The first medical system to care for soldiers wounded in battle was created by Dominque-Jean Larrey (1766-1842), a surgeon in Napoleon’s Grand Army. Larrey saw that men were dying of treatable wounds because there was no mechanism for retrieving them until the fighting was over. He organized an ambulance system that brought men from the battlefield to mobile hospitals behind the lines. 

Priority was given to soldiers who would die without immediate medical treatment. This was the first step in the development of medical triage — from the French “trier,” to pick or sort.

In 1846, British surgeon John Wilson (1780-1856) approached the sorting of wounded soldiers in a different manner with a different goal. Wilson believed army surgeons should initially focus on men who needed immediate treatment and for whom that treatment was likely to be successful — that is, would save their lives. Of secondary importance were the less seriously wounded and those so gravely wounded their injuries would prove fatal.

A battlefield triage system (the term was not used at the time) was implemented by Union Army surgeons during the Civil War (1861-65). Physicians sorted and treated wounded soldiers using the following criteria:

¯ First priority: severe bleeding, compound fractures, missing limbs or major trauma to the arms and legs that often required amputation.

¯ Second priority: soldiers who needed care but were in stable condition with no severe bleeding.

¯ Third priority: men who suffered minor injures and wounds that could be bandaged with some returning to the fight.

¯ Final priority: wounds that pierced the torso and/or the head. These patients were made as comfortable as possible and left to die, their wounds beyond the limits of medical science to provide life saving treatment. 

Battlefield triage was necessary because of a shortage of facilities, equipment and medical personnel. This got me thinking about triage and COVID-19 as the death rate was rising dramatically in Los Angeles County. Speaking of the six-fold daily increase in coronavirus deaths over seven weeks in November and December, Dr. Brad Spellburg of the University of Southern California Medical Center stated, “For most of the days of last week, we’ve had zero ICU beds in the morning and have had to scramble. … If we don’t stop the spread, our hospitals will be overwhelmed. If you have a heart attack, if you get into a car accident, if you fall from a ladder or have a stroke, we may not have a bed for you.”

As bad as the overwhelmed hospital pandemic situation is in many locales, it’s going to get much worse. On Dec. 24, the University of Washington’s Institute for Health Metrics and Evaluation projected the number of COVID-19 deaths in the United States would likely rise from 328,000 to 567,000 by April 1, possibly as high as 731,000 if states prematurely ease mandates aimed at controlling the virus. To put these horrific numbers in perspective, consider that 116,516 U.S. military personnel died in World War I and 405,399 died in World War II (total 521,915 deaths).

With the coronavirus we are experiencing wartime medical conditions and casualties. Is it time to sort COVID-19 patients into two groups: those who wore face masks and social distanced, and those who did not with the former receiving preferential medical treatment? The anti-mask people never fail to state (scream) they have a “right” to resist government mandates requiring them to use face masks, that such mandates are an infringement on their Constitution guaranteed “freedoms.”

If people have the right not to wear masks, doesn’t it follow that hospitals and medical personnel have the “freedom” and “right” to refuse treating them? Why should doctors, nurses and medical staff risk their lives (and the well-being of loved ones if they contract the disease) for people who have no regard for the welfare of others? 

Imagine your 5-year-old child or grandchild critically wounded in an automobile accident. If you lived in Orange County, California, the child’s chances of surviving would have been significantly diminished. In the week prior to Christmas, 20 of the county’s 25 emergency medical centers were so overwhelmed with COVID-19 patients that non-coronavirus incoming patients had to be diverted by ambulance to other county facilities. When timely emergency medical care can mean the difference between life or death for the critically ill and injured, the Los Angeles Times reported that “ambulances were having difficulty finding a hospital that would take patients.” 

What if your seriously injured child was finally admitted to a hospital, only to learn the last ICU bed and ventilator had been given to a COVID-19 patient who had adamantly refused to wear a mask and social distance? Would you defend the “right” of this individual to obtain medical care the child could not? Is “first come, first served,” morally acceptable and just in this situation?

Six heroic police officers spread the alarm to evacuate buildings in downtown Nashville, Tennessee, just before an explosion destroyed much of the area on Christmas Day. What if the blast had occurred a few minutes earlier, the officers (and others) had been seriously injured, and there were no ICU beds in nearby hospitals, the rooms filled with coronavirus patients who refused to wear masks?

Is this what freedom has come to in the U.S. for tens of millions of people? “I’ll do whatever I want regardless of the consequences of my behavior and not give a damn what happens to you.” The ongoing refusal of millions of people to wear masks is the most significant, lethal and needless moral failure of the pandemic crisis.

Military boot camp drill instructors often note that “Freedom is not free; it’s paid for in blood.” The irresponsible exercise of freedom is at times also paid for in blood — the blood of others. Much like soldiers, medical personnel are being killed by COVID-19 in the line of duty by people who refuse to wear masks. As the country battles a mass-murdering enemy, isn’t failing to wear a mask and social distance treasonous behavior, acts of sabotage undermining the efforts to win a war with the fewest number of casualties?

Medical triage has been described as a strategy for insuring the greatest good for the greatest number of people. Would providing priority medical treatment to mask-wearing coronavirus patients, and others requiring emergency treatment, yield the greatest good for the greatest number of deserving people?

The chances of passing, implementing and enforcing laws that give mask-wearing coronavirus patients preferential medical treatment over non-mask-wearing patients are near zero. The anti-maskers would howl, saying such a policy was unethical, unconscionable and unconstitutional — a gross violation of their rights and freedoms? Is it?

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George J. Bryjak lives in Bloomingdale and is retired after 24 years of teaching sociology at the University of San Diego.

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Sources:

Almassy, S. (Dec. 25, 2020) “Every U.S. coronavirus death is preventable, health expert says,” CNN, www.cnn.com 

“America’s Wars” (accessed 2020) Department of Veterans Affairs, www.va.gov

Keith. W. (1998) “Civil War Medicine, 1861-1865,” Globe Pequot Press: Connecticut 

“L.A. County hospitals overrun with COVID-19 patients as death rates spike sharply upward” (Dec. 28, 2020) KNX10,70 News Radio, www.radio.com/knx1070/ 

Slawson, R. (June 7, 2014) “The Development of Triage,” National Museum of Civil War Medicine, www.civilwarmed.org

Salahieh, N, (Dec. 24. 2020) “‘We’re getting crushed’: L.A. County hospitals won’t have room for other emergency patients if COVID-19 surge continues, doctor says,” CNN, www.cnn.com 

“The greatest good for the greatest number” (accessed 2021) National Museum of the Civil War, www.civilwarmed.org