Note: Due to recent events, part 2 of my gunshot wounds treatment series is postponed to next week. (See part 1 here.)

The START adult triage algorithm from the U.S. Department of Health and Human Services. Click the photo to enlarge. (If you don't have medical training, it will make more sense if you've taken my course or read my latest book.)

Click the photo to enlarge. This is a START adult triage algorithm from the U.S. Department of Health and Human Services. (If you don’t have medical training, the chart will make more sense if you’ve taken my course or read my latest book.)

For the past week, mass tragedies and mayhem have dominated U.S. news. In Dallas, a man shot and killed five police officers and injured seven more during a protest. In Nice, France, a man murdered more than 80 people when he plowed through a crowd in a transport truck. And in Turkey, hundreds were reportedly injured or killed during an attempted coup.

What if you were caught in a mass casualty situation? What if you weren’t injured but dozens around you were? Would you know what to do? How to help? Where to start?

Here’s a simple four-point plan to have in place anytime you’re in a crowd.

The 4 T’s of Mass Casualty Treatment

Whether it’s from gunshots, a truck driving through a crowd, a tornado, or an earthquake, multiple-trauma situations initially result in chaos and panic. But within that, there are opportunities for uninjured survivors to save lives of the injured.

In a nutshell, here are my four T’s for helping to save lives in a multi-trauma situation:

  1. Take cover.You can’t help others if you’re killed. So make reasonably sure the imminent danger to you has passed before venturing out.
  2. Take action. Don’t wait for someone else. Just do it. Many people freeze (through no fault of their own; it’s the way the brain works sometimes). Others don’t have the knowledge needed to help. Still others are overwhelmed and don’t know where to start or can’t calm down enough to help. Emergency responders are likely on their way, but they may be delayed or blocked.
  3. Triage. Find a person you think you can best help. The START system can help you decide (see below), or just choose the closest person.
  4. Treat. For instance, if someone is alive but bleeding badly, apply pressure or a tourniquet. After that, move to the next victim. If no one is alive, start chest compressions on someone.

How to Triage: The START System

If there are a lot of people with severe injuries and you can’t help them all, you may have make some hard decisions about who can use your help the most. Many first responder teams go by the START system. It stands for Simple Triage and Rapid Treatment. It’s not perfect, but it can give you guidance to avoid the paralyzing enormity of it all.

The START system technically involves using colored tags to triage (sort) people according to how injured they are. You probably won’t have tags, but the general guidelines can help you decide who you should spend your main time on. The categories are:

  • Black: Are so severely injured they’re unlikely to survive no matter the treatment
  • Red: Have life-threatening injuries that need immediate treatment if they’re going to survive
  • Yellow: Have injuries but can likely wait for treatment until the red group is treated and transported
  • Green: Have fairly minor injuries—sometimes called the walking wounded

For instance, here’s a situation you might face: A person shows no sign of life. You know that the treatment is immediate chest compressions until expert help takes over. But do you spend your time on that person, who is very unlikely to survive, or do you help the other one who will die if her bleeding is not stopped? Or the one with severe difficulty breathing?

The START system can help you make those horrible choices in a more objective manner. At the least, it will give you a place to … start. In the end, it’s a judgment call. But please, unless you are hurt or in danger, help someone. If you do, in my opinion, no one has the right to judge that you were wrong.

And then there’s the walking wounded. If they’re alert enough, you might even be able to get them to assist in saving the others.

Questions? Does this make sense?

If you’ve experienced treating victims on-site in a multiple-trauma situation, please share your experience to help other readers.

Source for triage algorithm: