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Sort Victims, Save Lives

What every cop must know about triage



Eric Dickinson | From the August 2009 Issue Wednesday, August 12, 2009

When you consider the possibility of a multiple casualty incident (MCI) in your jurisdiction, what sort of scenario do you envision? Traditional scenarios include such examples as the Force 3 tornado that struck an Iowa Boy Scout camp, killing four young Scouts and injuring 48; the Rhode Island nightclub fire that killed 100 people and injured more than 200 during evacuation; or the Minnesota school bus accident that killed four students and injured at least 14. Unfortunately, agencies must also consider the possibility of an MCI caused by an act of terrorism or mass shooting.

Depending on the type of event, EMS personnel may not be able to enter the scene initially because of ongoing or suspected hostile threats. EMS may also have a lengthy response time due to traffic, distance or road and weather conditions. What are you going to do while you wait for EMS to arrive? Some law enforcement functions may take priority, but you may also find yourself in a position to help the injured and speed up the treatment process to increase the likelihood of survival for those patients.

Regardless of the cause of the MCI, one thing is certain: Anytime you respond to a situation that involves more casualties than medically trained responders, someone has to sort the victims in a rapid, systematic manner.

Critical Considerations
So what is an MCI? It’s any incident in which the number of patients overwhelms your standard resources. Considering that a single ambulance can transport a maximum of two supine patients, it’s easy to see how quickly an MCI can occur, especially in rural jurisdictions. For many rural EMS providers, three or four patients may be enough to stress the system to its maximum load. If you imagine the possibility of an overturned school bus with 30–40 students in the same jurisdiction, you quickly realize the importance of a standardized and well-trained response that includes law enforcement officers.

Imagine you respond to a mass shooting at a local high school. SWAT teams and their tactical medics are en route. Contact teams have successfully contained or neutralized the bad guys, and you’re assigned to begin rescuing the numerous victims to waiting EMS units who can’t enter due to a fear of additional hidden shooters and explosive devices. You enter a room and find 10 victims. What do you do?

You could drag each body outside to EMS. By doing so, you may be wasting valuable time for both responders and patients—if you don’t first ask a few simple questions: Which patients need immediate medical attention and transport? Which patients can likely survive a delay in treatment? Which patients are likely to die regardless of treatment? How far do you have to move victims to reach EMS? Consider that anyone you attempt to rescue may have to be carried, dragged or shuttled by patrol cars for several hundred yards, as occurred at the Columbine massacre.

At an MCI, there probably won’t be enough EMS providers or tactical medics, at least initially, to perform all the patient care tasks required, including triage, treatment and transportation of the injured to hospitals. Sparsely populated rural areas with small volunteer EMS and fire agencies may be especially susceptible to being overwhelmed and under-equipped. Those EMTs and paramedics who are present will be best used for actual treatment of the injured, leaving the possibility that law enforcement officers may be needed to assist in performing initial triage duties. A basic understanding of the triage system used by your local EMS will allow you to provide valuable assistance and increase the odds of survival for those casualties.

Triage isn’t rocket science. It doesn’t require any medical training above a simple first-aid class. In fact, a 2003 study of British firearms officers who were cross trained in simple methods of patient triage concluded that officers have “great potential to provide accurate triage decisions in a mass-casualty scenario,” or an MCI. 

Cases in Point
Several cases exist in which 20/20 hindsight suggests that triage and rapid evacuation of patients by officers may have been very beneficial to the successful resolution of an MCI. In one example, officers at a mass shooting rescued several subjects found hiding from the shooters. A seriously wounded male was among those hiding. When the other victims were escorted to safety, this critically injured male was kept inside the building for approximately 40 minutes while officers waited for paramedics to enter the scene to provide treatment and evacuation. Sadly, the victim died alongside the rescuing officers, waiting for a traditional medical provider. 

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Eric Dickinson

Eric Dickinson is a lieutenant with the Vinton (Iowa) Police Department, an Advanced EMT and an instructor in various topics related to use of force, officer survival and emergency medical tactics. He’s the author of the book, The Street Officer’s Guide to Emergency Medical Tactics, available at Contact him at



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