Photo 5: A nurse assigns numbers to casualties (personal collection).
other conflict of the twentieth century9, 10. Indeed, the specificities of the fighting (short range) made it easy to aim at the enemy, but it also increased the risk of lesions to the head and the torso. Furthermore soldiers did not wear helmets or protection against bullets (nine fatal cranial/brain injuries), this, combined with their lack of SC1 Level 1 combat rescue training and the time it took to deal with haemorrhages, increased the number of fatalities which could otherwise have been avoided11, 12. We used a simplified classification system, based on the SSA’s13, 14 (table 3) so as to be better understood by our Chadian colleagues. As opposed to the data in the literature15, we observed fewer extreme emergencies due to the greater initial death rate. This is typical to conflicts on the African Continent where only those who survive the famous Anglo-Saxon ‘‘platinum ten minutes’’ reach the wounded nests8, 16, 17. The criteria chosen to classify the casualties were as follows: - Nature of the wound: localisation, depth, number of open wounds. - Gravity of the bleeding: impregnation of the clothing, need for a tourniquet. - Simple physiological parameters: radial pulse, respiration frequency, Glasgow coma scale.
In this type of a massive inflow of casualties in an unstable environment, the elements of monitoring must remain simple and clinical18. Furthermore, the use of simple physiological parameters (radial pulse, respiration frequency, Glasgow coma scale) which the whole medical staff could apply, irrespective of their nationalities, made it possible to optimize the follow up of the casualties, even if the Chadian medical staff did not know about the SSA doctrine. If ultrasounds can help implement triage because this tool can prevent the excessive medicalization of some casualties and quicken the decision process19, its use must be confined to secure environments (as was the case during the second triage).
As stressed by Lafont20, triage yields some kind of disillusion among doctors. Medicalization is a deliberate act of discrimination, yet it can also be seen as a strategy at the service of the whole community, in the sense that one aims ‘‘to provide the best possible care for the greatest number of casualties, rather than to do everything for each individual’’ In this particular context of medical aid for a foreign army, the medical teams’ lack of experience may result in the urge to put all one’s resources into caring for the first casualties. Conversely, the risk is also to save one’s resources and to deprive some patients of the medical treatments or
International Review of the Armed Forces Medical Services
Revue Internationale des Services de Santé des Forces Armées