Emergency Medicine in the Persian Gulf War—Part 2: Triage Methodology and Lessons Learned

Abstract

Study objective: To describe the conventional triage consequences of war zone casualties compared against expected NATO triage casualty estimates; the influence of the Revised Trauma Score on triage sensitivity; and evaluation of physiological parameters considered potentially useful to improved triage specificity and sensitivity. Study design: A retrospective analysis of conventional triage and Revised Trauma Score data. Setting: A military field trauma center during the primary ground assault into Kuwait. Type of participants: Four hundred sixty-one coalition and enemy force personnel who were triaged as casualties. Main results: Triage categories for coalition and enemy forces were remarkably similar, but deviated significantly ( P < .001) from expected NATO triage casualty estimates. Medical diagnoses were 6% and 11% of these forces, respectively. Only 7% of enemy forces casualties and 2% of coalition casualties required retriage. Neuropsychiatric triage categories identified 16 immediate casualties potentially at risk for post-traumatic stress. The Revised Trauma Score for triage failed to provide significant triage sensitivity. Conclusions: Conventional triage is a useful tool for war and conflict; it is experience dependent. Had the anticipated number of casualties actually occurred in this war, we conclude that the triage process would have benefitted from additional information, probably physiologic information, to improve the sensitivity and specificity of our findings. [Burkle FM Jr, Newland C, Orebaugh S, Blood CG: Emergency medicine in the Persian Gulf War—-Part 2: Triage methodology and lessons learned. Ann Emerg Med April 1994;23:748-754.]