title: Triage of mass casualties in war conditions: realities and lessons learned.
abstract: OBJECTIVE
  The authors made a retrospective analysis of three triage situations of war wounded in Chad and Rwanda in which mass casualties overwhelmed available medical facilities.
  
  
  METHODS
  The triage classification is based on the waiting period for surgery. The categories are: extreme, first, second and third emergencies, expectant, walking wounded.
  
  
  RESULTS
  In Chad, 23 wounded adults were received in 24 hours, and 19 were operated up on within 48 hours. In Rwanda 1, 94 wounded were received in two hours, of whom 68 were operated upon, 23 on the first day. In Rwanda 2, 59 wounded were received in 12 hours, treatment of extreme and first emergencies required 48 hours, while second and third emergencies were treated during the three following days.
  
  
  CONCLUSIONS
  These episodes were very different when considering the setting, the number of casualties, the type of wounds, the logistical and medical difficulties. The authors report the difficulties faced and the lessons learned. "Il faut toujours commencer par le plus douloureusement blessé sans avoir égard aux rangs et aux distinctions." You must always begin with those who are most seriously wounded without regard to rank or other distinction. Baron Larrey (1766-1842), surgeon to Napoléon's Imperial Guard.
authors.affiliation: Clinic of Traumatology and Orthopaedics, Percy Military Hospital, Clamart, France. s.rig@libertysurf.fr
authors.forename: Sylvain
authors.initials: S
authors.lastname: Rigal
authors.forename: François
authors.initials: F
authors.lastname: Pons
mesh_terms: D000328:Adult; D002596:Chad; D002648:Child; D013502:General Surgery / Q000941:ethics / Q000379:methods; D006801:Humans; D007858:Learning; D054527:Mass Casualty Incidents; D008887:Military Medicine / Q000941:ethics* / Q000379:methods*; D012189:Retrospective Studies; D012432:Rwanda; D015599:Trauma Severity Indices; D014218:Triage / Q000941:ethics / Q000379:methods; D014857:Warfare