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You are here: Home > Triage Categories with and without Combined Injury > Text Version


Priorities in Triage of Patients with and without Combined Injury,
Based on Dose of Radiation*

Modified Military Triage System Used in Mass Casualty Scenarios
Conventional Triage Categories for Injuries without Exposure to Radiation Changes in Expected Triage Categories after Whole-Body Radiation
  <1.5 Gy 1.5-4.5 Gy >4.5 but <10 Gy
Delayed Delayed Variable** Expectant
Immediate Immediate Immediate Expectant
Minimal Minimal Minimal*** Minimal***
Expectant Expectant Expectant Expectant
Absent Ambulatory monitoring Ambulatory monitoring with routine care and hospitalization as needed

*The military triage system was modified to develop priorities for therapy of individuals with radiation exposure and combined injury (i.e., significant mechanical trauma or burns). Priorities change as a function of radiation dose (range based on acute photon-equivalent exposures). At a whole-body dose <1.5 Gy, triage categories remain the same: 1) delayed treatment for those who are medically stable with significant injury but who may survive until definitive treatment is available; 2) immediate therapy for those with high survivability and significant injury, provided that immediate therapy is available; 3) minimal therapy for medically stable patients with minor injury; and 4) expectant therapy for patients who are seriously injured and in whom survivability is poor. All patients with the combined injury syndrome and an exposure dose >4.5 Gy should be treated expectantly, except for those with minimal or no injury. Patients with radiation injury alone (i.e., without combined injury) should be triaged to the ambulatory setting if dose <1.5 Gy. For those with a higher exposure dose, routine care should include therapy with cytokines, antimicrobial agents, blood transfusion, and frequent outpatient follow-up with laboratory monitoring. Hospitalization may be required.
**Triage category depends on the nature and extent of physical injury.
***Although other injuries may be minimal, treatment guidelines for Acute Radiation Syndrome should be followed for patients receiving a whole-body radiation dose greater than 2 Gy.

Adapted from:

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US Department of Health & Human Services     
U.S. Department of Health & Human Services Office of the Assistant Secretary for Preparedness and Response National Library of Medicine