6.1. Pre-hospital management of massive numbers of victims

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manejo pre hospitalarioIf all victims are immediately transported to a health center that may have limited resources, the care of the most seriously injured will be at risk. Therefore, specialized on-site care is needed to stabilize victims, who are then transported in better condition.

At this stage, triage is crucial. Triage is a method for classifying victims according to the severity of their injuries, based on the likelihood of their survival and on the physicians available. Triage at the site of a disaster takes place in three stages:

  • On-site triage (stage one) is carried out where victims are found, to distinguish those who need immediate medical care (rapid transport to the victim assembly area (VAA) from those who can wait. The most common triage method at this stage is known as START (Simple Triage And Rapid Treatment).
  • Medical triage (stage two) is carried out by medical personnel upon admission to the VAA, and determines what level of care is needed.
  • Evacuation triage (stage three) classifies victims according to their priority for transfer to a hospital prepared to receive them.

6.1.1. Search and rescue of victims

Search and rescue is performed by groups that use standardized techniques and procedures to govern their operations from their arrival at the site of the incident until the on-site operations conclude. Rescue teams conduct preliminary (stage one) triage to ascertain the condition of the victims.

One of the principal objectives of search and rescue is to reduce the loss of life by as quickly as possible providing effective care to all victims. Thus, rescue personnel can be the principal source of first aid, although following the principle that victims in acute condition must be transported to the VAA as quickly as possible.

6.1.2. Classification and stabilization of victims


Medical care at the site of a disaster is one of the most critical phases of pre-hospital operations, since victims’ survival can depend on the efficiency with which their care is administered. For medical care, the victim assembly area (VAA) is used to:

a. Classification of victims: Rescued victims are transferred to the VAA, where medical triage is performed, patients are reclassified if necessary, and the urgency of their care is determined. All patients must be identified with tags stating their name, age, sex, place of origin, triage category, diagnosis, and initial treatment. Standardized tags must be chosen or designed in advance as part of the national disaster plan. Health personnel should be thoroughly familiar with their proper use. Read more about the decisions that must be taken to properly classify patients during triage.

b. On-site medical care: Victims are given the essential care needed to preserve life—in other words, first aid and stabilization of vital functions prior to transfer to care facilities for further treatment of injuries.

An on-site medical coordinator should be designated, with sufficient authority to direct and manage the performance of all the health personnel. The main responsibilities are to:

  • Organize and coordinate the operation of the VAA and emergency medical care, balancing the priorities for care with available resources.
  • Supervise the field classification and reclassification of the patients and their referral to hospitals according to their conditions.
  • Establish and maintain contact with other coordinators and command posts in order to optimize the use of resources.
  • Designate a person to be responsible for dispatching patients to hospitals.

Read more in the CDC Guidelines for the Field Triage of Injured Patients.

6.1.3. Transfer of victims to hospitals

Decisions on transferring patients to hospitals should consider:

  • The severity of injury as determined during triage in the VAA.
  • The suitability of the hospital where the victim is to be sent as a function of the patient’s medical needs.

The person responsible for transferring patients from the VAA to the hospital must also:

  • Identify, organize, and manage available transportation resources.
  • Keep in touch with area hospitals to determine their capacity to receive patients and report on patients currently being transferred and their condition.
  • Organize safe, fast, and efficient transfer of victims in appropriate vehicles to hospitals that are prepared to receive them.
  • Control the flow of patients transferred so as not to overload the referral hospitals.
  • Maintain strict control of the information on the patients sent.