Assessing injury severity during general war. Will the Military Triage system meet future needs?

The injuries likely to occur during a future general war will differ in severity and number from those experienced during recent short campaigns, terrorist incidents and natural disasters. If general war should break out in Europe, casualty numbers will lean towards the First World War rather than the Second in scale. Medical assets can expect, at least temporarily, to be overwhelmed with casualties. To deal with this problem, casualty management will be staged through five echelons or lines of medical support. The principal problem that will face medical attendants at the forward lines will be the sorting of casualties by priority so that those unable to tolerate delay in treatment will be evacuated rapidly before the less severely injured. Sorting will be achieved by the application of a crude scoring system known as Military Triage. We examine this concept and discuss its likely effectiveness in a scenario characterised by limited medical resources and a high flow of casualties. With the widespread introduction of modern and complex injury severity scoring systems into civilian trauma practice it is timely to examine their potential role in augmenting or replacing the current Military Triage system.