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Reassessing reverse triage in future conflict
  1. Daniel J Hurst1 and
  2. T L Ray2
  1. 1Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
  2. 2United States Air Force Reserve, Dover, Delaware, USA
  1. Correspondence to Dr Daniel J Hurst, Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, CT 08084, USA; hurst{at}rowan.edu

Abstract

Future warfare will likely involve near-peer or peer-peer conflict in which there is a great risk of mass casualty scenarios. Because of anti-access and area denial, air superiority will not be guaranteed, which will hamper rapid evacuation of casualties as well as resupply. Under such circumstances, military medical personnel may be forced, due to the constraints of the battlefield and tactical necessity to return servicemembers to duty, to implement reverse triage in which servicemembers with less severe injuries are treated first. However, reverse triage is potentially incongruent with international humanitarian law. Furthermore, should reverse triage need to be implemented, from the extant military doctrine it is not certain when this would be appropriate or the steps that might be followed, which highlight the gaps that exist before reverse triage should be considered as military doctrine on the battlefield. Lastly, we question the psychological impact that reverse triage could portend on military medical personnel, unit morale and unit cohesion. While there have been recent recommendations that reverse triage might need to be implemented in a near-term future conflict, these issues linger. It is time for Western militaries to assess the merits of reverse triage and the potential drawbacks.

  • MEDICAL ETHICS
  • ACCIDENT & EMERGENCY MEDICINE
  • TRAUMA MANAGEMENT

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Footnotes

  • Contributors DJH wrote the initial draft of the manuscript and TLR contributed to specific sections and the overall editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The viewpoints expressed here are their own and are not intended to represent the US Department of Defense.

  • Competing interests Both authors are officers in the US Air Force Reserve.

  • Provenance and peer review Not commissioned; externally peer reviewed.