Often when an accident occurs, any casualties of that accident will have sustained more than one injury. If you’re the type of first aider who feels compelled to actively help during situations like these, once you have assessed the situation and found multiple sustained injuries, first and foremost know that it is completely normal for you to feel overwhelmed with the situation.
The purpose of this article is to help you learn how to get through this feeling of being overwhelmed, and to help you know in what order to do things. Thinking this through in advance of rushing in will help you regain the calm demeanor you will need to help as best you can.
Your base instinct when you come across an accident where one or more people have sustained multiple-injuries will be to deal with what appears to be the most life-threatening looking wound first. Stereo-typically, this will be an open wound featuring copious amounts of blood. For the sake of your patient, however, you should take a deep breath in, and make sure you go by order of highest priority instead. This priority should be based on medical necessity, and nothing else.
In the case of multiple casualties, assess and evacuate the victims as quickly (and safely) as possible. Obviously, this requires a judgement call on your behalf that can be quite stressful, but at the end of the day, it’s about the patients well being and if you’re following the proper protocol for keeping yourself out of legal trouble as a first aider, other than that – just do the best you can. Remember to frequently re-assess the casualties and change priorities as the situation develops (or deteriorates, as the case may be).
All in all, organize your priority in terms of these three tires of injuries, being sure to deal with tier 1 injuries before tier 2 injuries, and tier 2 before tier 3.
Multiple Injury Triage: Tier 1
Highest priority. Stabilize as best you can and arrange immediate evacuation should the casualty present the following;
- Severe bleeding (flow of blood cannot be stemmed using pressure).
- Unconsciousness (patient completely unresponsive and appears to be comatose or comatose like state).
- Asphyxia or respiratory issues affecting ability to breath (self-explanatory, people gotta breathe).
- Other life-threatening emergencies, which you will have to use your own judgement to assess (at the end of the day, assess the best you can and if you think someone is at risk of dying – place them in Tier 1).
Multiple Injury Triage: Tier 2
Medical emergencies which can be put on hold due to relatively stable condition of the victim in question such as;
- Burns (these are painful, but rarely life-threatening).
- Back injuries (yes, it may be surprising to see back injuries in this category, but as long as the person is not moved and in a safe position, back injuries are not, generally speaking, life threatening).
- Fractures (try to limit movement, but as a general rule, you can move on to more serious injuries).
Multiple Injury Triage: Tier 3
Mild injuries that are not life threatening and in which the medical care can be deferred safely belong in Tier 3.
- Minor bleeding (flow of blood is easily contained using pressure).
- Minor fractures (dislocated joints would also fall in the category).
- Erratic behaviour or shock of a psychological nature (as long as they are not a threat to themselves or others, don’t get involved and let the professionals deal with this).
Always provide medical care to casualties with these tiers in mind. Whether you are dealing with one victim with multiple injuries or multiple victims with individual injuries, or, of course, multiple victims with multiple injuries – regardless, the process should not change.
Triage is important in order to ultimately help save each victim’s life. Your goal as a first aider should always be to stabilize each person for transportation so that they can receive professional treatment in a medical facility where further tests can be performed to establish the true extent of their injuries.
Obviously, my list is non-exhaustive in nature, as there are many other injuries that can be sustained and should be placed into different tiers based on seriousness, but much depends on the particular situation, and your own judgement. It’s much better to have a rough understanding of the different tiers, before you end up in the field, however, as when you encounter multiple injuries in the field, you simply won’t have the time to do a thorough analysis of each and every injury if you’re dealing with multiple injuries from multiple people. As a result, you will have to depend on rough parameters – which would be more difficult to do if your list was longer and thus harder to understand, keep track of, and remember.
Never ever opt to treat minor injuries “just because you can” when you have the option to transport a person to a medical facility. As a first responder, it is not your role (or responsibility) and could lend you in some trouble in terms of liability. Again, be sure to know how to minimize the amount of legal trouble you might get into by knowing proper protocol! I would recommend at the very least – should you initiate medical care – that you stay with the patient until all responsibility can be divested from you to the professionals. And if you are uncomfortable with a situation, call for help from a professional. Do not take unnecessary risks because you think you might be able to help. Unless you know what you’re doing – don’t dive in. You could do more harm than good!
Everyone wants to be the hero, but not all victims will see you as such, and there are many times where they will resist medical care for a slew of different reasons. If they are adults and conscious, I would frankly suggest you to listen – if they don’t want your help, do yourself a favour and walk away. You could get into serious trouble for helping someone when they explicitly told you they don’t want that help from you. I know that this is a grim analysis but many good Samaritans have been screwed over in lawsuits for trying to help, so I feel its my duty to drive this point home to my readers.
Stay safe out there, and if you find yourself feeling overwhelmed, take a deep breath and make sure to calm your nerves before you dive in. You can triage. You are perfectly able to determine who needs help first. And if you’ve done your best to deal with the most serious injuries first, you will have the best shot at helping the most people during an emergency situation.
More First Aid Resources
When it comes to first aid, you need two important things to help you on your quest to keep yourself and those around you safe & healthy: knowledge and (to a lesser extent) supplies. To tackle the prior, take a look through our list of the top 22 emergency & survival first aid books and grab those that you think will best help you gain the knowledge you’ll need. For the latter, take a look at our Ultimate First Aid Supplies List to see if there’s anything you should be adding to your at-home first aid supplies stockpile, or if there’s something you’ve forgotten to add to one of your first aid kits.
Do you know how to tell if a cut is infected, whether to use Advil, Tylenol, or Aspirin, and how to quickly assess and address emergency situations? Did you know you can superglue cuts and that Imodium is an excellent tool for survival?
If you have some time, you can also quickly browse through all our first aid articles, to see if there’s anything valuable you’ve yet to learn on the topics we’ve written about.