Clinic of Traumatology and Orthopaedics, Percy Military Hospital, Clamart, France.
Int Orthop. 2013 Aug;37(8):1433-8. doi: 10.1007/s00264-013-1961-y. Epub 2013 Jun 23.
The authors made a retrospective analysis of three triage situations of war wounded in Chad and Rwanda in which mass casualties overwhelmed available medical facilities.
The triage classification is based on the waiting period for surgery. The categories are: extreme, first, second and third emergencies, expectant, walking wounded.
In Chad, 23 wounded adults were received in 24 hours, and 19 were operated up on within 48 hours. In Rwanda 1, 94 wounded were received in two hours, of whom 68 were operated upon, 23 on the first day. In Rwanda 2, 59 wounded were received in 12 hours, treatment of extreme and first emergencies required 48 hours, while second and third emergencies were treated during the three following days.
These episodes were very different when considering the setting, the number of casualties, the type of wounds, the logistical and medical difficulties. The authors report the difficulties faced and the lessons learned. "Il faut toujours commencer par le plus douloureusement blessé sans avoir égard aux rangs et aux distinctions." You must always begin with those who are most seriously wounded without regard to rank or other distinction. Baron Larrey (1766-1842), surgeon to Napoléon's Imperial Guard.
作者对乍得和卢旺达的三起战伤分诊情况进行了回顾性分析，这三起情况都出现了大量伤员，超过了现有医疗设施的承受能力。
分诊分类基于手术等待时间。类别为：极危、危急、重伤、次重伤、轻症和可步行伤员。
在乍得，24 小时内接收了 23 名成年伤员，48 小时内对 19 人进行了手术。在卢旺达 1 号事件中，两小时内接收了 94 名伤员，其中 68 人接受了手术，23 人在第一天接受了手术。在卢旺达 2 号事件中，12 小时内接收了 59 名伤员，对极危和危急伤员的处理需要 48 小时，而对次重伤和轻伤员的处理则在随后的三天内进行。
考虑到环境、伤亡人数、伤口类型、后勤和医疗困难，这些情况非常不同。作者报告了所面临的困难和吸取的教训。“必须始终从最痛苦的伤员开始，而不考虑军衔或其他区别。”Baron Larrey（1766-1842），拿破仑帝国卫队的外科医生。
