirin aint gonna do poo for it.
How do you plan to make the decision on who is treated with precious medical resources and who do you let go?
 I suppose those who are already very ill will go first.
Then we must decide who to treat within our level of training and our limited and precious medical supplies.
 Normal triage protocols may not work due of the lack of an EMS service. With no way to transport or place to transport the PT to what are you going to do? Unless you have real medication for pain, hemorrhaging, and an almost endless list of other meds, a serious trauma PT is going to be a big problem. Not to mention the lack of surgical interventions.
  From my perspective, medical treatment is the big stumbling block when it comes to the excrement hitting the rotor.
If all you EMT-P's. RN's amd MD's out there could throw this newbie EMT-B/WEMT a pearl of wisdom or two and I'll be much obliged.
 Thanks and be of good cheerl
 

Goatdog62

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Re: Triage when the SHTF
« Reply #1 on: June 09, 2009, 07:18:20 PM »
This has been my area of focus for several months now. I have the food, the water, the BOL, the BOB's, the BOV's, the guns, the ammo, and plans for all. I am working on gardening knowledge and medical stuff. I have a decent amount of stashed meds and some decent medical training, but always feel like I need more.

I'm in a week long emergency medical class right now, by choice.

I'm an alpha male, I've always been Superman and have come through for my friends and family. I can make things happen, but I always wonder how helpless I'll feel if I have to watch one of my six children slip into an ever worsening medical condition that I can't do anything about, because of lack of knowledge or meds.

I even have retired Special Forces 18D and SEAL medic friends as part of my Bugout plan who have agreed to join me. They are among the best, but I still have that "not quite ready yet" feeling in the health area of my preps.

walker

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Re: Triage when the SHTF
« Reply #2 on: June 09, 2009, 10:36:27 PM »
Hi ya'll, Any thoughts on triage in a SHTF fan scenario?
I depends entirely upon the scenario that you anticipate, and for how long you anticipate living under those conditions.

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We won't have EMS to haul us to the ER, we are going to lose a lot of folks from the git go no matter how we prep.
If you mean folks who survive day to day based upon modern medicine, yes they would likely perish quickly within weeks to months.  If you mean folks who suffer severe traumatic injuries, yes some of those would perish within a couple hours to days of time.  I also think you would be surprised at how tough a healthy human body can be, and some simply require supportive care to survive.  Depends upon the health of the individual, the nature of the injury, supportive care available, environment, etc.

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What protocols do you think would work the best regarding Triage in a SHTF. Say 3 months without essential services or community infrastructure.
This would be a question of ethics based upon both the likelihood that the individual will survive 3 months without advanced care, and the amount of suffering the individual is reasonably able to endure.  Let's say your wife suffers a spinal injury, she survives the initial injury, but has no ability to walk, no ability to urinate without a catheter, and develops a kidney infection.  Are you going to use your last course of Cipro to treat her infection?  I would, even if it was MY last course of Cipro given to YOUR wife.  But that's me, I couldn't sleep well knowing I would let her die from something I could treat, unless she refused treatment.
 
Quote
Would a broken Femur be a death sentence? Without some ALS that box of band aids and aspirin aint gonna do poo for it.
Depends upon the broken Femur, and if it lacerates the femoral artery.  If yes, the individual is likely not going to survive 10 min, or the "golden hour", unless that artery is ligated or clamped.  Also, if you don't repair that artery within a reasonable time frame the leg will become necrotic requiring amputation.  Again, you do what you can at the time, and worry about the next step when you get there.

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How do you plan to make the decision on who is treated with precious medical resources and who do you let go?
I don't think you can make that call until you have the case in front of you and know the details of the actual real-life scenario.
Let's say your hunting buddy goes into a full cardiac arrest in the middle of the mountains, you are alone, how long will YOU do CPR?  Not at all, 5 min, 10 min, 20 min?  I think you will do it as long as necessary for you to live knowing you did everything to the best of your ability under the given circumstances.  Meaning, I would do it until I felt assured it was of no further use, even though I know that CPR is fairly useless to begin with.

