In a large rescue operation, more people may need medical attention simultaneously than the medical team can treat individually. Triage — from the French trier, to sort — is the process of categorising patients by the urgency of their need so that limited medical resources are directed where they save the most lives.
Triage is led by a single trained person — supported by the medical team. On some vessels, trained non-medical crew may be asked to perform it. Whether or not that is your role, understanding the system prevents well-meaning interference that disrupts it — and helps you support the process effectively when it is under way.
Without triage, medical resources in a mass casualty situation are distributed based on who arrives first, who shouts loudest, or who happens to be near the medical team. This results in resources being used on minor cases while critical cases deteriorate — and in more people dying.
Triage directs resources systematically. A patient triaged as T3 (minor) is not being neglected — they are being correctly identified as stable enough to wait while more critical cases are treated first. This is a professional and ethical decision, not indifference.
The primary survey is a rapid assessment used at initial triage. It happens in the first few seconds — a trained medical staff member scans for immediate life threats: major haemorrhage first, then Airway, Breathing, Circulation (ABC). This immediate scan determines triage category before any detailed assessment. It is performed by trained medical staff.
Triage is not a fixed decision. A person's condition can deteriorate or improve. Someone triaged T2 may become T1. Medical staff reassess continuously during the operation. Categories are marked visibly on survivors where possible — using coloured tags (T1 red, T2 yellow, T3 green, T4 black) or other markers — so any team member can identify priority at a glance.
Standard triage uses four categories. These are internationally consistent — the same framework is used in disaster response, military medicine, and maritime SAR.
Maritime SAR triage has specific features that differ from land-based mass casualty situations.
RHIB crew make a preliminary assessment before survivors come aboard — identifying visible critical cases and persons in the water. This pre-boarding assessment allows the medical team on the mother vessel to prepare for what is arriving. RHIB crew use a radio to pass this information to the bridge and medical team.
Recovering someone from the water is an immediate priority — it takes precedence over almost everything else. Once aboard, triage follows the same algorithm as any other survivor. Someone who is walking and talking is T3. Someone unresponsive is assessed for T1. In a mass casualty situation, resuscitation is sometimes attempted if resources allow and the person was recently seen alive — this will be decided on a case-by-case basis by the medical team.
A humanitarian SAR vessel has limited medical equipment compared to a hospital. The medical team works within these constraints. Medical evacuation (MEDEVAC) to a hospital — by helicopter or faster vessel — is requested for cases that exceed vessel capacity. The SARCO coordinates this with the MRCC.
If asked by the medical team to assist — holding a patient, helping someone move, fetching equipment — do exactly what you are asked and nothing more. CPR is physically exhausting, and in a mass casualty situation the medical team may recruit general crew to rotate through compressions so the medical team remains free for clinical tasks. If asked to assist with CPR, you will be supervised and directed by medical staff throughout.
You may also be assigned to manage T3 (green) survivors — the walking wounded. This is an active role: providing basic reassurance and psychological support, watching for signs of deterioration, and keeping people within the designated area. A T3 person who deteriorates needs to be reported to the medical team immediately. Do not assume someone is fine because they were triaged green.
Do not perform medical interventions beyond your training. Do not argue with triage decisions. If you observe something the medical team has not — a person hidden or overlooked — report it clearly and directly.
Eight survivors have just arrived aboard from an overcrowded boat. The medical team needs you to help with preliminary sorting before formal triage. Read each survivor's presentation and assign them to the correct category.
Your classification won't be used operationally — this is a learning exercise. Think about what you've read in the previous sections before deciding.
For reference, the NHS Ten Second Triage (TST) tool is one example of a rapid triage algorithm that may be used in mass casualty situations.
Five questions on triage awareness.