Triage and treatment of wounded during armed conflict

Table 47.2. Factors influencing discrete categorization of the wounded

help protect (or at least not breach) the internal morality of military physicians, whose behavior by virtue of formal and informal authority influences others. Treating enemy non-combatants the same as wounded friendly soldiers emphasizes the enemy’s humanity and may prevent abuses rooted in the dehumanization of the enemy. Practically, physicians hope that following this agreement will incent their enemies to do the same.

Civilian non-combatants

Civilian non-combatants are those taking no active part in hostilities such as the local civilians, aid workers, displaced persons, and media. Similar to enemy non-combatants, civilian noncombatants are to be triaged akin to friendly soldiers. Noncombatants may have involuntarily diminished autonomy due to the hegemony of the armed conflict. Despite the humanitarian imperative and the public relations boon of treating civilian noncombatants, access to care may be hindered in a resource-poor environment.

Principled triaging

Principled triaging is arduous. It would be easy for honorable physicians to be unconsciously influenced during triage. One can also imagine physicians consciously overcorrecting to inappropriately prioritize enemy noncombatants out of a fear of being unfair. On the other hand, it takes courageous physicians to choose appropriately to spend limited resources on enemy noncombatants instead of countrymen.

The case emphasizes the murkiness of triage. One could imagine prioritizing the friendly soldier given his more tenuous state and the realization that resources may diminish after the others receive care and other wounded arrive. On the other hand, repairing a vascular injury could be time and material consuming and more pressing demands eventually may require intraoperative abandonment and re-categorization of the soldier to expectant.

If all the wounded men were treated as equals, then one could imagine starting with the patients with internal bleeding (on the theory that an easily fixable problem now may turn into a more costly problem later), temporizing the femur fracture and delaying work on the patient with the vascular wound until the next wave of wounded and more resources arrive.

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