Embarrassed to admit that triage decisions are made
Triage seems a term dating back centuries, it is a concept stretching back millennia. It was in a history of the First World War that I first encountered it.
Doctors at the front had to make instant decisions on who they would treat: there were the walking wounded, who would live regardless of what treatment was received; there were those who were going to die, regardless of what intervention was made; and there were those for whom medical attention could be the difference between life and death.
There must have been many triage decisions that caused doctors to ponder afterwards. What if one of the walking wounded was more seriously injured than it had appeared and subsequently died from their wounds? What if one of those who were expected to die actually survived longer than had been expected and might have lived if they had received more medical assistance? The psychological pressure created by the appalling physical circumstances in which the doctors had to operate must have been intensified by the constant requirement to make immediate decisions on whether a person might have a chance to live, or should be left to die.
The need to take triage decisions arose from the situation of very finite resources. Had there been hospitals and staff to care for every one of the wounded, then every one of the wounded might have received care. As it was, medical staff were few and hospitals were overcrowded. Testament of Youth, Vera Brittain’s biographical account of life at the Front, where she served as a member of the Voluntary Aid Detachment, describes the shortages and the pressures faced by staff.
A century after the end of the Great War, and resources are still finite, triage decisions must still be made. The triage process operates in the accident and emergency unit of any hospital, decisions are taken about who should be treated as a matter of priority and who can be safely left to wait for the availability of staff members. Were triage not used, were people treated on a first come-first served basis, then someone seriously injured in a road traffic accident might be left to wait while a strapping is applied to a sprained ankle.
Triage is common sense, doctors must decide which patients are those for who medical assistance may achieve a positive outcome, (and, sadly, which patients are those for whom little can be done).
As journalists question government ministers on the decisions taken regarding who will be treated for Covid-19, (and, because there is not an infinite supply of staff and equipment, who, unfortunately will not be treated), the ministers seem embarrassed to admit that triage decisions must be taken.
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