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Comment by willyt | Hacker News Reader

I think he was talking about the first few car loads, while he knew there were a bunch of doctors inside with nothing else to do, he was not doing this the whole night?

This triage system is pretty standard, you can see the same triage armbands in this RNLI medical kit in the bottom right corner[0] (I couldn't find a standard UK ambulance kit image), but I am told that it takes a huge amount of mental discipline to follow this training to the letter in real life. It probably took a few people going through the system for him to get into the swing of it.

I can't imagine having to do this, this guy will be going back over the decisions he made that night for the rest of his life. I hope that in writing this article he has felt validated in himself because it sounds like he and his colleagues did an incredible job.

[0]https://twitter.com/TowerRNLI/status/593180062565924865

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It's definitely hard. That's part of the reason the criteria is so clearcut. Not breathing = black tag.

From my reading of the article, he was the triage officer during the arrival of almost all the critical patients, and it was only after the acuity level started to drop off that he delegated to a nurse.

This is not my understanding of how to triage in MCI. ATLS definitely does teach the importance of deprioritizing people that will be hard or impossible to resuscitate in favor of prioritizing people that leads to a roughly utilitarian greatest good.

That said, I have never heard "black tag = not breathing = don't try to help"[1]. I know for a fact that the boundary for who to try to save immediately and who to deprioritize is very grey in many cases (it is why you should have an experienced doctor doing it). A common example why that equivalency is not taught in ATLS is the case of a boat capsizing in frozen waters. There may be many frozen victims who are not breathing but could still be very salvageable medically. If you chose to not help those who are not breathing in that case you would plausibly be found negligent without some extraordinary situation to justify yourself with.

Another example would be mass overdose on fentanyl, many are saveable but none would be breathing when you first see them.

1. https://en.wikipedia.org/wiki/Triage#Conventional_classifica...

Yes, those are two special cases where respiratory statues would not map well to expected outcomes. As far as I know, there was no capsize or mass opioid overdose involved...

I'm not sure where your understanding of triage comes from, but you're mistaken if you think respiratory status isn't the primary determining factor in black/expectant classification (in the US, there may be differences in other international systems I'm not aware of).

The vast majority of triage in US is done using the START system (or START-derived systems, like SALT).

Here is a graphical depiction of the START classification algorithm: http://citmt.org/Start/images/flowchart2.jpg

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