On Friday, I braved
a fusillade of rain to lecture engineering students at the University on my work
on a fuzzy logic system to triage hemorrhagic shock. After the last slide, Dr.
Abel, who invited me, asked, "What determines who enters each triage category?"
"Triage is French, meaning to sort," I said. "Tri also means three. The
first thing a responder to a mass casualty does is tell the victims, 'Walk over
there and form a group to await transportation.' All who do are walking wounded.
They can survive without assistance."
"And the most sincerely dead?"
"Ah, you've seen the Wizard of Oz. They're the KIA, killed in action.
They can't be helped. If you've seen The Princess Bride, you know the most critical
group is the almost dead. They have survivable wounds but need a life-saving intervention.
The medic's job is to stabilize and prepare them for transportation. Everyone
ultimately dies from lack of oxygen. Stop the bleeding, start the breathing and
give intravenous fluid to replace lost blood volume and raise the blood pressure."
"How do you decide who are the most critical and what about other wounds
like brain injury?" asked a student.
"You have to balance need with probability
of survival, the greatest good for the greatest number. You can make a good estimate
of the probability of survival without any special instruments." I held up two
fingers. "Ask, 'How many fingers am I holding up?' The response tells you how
well the victim's visual and verbal capacity functions. Look for the pulse. Is
it normal, weak or absent?"
After the seminar, we gathered in the lobby
for bottled water, soft drinks, brownies and fruit slices. Outside, the rain stopped
and hummingbirds fed in the Bougainvillea.
A faculty member recognized
me from my days as a college professor. I spoke of changes in war and wounds.
"Because of body armor, soldiers survive injuries that would have been fatal in
other wars, but they suffer serious injuries, such as loss of limbs."
"Wounded soldiers are more expensive, because of the cost of care," he said.
"Yes, there is a scene in Braveheart, where King Edward is asked by his lieutenant
if the English should use their archers against the Scots. 'No,' said Edward.
'Send in the Irish. Arrows are expensive. Dead men cost nothing.' It's more expensive,
but it's a more humane way to fight a war, if there is such a thing as a humane
way to fight."
"You were a Marine," he said, "so you know about this."
"I was a flight line officer. Infantrymen know war. I was trained to
fight, but that's no more real than watching a movie." That's my wound.
First published: May, 2007
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