Everyday triage

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I’m one of those people that likes to listen to podcasts or YouTube on autoplay when doing chores around the house or when doing simple tasks at work. I guess most people are like that, perhaps listening to the radio or music or having a news channel as background noise.

During the last week I was looking for interesting material to listen to, so I followed one of Reddit’s suggestions and had a go at Radiolab’s episode Playing God. Now, quoting straight from the episodes description

When people are dying and you can only save some, how do you choose? Maybe you save the youngest. Or the sickest. Maybe you even just put all the names in a hat and pick at random. Would your answer change if a sick person was standing right in front of you?

In this episode, we follow New York Times reporter Sheri Fink as she searches for the answer. In a warzone, a hurricane, a church basement, and an earthquake, the question remains the same. What happens, what should happen, when humans are forced to play god?

Since I’m not a medical doctor, I won’t even try to get into that debate. However, I think that we can take a look at triage, the allocating of treatment to patients based on their needs or their likely benefit, and how we can apply some of its ideas to the little emergencies we all face in our daily life.

The basics of triage

The idea behind triage is that, when there aren’t enough medical resources to care for everyone at once, some rationing of treatment must be imposed. The way that this rationing is done is through evaluating the severity of a patient’s condition and likely outcome, and then determining the order and priority in which patients will be treated or transported to other locations.

Given that description, a question naturally arises: what should the criteria be when categorizing a patient’s priority? How do we choose who lives and who dies? Personally, I’d say that there isn’t a universal response to that question, especially considering how many variables are at play, how they may interact with one another and the countless possibilities that may result from those two factors. At the same time, that doesn’t mean that we can’t come up with some set of principles to aid in making the decision. I mean, treating people during a crisis seems difficult enough without adding moral questions into the mix.

If all this reminds you of the the trolley problem (and its variants), the thought experiment in which a train is headed for someone tied up on the train tracks and it’s up to you to direct the train into another track, then you aren’t the only one. Just like with those thought experiments, there have been several proposed solutions and the most obvious are the following: perhaps it should be the most critical patients who should receive treatment (since they need it the most), perhaps the healthiest (since they are the most likely to survive and will require the least amount of resources), perhaps it should be a first-come, first-served system (treating everyone equally), perhaps through a lottery (another way to treat everyone the same), or perhaps priority should be given to treating first responders.

I think it would be fair to say that there are as many solutions to that problem as people who are willing to think about it. After all, that’s a question in which we all have skin in the game and we would like to receive treatment or have our friends and loved ones get help.

Fortunately, we can leave the difficult choices to others for now and just focus on how we can use a particular triage method in our daily life.

Simple Triage And Rapid Treatment (START)

The goal of this section is for us to learn how one method for classifying victims works, so although medical terms will be used, just keep in mind the bigger picture and focus on how the terms are used, rathern than what they mean. According to MedicineNet

In START, victims are grouped into four categories, depending on the urgency of their need for evacuation. (…) The categories in START are:

+ the deceased, who are beyond help

+ the injured who could be helped by immediate transportation

+ the injured with less severe injuries whose transport can be delayed

+ those with minor injuries not requiring urgent care.

Another system that has been used (…) is an example of advanced triage implemented by nurses or other skilled personnel. This advanced triage system involves a color-coding scheme using red, yellow, green, white, and black tags:

+ Red tags – (immediate) are used to label those who cannot survive without immediate treatment but who have a chance of survival.

+ Yellow tags – (observation) for those who require observation (and possible later re-triage). Their condition is stable for the moment and, they are not in immediate danger of death. (…)

+ Green tags – (wait) are reserved for the “walking wounded” who will need medical care at some point, after more critical injuries have been treated.

+ White tags – (dismiss) are given to those with minor injuries for whom a doctor’s care is not required.

+ Black tags – (expectant) are used for the deceased and for those whose injuries are so extensive that they will not be able to survive given the care that is available.

And from Wikipedia, on how the method is applied,

Responders arriving to the scene of a mass casualty incident may first ask that any victim who is able to walk relocate to a certain area, thereby identifying the ambulatory, or walking wounded, patients. Non-ambulatory patients are then assessed. The only medical intervention used prior to declaring a patient deceased is an attempt to open the airway. Any patient who is not breathing after this attempt is classified as deceased and given a black tag. (…) Patients who are breathing and have any of the following conditions are classified as immediate:

+ Respiratory rate greater than 30 per minute;

+ Radial pulse is absent, or capillary refill is over 2 seconds;

+ Unable to follow simple commands

All other patients are classified as delayed.

So, essentially, first responders go down a checklist so that patients can be quickly classified and given the needed treatment. The problem, then, is creating our own categories and the criteria for them. Let’s see how we can integrate this into our daily life to deal with life’s more mundane emergencies.

Everyday triage

We all face our own emergencies in daily life from time to time. Locking ourselves out of our car or home, getting involved in an accident, perhaps becoming victims of a crime, going through some serious medical incident or having a financial setback. Perhaps it’s a series of small events that compound into a very difficult situation. Whatever the case, in addition to knowing how to escape from the paralysis by analysis trap, having a method similar to triage can help us stay focused on what we should do and the steps to get it done while going through a stressful situation.

So we must first come up with the categories in which we’ll put those issues. Personally, I’ve think that Covey’s quadrants are well known enough to serve as an example of this. If you don’t know what I’m talking about, the quadrants are a two by two matrix in which activities that are organized by how they fit urgent-important, urgent-not-important, not-urgent-important, not-urgent-not-important considerations.

An example of the four-quadrant matrix, filled out. Source.

The image above also has some good examples of activities that can fit each category. Now we need a method to classify issues into the different categories. Now, if we were to follow the example, the criteria of importance and urgency can easily fit into a couple of questions (is this important? is this urgent?) and asking ourselves those questions would be the method to follow. In my case, the way I tend to organize life’s little annoyances is by considering their impact in the immediate and long term scale, but also if they can cause other issues down the line. In this way, stuff that doesn’t create new problems and only impacts the present would be classified as useless to worry about. The next category would be stuff that only affects the present but can create or complicate other issues. Next stuff that may also affect the future but doesn’t make things worse and finally, the issues that are long term and make things worse.

Of course, your own version of triage can get as complicated as you want, and chances are it will change over time as you see life differently and your priorities change.

In closing

So what do think about this? From my experience, this way of doing things has been very helpful and has allowed me to focus on what actually matters.

See you next week!