genuinely curious what a lot of average everyday people think about mass casualty triage training
and I bring it up because I think how you react to that, how it hits your morals, and how you are able to understand your initial reaction vs a more measured, nuanced take on an ethically ambiguous situation (+ whether you're able to recognize it as ethically nuanced with no 100% clear answer; some people double down that their interpretation of morality is the correct one & cannot hold that multiple interpretations exist at all because they see theirs as the only possible right choice & are very dogmatic about it)
I've noticed that there are, generally, 3 (maybe 4) major groups of people
1. people who see it and recognize how awful it is to need to make that decision in the first place, but understand the nuance immediately & understand the assignment. it may take them a minute or two of silence and there may be some discomfort, but they'll usually run in their head "is this the best way we could go about this? unfortunately, yeah, I can't think of any better way". it's not about being dogmatic, it's about looking at the options and recognizing that certain standards are formed with (often) good intentions (but still wanting to double check isn't a bad thing; I think it's normal to question it. these people still get to the same conclusions, though)
2. people who are so appalled at the idea of kinda playing god and deciding who lives or dies that they reject it entirely. they demand that the protocols be changed, even if it means more people die, because they cannot ethically stomach the idea of the color system in the first place. they think you should go to whoever you see first and do zero assessment of anybody else until you saved that person. they are anti-strategy for the most part, and think it is literally evil to do anything other than what they suggest. they think the thought of an uncomfortable situation is worse than the actual material lives lost due to their suggestions. these people are also typically pro-forced-birth for similar reasons; they have a sort of moral absolutism that they stand by and cannot be convinced out of because it is a strongly avoidant behavior that is not rooted in rationality or reason, but instead rooted in a desire to escape the discomfort of moral ambiguity.
3. people who have an initial gut reaction like number 2, but who fairly quickly land on number 1 because they have more moral and intellectual flexibility and they are coming to this decision out of a genuine desire to help people, instead of a desire to flee their own feelings of discomfort.
because, if you don't know, mass casualty triage involves a tagging system. usually it's colors, but I've seen people do it with letters as well. first and foremost, before helping anybody, you must verify that the scene is clear and safe for you. a lot of people get an initial feeling of disgust at that, because it feels self-serving and selfish to protect yourself when others are dying. but the reality is that you can't help them if you're dead or injured during the process of trying to help them because you didn't clear the scene. obviously, there's nuance, but you as a medical provider & first responder are a scarce resource that needs to be guarded because seconds matter and if you're down for the count, welp, there goes everybody else. if there's a shooter still actively in the area, and you end up getting shot because you tried to save somebody, that doesn't make you a hero, because now everybody you could've helped had you waited an extra minute to clear the scene are extra guaranteed to not get the help they need. they teach you this in any training for these scenarios for good reason.
once the scene is clear, you go around and assess people. anyone with minor injuries that are not life-threatening and wouldn't ever realistically become life-threatening (cuts, small-ish bruises; I say "realistically" bc technically infections exist but like cmon. are you going to potentially die in the next hour or 2 if you don't get medical care? no? then that's your group) is placed into one group. this is typically your "green" group and they are usually placed 2nd to last in terms of priority.
the next group are people with more serious injuries, but who can still wait before getting help without much issue. smaller broken bones, dislocations, people who seem fine but you want to monitor or keep for observation just in case, etc.--these people are in the "yellow" group and are 3rd to last in terms of priority.
the next 2 groups are people who have serious life-threatening injuries that WILL kill them if left unattended to in the next few minutes to seconds. these are your black (sometimes blue) and red. the difference between these two groups is 1) whether or not receiving medical assistance would improve their chance of survival (or if they are very likely to die anyways even if you try your hardest to help them; time is a resource and all time "spent" on one person is time lost for another. if you effectively waste time on somebody who is likely to die anyways, you have just killed somebody else who could've survived instead) 2) if you've got the resources to help them and anyone else. obviously, if you have the resources, you should still try to help people who have a slim chance of survival. but if you don't, you instead go with the "red" group (people who have a higher chance of survival if they receive medical care immediately) because you are trying to maximize lives saved.
yes, this means there are times during mass casualty triage where you are taught to literally leave some people to die. obviously, you try to offer palliative care when available, but there are circumstances where that's not possible and you've got 20 victims and only 3 EMTs on the scene and 5 of those victims are in critical condition literally bleeding out in front of you. if you can recruit people on the scene to help out with tourniquets, good! but that's not always what's going on with the patient and sometimes people do in fact get put in situations where they must strategically pick who they should save. it is a trolley problem of a sorts that I wish on nobody. but there are a lot of people for whom this type of action is unconscionable (even if the choice not to do that would cause even more people to die; it is ultimately far more selfish to value your feelings of not doing something you deem to be immoral over the lives of other people & their material reality).
and yes, there is a wide range of nuance--wider than I'm probably giving justice to, here. but it's always interesting to me to have discussions about politics etc. and almost watch people make the same mistake as group number 2, because they do tend to be the same people who find all of the above to be unconscionable. they are inherently a lot more uncomfortable with the systematizing of it all, even though it's the most efficient method of preventing loss of life in dire circumstances.
jacobvanloon
