Blood Sweep, Deep Breath, Pulse Check: Point-of-Injury Triage

<p>Most of us were taught START, the sieve, RAMP, DIME, P1–P3. Andrew — EM physician on a small surgical team out of Fort Liberty — used none of it the night a helicopter went down with 22 people on board.</p><p>The rest of his medical team could not walk. Dust, firelight, yelling. Thirty-to-sixty seconds per patient on a linear algorithm is ten minutes before you reach number ten. People die of massive hemorrhage and lost airway in that window.</p><p>So he ran a binary pass: dying now or not. Blood sweep. “Take a deep breath.” Pulse. Ten to fifteen seconds. Keep a mental list of who leaves first. He got through about twelve before other medics arrived. He never reached the massive bleeder — a non-medic first responder did. That is the point.</p><p>Rick Hines puts the doctrine next to the wreckage. Triage is continuous, not a one-and-done sort. The most senior medical person is often the worst person to own the sort if they should be operating. Algorithms used after the first pass are training tools — studies put accuracy around or under 50 percent. </p><p><br></p><p>Training has to match that. Four casualties before twenty-two. Global endpoints, not a perfect score on every manikin. Delayed birds. Command decisions. Unit buy-in, not a tourniquet-and-check-the-block.</p><p>No perfect MASCAL. You were already behind when it started.</p><p>Listen: PFC Podcast · prolongedfieldcare.org · @prolonged_field_care</p><p><strong>Top 5 takeaways</strong></p><ol><li><strong>First contact is binary.</strong> Dying now / not dying now. Blood sweep, air movement, pulse. 10–15 seconds. Do not spend a minute running START on patient one while patient ten bleeds out.</li><li><strong>Then deliberate triage.</strong> After LSIs and a move to the CCP: urgent / priority / routine (what TCCC/CoTCCC are leaning toward). Expectant exists when resources force it — not on the first pass.</li><li><strong>Move, treat, transport.</strong> Rush’s three verbs beat a four-color card at the wreck. Get off the X, stop hemorrhage and airway loss, get them to the next level.</li><li><strong>The senior clinician should not automatically own the sort.</strong> If they are the surgeon, someone else runs triage. Non-medic first responders are part of the system — Andrew never reached the massive hemorrhage; someone else did.</li><li><strong>Train the real constraints.</strong> Nail four before you role-play twenty-two. Score the lane on whether life threats were found, blood got to shock, account