When a large number of injured people are brought at the same time to the health establishment, the more expert among the local health workers, taking into account the equipment and professional skills available, must sort the cases into the following categories:
A. Those who must be sent urgently to the nearest properly equipped hospital. Among these two orders of priority may be distinguished:
A. 1. Emergency cases that must be operated on within the hour:
· acute cardio-respiratory insufficiency,
· severe haemorrhages,
· internal bleeding,
· rupture of the spleen,
· injuries to the liver,
· severe chest lesions,
· severe cervico-maxillary lesions,
· states of shock,
· severe burns (over 20%),
skull injuries with coma.
A.2. Emergency cases in which it is possible to wait a few hours before operating:
· ligatured vascular injury,
· intestinal lesions, severe haemorrhage or shock,
· open joint and bone injuries,
· multiple injuries with shock,
· injuries to the eyes,
· extensive closed fractures and dislocations,
· less severe burns,
· skull injuries without coma.
B. Those given attention on the spot. Priority is given to the most serious cases among those with a chance of surviving: there are those who are attended to while waiting to be sent to a specialized centre and those who do not need major medical care and can be treated on the spot. The B group also includes very serious cases with no chance of survival that it would be pointless to move.
Victims can be transported from the local health establishment to a better-equipped hospital by local means of transport or, later, by means of transport (ambulances, cars, helicopters, ships, etc.) from elsewhere. The people in the community or from outside who deal with transport must know what hospitals can receive the injured. This information must be given to the community by the authorities at intermediate level or the national authorities. The local health personnel must also be prepared for the possibility of all communications being cut and being forced for a certain time to rely solely on their own resources and professional skills.
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