Quote
If all you EMT-P's. RN's amd MD's out there could throw this newbie EMT-B/WEMT a pearl of wisdom or two and I'll be much obliged.
I will give you the same advice told by an old "country doctor" to a first-year PA working in a very remote area of Alaska.  "You won't be prepared for everything, keep in mind that people will die with or without you here, you can only save the ones who can be saved, and do your best not to be the cause of death."  Finally, "If you find that you can't sleep knowing you can't save them all, find another job."   

In short, worrying about who can be saved and who will die is wasted energy and emotion.  Preparing for the most likely, and planning for what I am trained to treat is what I focus upon.  You do the best you can with what you have, and this applies to both gear and what is stored between your ears. 

"As you know, you go to war with the Army you have. They're not the Army you might want or wish to have at a later time." -D.Rumsfeld 
« Last Edit: May 01, 2013, 12:24:42 AM by Archer »

Offline USA83

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Re: Triage when the SHTF
« Reply #3 on: June 10, 2009, 03:56:40 PM »
Almost none of the questions you asked can really be answered in the here and now. People, friends, family are going to die no matter what we can do. If the time comes Almost anything can influence the decision. As you grown and practice more medicine you will learn to understand who you can help and who you can't. That can't come in a book or a movie or a website. And sometimes even though you mentally know you can't help someone you will do everything you can to help them pull through. Your beliefs can also play a certain part in what happens. For instance, looks like your a contractor by your avatar, Who would you save first Iraqi or GI Joe? Even though medicine says take care of who ever needs you worse. Your beliefs WILL play a part. The best thing you can do is Go LEARN MORE. High speed tools are never a good crutch for  bad training.  I know I didn't help but hopefully I The more thinking and ideas will encourage you and others to Gain more knowledge. Medicine is a tough job/life If you actually practice you will do somethings you regret. You will second guess your decisions and you may find yourself in a situation where you are really overwhelmed. Take it by the numbers do what you can and MOST of all know that EVERYONE DIES. Your goal is to keep back the ripper for just a little while longer.

Butch

Offline Buffy

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Re: Triage when the SHTF
« Reply #4 on: June 10, 2009, 05:25:14 PM »
Quick answer.
My family comes first no matter what.

walker

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Re: Triage when the SHTF
« Reply #5 on: June 10, 2009, 09:20:15 PM »
USA83/Butch, great post full of wisdom.

+1
« Last Edit: May 01, 2013, 12:24:19 AM by Archer »

Offline Tennessee Mountaineer

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Re: Triage when the SHTF
« Reply #6 on: June 11, 2009, 09:49:53 PM »
Thank you all for the replies. Triage is a tough call, no doubt. I was a 91B/91C with the 128th CSH and HHC 4Bn/9 Reg 7 I.D.(Light) back in the day. Recently got my NREMT cert with a WMI wilderness medicine course too.
It was the WEMT course that brought up the idea of triage in  sub-optimal conditions again.In the end you can only do what you can for who you can.
I agree that you cannot plan for every possible scenario and you cannot save them all. Or even most of them in a SHTF scenario. Also you can only plan for what you can do within your training and equipment. Triage is an important concept in survival, disaster medicine, etc that gets little attention.
Thanks again.

Offline LGM30

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Re: Triage when the SHTF
« Reply #7 on: June 12, 2009, 12:03:23 PM »
I will give you the same advice told by an old "country doctor" to a first-year PA working in a very remote area of Alaska.  "You won't be prepared for everything, keep in mind that people will die with or without you here, you can only save the ones who can be saved, and do your best not to be the cause of death."  Finally, "If you find that you can't sleep knowing you can't save them all, find another job."   

In short, worrying about who can be saved and who will die is wasted energy and emotion.  Preparing for the most likely, and planning for what I am trained to treat is what I focus upon.  You do the best you can with what you have, and this applies to both gear and what is stored between your ears. 

"As you know, you go to war with the Army you have. They're not the Army you might want or wish to have at a later time." -D.Rumsfeld 
This reminded me of a quote from MASH.
Rule #1 - Young men die in war.
Rule #2 - Doctor's can't change rule #1.

