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Ethics and Triage

Published online by Cambridge University Press:  28 June 2012

Bernd Domres ,
Michael Koch ,
Andreas Manger  and
Horst D. Becker
Bernd Domres*
Affiliation:
Abteilung für Allgeraeinchirurgie und Poliklinik (Direktor Prof. Dr. med. H. D. Becker)
Michael Koch
Affiliation:
Abteilung für Allgeraeinchirurgie und Poliklinik (Direktor Prof. Dr. med. H. D. Becker)
Andreas Manger
Affiliation:
Abteilung für Anästhesiologie (Prof. Dr. med. K. Unertl) der Eberhardt-Karls- Universität Tübingen
Horst D. Becker
Affiliation:
Abteilung für Allgeraeinchirurgie und Poliklinik (Direktor Prof. Dr. med. H. D. Becker)
*
Arbeitsgruppe Katastrophenmedzic, Universtätsklinkum Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany, E-mail: bernd.domres@med.uni-ruebingen.de
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Abstract

A disaster is characterized by an imbalance between needs and supplies. In circumstances in which there occur mass casualties, it is not possible to provide care for all of the victims. Thus, it may be necessary to triage the casualties according to pre-established priorities. The performance of triage is associated with many ethical issues.

Currently, no Europe-wide agreement on triage and ethics exists. One system based on a categorization into four groups is proposed. Triage should be avoided whenever possible, but, when it is required, there is an obligation to respect human rights and the humanitarian laws, especially with reference to the Geneva Convention of 1864 and the Universal Declaration of Human Rights of 1948. The condition of informed consent must be followed, even in mass casualty situations. Triage always must follow established medical criteria and cannot be based on any other principles. Triage implies constant re-evaluation of victims as conditions of the victims and of available resources change continuously. In order to facilitate international coordination and cooperation, a universal classification system must be adopted.

Resumen

Un desastre se caracteriza por un desbalance entre las necesidades y los suministros. En circunstancias en que se producen víctimas en masa no es posible dar atención a todas las víctimas. Por lo tanto puede ser necesario tamizar las víctimas de acuerdo a prioridades preestablecidas. El tamizaje o “triage” se asocia a muchos aspectos éticos.

En la actualidad no existe un acuerdo europeo sobre tamizaje y ética. Se propone un sistema de clasificación basada en la categorización en cuatro grupos. El tamizaje debe evitarse siempre que sea posible, pero cuando se requiere existe obligación de respetar los derechos humanos y las leyes humanitarias, especialmente las referentes a la Convención de Ginebra de 1984 y a la Declaración Universal de los Derechos Humanos de 1948. Se debe observar la condición del consentimiento informado aún en situaciones de víctimas masivas. El tamizaje siempre debe seguir los criterios médicos establecidos y no se puede basar en ningún otro principio. El tamizaje implica constante reevaluación de las víctimas ya que su condición y los recursos disponibles cambian constantemente. Para facilitar la coordinación y cooperación international, un sistema de clasificación universal debe ser adoptado.

Keywords

consentinformeddisaster managementethicsHippocratic OathNuremberg Codereliefmedicalrightshumantriage
Type
Theoretical Discussion
Information
Prehospital and Disaster Medicine , Volume 16 , Issue 1 , March 2001 , pp. 53 - 58
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2001

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References

1.Gunn, SWA: Multilingual Dictionary of Disaster Medicine and International Relief. Kluwer Academic Publishers: Dordrecht, Boston, London 1990. p 81.CrossRefGoogle Scholar
2.Domres, B: Theoretische und Praktische Erfahrungen mit der Triage. In: Notfallvorsorge und zivile Verteidigung 1991;1:40–45.Google Scholar
3.Kollesch, J, Nickel, D: Antike Heilkunst. Ausgewählte Texte aus den Medizinischen Schriften der Griechen und Römer, Stuttgart, 1994. pp 53–55.Google Scholar
4.Trials of War Criminals before Nuremberg Military Tribunals under Control Council Law No. 10: Nuremberg October 1946–April 1949, Washington: Government Printing Office (oJ) Vol. 2, 181 ff.Google Scholar
5.Katz, J: The Nuremberg Code and the Nuremberg Trial: A Reappraisal. JAMA 1996; 276(20):1662–1666.CrossRefGoogle Scholar
6. United Nations General Assembly Resolution 217 A (III) of 10 December 1948.Google Scholar
7.Domres, B, Manger, A: Abstimmung chirurgischer einsatzkonzepte in der internationalen gemeinschaft. Langenbecks Arch Chir; Suppl II (Kongressbericht 1997):985–990.Google Scholar
8.Debacker, M: Triage in disaster situations. 9. Jahrestagung der Gesellschaft für Katastrophenmedizin in Tübingen. Internationale Katastrophenhilfe, Luftrettung, Krankenhaus-katastrophenplanung, Tropenmedizin, Infektiologie und Seuchengefahr, Telemedizin. 1998;12–13. 9.98 Tübingen, 94–99. Abstract.Google Scholar