Triage
Source: Dominique Jean Larrey, Memoires de chirurgie militaire et campagnes, 1812; Emanuel et al., NEJM 382, 2020 Institution: Napoleonic Imperial Guard; University of Pennsylvania
Finding
Triage allocates medical resources when demand exceeds supply. Originated in Napoleonic military medicine: Larrey organized casualties into those who would survive without treatment, those who might survive with treatment, and those who would die regardless. Modern systems (Manchester Triage, Emergency Severity Index) formalize this into 5-level scales. The ethical foundation is utilitarian: maximize total benefit from limited resources. During COVID-19, ventilator allocation protocols forced explicit decisions about who would receive life-sustaining treatment.
Pattern Mapping
Proportion — Triage is proportion under constraint. When resources are scarce, care is allocated based on need and likelihood of benefit. Treating a patient who will die regardless, at the cost of not treating one who could survive, is disproportionate — action exceeds what the purpose requires.
Humility — Triage requires accepting that not everyone can be saved. The physician’s authority to treat is bounded by resources available. The allocation must reflect that boundary, not the physician’s desire to help every individual.
Alignment — An honest triage system aligns its stated criterion (medical need and survivability) with actual allocation. When status or wealth determine who receives care, stated criterion and actual allocation diverge.
Connections
- Hippocratic Oath — triage operationalizes the Oath’s proportionality under scarcity
- Tragedy of the Commons — resource allocation under scarcity; proportion as policy
- Palliative Care — both: medicine recognizing its limits and acting within them
- Apoptosis — both: structured removal that serves the larger system
- Lotka-Volterra Equations — population-level proportion in resource-limited systems
Status
Larrey (1812). Manchester Triage System: Mackway-Jones et al. (2006). COVID-19 triage: Emanuel et al., NEJM 382, 2020. The mapping to the five properties is this project’s structural interpretation.
The mapping to the five properties is this project’s structural interpretation.