Kind of applies to preparing...People will die in  disasters and emergencies.  No Amount of preparation will change that.
« Last Edit: May 01, 2013, 01:08:07 AM by Archer »

Offline archer

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Re: Triage when the SHTF
« Reply #8 on: June 12, 2009, 12:19:53 PM »
When I was in my CERT training, the hardest part was when they explained how to classify the injured after a accident. People said they would not black tag people since that meant they felt they were condemning them. The teachers took a lot of time to explain they were not condemning them, that the people were going to die and there was nothing the helpers could do help them. But they could help the people that could be saved if they received help quickly.

Angie

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Re: Triage when the SHTF
« Reply #9 on: June 12, 2009, 01:27:22 PM »
As a Registered Nurse with 30 years E.R. experience  I can tell you that with time you will know just by looking.  It's a big responsibility, but you must use irreplaceable resources on people who will actually survive.  In our society, we try to keep the very ill and the very old alive well beyond the time when they should have died.   Instead, family cannot let go of loved ones, and it's the loved ones that suffer.  In a TEOTWASKI only the strong will survive.  Resources will go to them, and that's the way it should be.  Unfortunately, those who have those resourses will be in a position to use medical supplies as barter to desperate people rather that share.

Offline Hoxbar

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Re: Triage when the SHTF
« Reply #10 on: August 28, 2009, 03:12:35 PM »
When I was in my CERT training, the hardest part was when they explained how to classify the injured after a accident. People said they would not black tag people since that meant they felt they were condemning them. The teachers took a lot of time to explain they were not condemning them, that the people were going to die and there was nothing the helpers could do help them. But they could help the people that could be saved if they received help quickly.

I had a big problem wrapping my brain around this one too, during my EMT training. I know it's very hard to decide who "makes" it and who "doesn't" in the real world. I've been a fireman/Emt for the last 7 years and it's not easy.  Thank God I've never had to black tag anyone yet but been really close. It's hard to decide who get a chopper and who rides in on the ambulance, knowing the person on the chopper is going to make it and the ambulance is not. I've had to make that decision and it's not easy. When we have a SHTF moment I feel I'll be more mentally prepared than most to make these decisions. 

Offline SaltyHobbit

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Re: Triage when the SHTF
« Reply #11 on: September 30, 2009, 07:22:56 PM »
Almost none of the questions you asked can really be answered in the here and now. People, friends, family are going to die no matter what we can do. If the time comes Almost anything can influence the decision. As you grown and practice more medicine you will learn to understand who you can help and who you can't. That can't come in a book or a movie or a website. And sometimes even though you mentally know you can't help someone you will do everything you can to help them pull through. Your beliefs can also play a certain part in what happens. For instance, looks like your a contractor by your avatar, Who would you save first Iraqi or GI Joe? Even though medicine says take care of who ever needs you worse. Your beliefs WILL play a part. The best thing you can do is Go LEARN MORE. High speed tools are never a good crutch for  bad training.  I know I didn't help but hopefully I The more thinking and ideas will encourage you and others to Gain more knowledge. Medicine is a tough job/life If you actually practice you will do somethings you regret. You will second guess your decisions and you may find yourself in a situation where you are really overwhelmed. Take it by the numbers do what you can and MOST of all know that EVERYONE DIES. Your goal is to keep back the ripper for just a little while longer.

Butch

Great advice. I can tell you that trying to triage during the SHTF is one of the hardest and most heart breaking things you can ever do. If it is random people you can distance yourself during the act. I know it sounds cold but it is true and very important. The worst thing in the world is if you are really close to the casualties. I have been involved in some MASCALS while deployed. The last one unfortunately involved loosing 7 guys I was really close with and it's haunted me ever since with did I make the right call with who got on the birds first. But we all deal with our own demons. Looking back I must have made some right choices since we had 17 injured and 10 made it home again. I guess my story only has partial relevance, but you just have to go with your gut and know that you did all you could.