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Triage, and deciding in advance

Triage, and deciding in advance: do this now

Not a procedure to run during an emergency. A conversation to have once, calmly, years early, and the value is entirely in having had it.

  1. Have the conversation on an ordinary evening, with nothing happening.
  2. Agree who decides if two people are hurt and one adult is there.
  3. Ask each adult what they would want if they were the one beyond help, and write it down in their own words.
  4. Talk about where the line sits between keep trying and make comfortable. Nobody can define it, and having named it is most of the benefit.
  5. Agree who goes for help, and at what point.
  6. Be honest about the household's actual medical limits: what is in the kit, who has training, what nobody has ever done.
  7. Remember the two things an untrained person can genuinely do in seconds: stop catastrophic bleeding, and open an airway.
  8. Remember that anyone walking and talking can wait. Speech proves airway, breathing and brain perfusion at once.
  9. If cure is not available, care still is: stay with them, keep them warm, control pain, wet their mouth, talk to them.
What this page is
A conversation, not a checklist
Fast and decisive
Bleeding, and the airway
Can wait
Anyone walking and talking
Afterwards
Say it out loud to another adult

The mistake that costs lives: Believing that a different decision, made faster by a better person, would have changed an outcome that was never in anybody's hands. That is where the lasting harm from this page comes from, and it is almost never bad triage. In a situation with no surgery, no blood and no intensive care, some injuries and illnesses are simply not survivable, and recognising that is a fact about the circumstances rather than a verdict on how hard anyone tried. Deciding you cannot save someone is not the same as deciding not to care for them. If the household has one conversation about any of this, have that one.

Not a procedure to apply in the moment, but a conversation to have once, calmly, years early. The value is in having thought about it, not in a checklist you follow while someone is dying.

Every other page in this domain is about paperwork, money and caches. This one is here because the playbook's own hard pages put it here, and because it is the entry most likely to be skipped and most costly to skip.

What this page is and is not

It is not a procedure to follow during an emergency. Sorting casualties under pressure is a trained skill, and a family in crisis applying a half-remembered scheme to people they love will not do it well, will not do it consistently, and will carry the result for the rest of their lives.

It is a conversation to have once, calmly, when nothing is happening. The value is entirely in having thought about it in advance. That is the same claim the playbook already makes, and it is right.

So this page gives you the shape of the thinking and the questions to settle, and deliberately does not give you a scoring system to apply to your children.

Why the framework exists

Triage was invented for one situation: more casualties than carers, with limited supplies and limited time. It is not about deciding who deserves to live. It is a method for producing the largest number of survivors from a fixed amount of help.

Two facts about it that are worth understanding before any of the rest:

It is counterintuitive on purpose. The instinct is to go to the person screaming, or the person you love most, or the most visibly horrifying injury. Triage says the screaming person has a clear airway and can breathe, so they can wait. That inversion is the entire point and it is why it has to be thought about beforehand, because instinct will not produce it.

It is temporary. Triage decisions get revisited as circumstances change. Someone deprioritised at 9am may be treated at 11am when more hands arrive. Nothing about it is a permanent verdict.

The only version worth knowing

If you retain one thing from this page, retain this, because it is what an untrained person can genuinely apply.

Reassess constantly. People move between these as time passes and as help arrives.

The decisions to make in advance

These are the questions worth settling as a household, calmly, once. Not answered here, because they are not ours to answer.

  • Who is the decision-maker if two people are hurt and one adult is present? Agreeing this in advance removes an argument at the worst possible moment.
  • What does everyone want if they are the one who is beyond help? Say it out loud to each other. It is a five minute conversation that changes how the survivors feel for decades.
  • Where does the line sit between "keep trying" and "make comfortable"? Nobody can define it precisely, and having discussed that it exists at all is most of the benefit.
  • Who goes for help, and when? Splitting up has real costs, and deciding the threshold in advance beats deciding it while panicking.
  • How do you handle a child versus an adult? Most people's instinct is children first, and it is worth knowing that about yourselves rather than discovering it.
  • What are the household's actual medical limits? What is in the kit, who has training, and what have you honestly never done. Knowing the ceiling in advance prevents both false confidence and unnecessary despair.

What good care looks like when cure is not available

This is the part most preparedness writing omits entirely, and it is the part most likely to be needed.

When you cannot fix something, there is still a great deal to do, and it is not nothing:

  • Stay with them. Do not leave anyone to die alone. This is the single most important thing on the page.
  • Keep them warm and dry, and off a cold floor.
  • Control pain as far as you can. Paracetamol and ibuprofen at proper doses, positioning, immobilising fractures, which is genuinely effective pain relief.
  • Wet their mouth even if they cannot drink. A damp cloth on the lips relieves a great deal.
  • Keep them clean.
  • Talk to them. Hearing persists long after responsiveness goes. Say the things that need saying, whether or not you think they can hear.
  • Hold their hand.
  • Let the family be present, including children if they want to be and are prepared for it. Being excluded is usually worse for a child than being present, though that is a judgement for the parent.
  • Do not lie to them, and do not force truth on them either. Answer what they ask.

Afterwards

The people who make these decisions carry them, and the app would be dishonest to end without saying so.

  • You will replay it. Everyone does, and it does not mean you got it wrong.
  • Hindsight has information you did not have. The decision was made with what was available at the time, which is the only way any decision is ever made.
  • Say it out loud to another adult. Silence is what turns this into something lasting.
  • Children need age-appropriate honesty, not protection from the fact that something happened. See the children's tier for how that is pitched.
  • If services ever return, take the help. Trauma from this is a normal response to an abnormal situation, and it is treatable.

The playbook's own framing is the right one to end on: this is a page about thinking clearly once, in advance, so that nobody has to think clearly for the first time on the worst day of their life.

Why this matters: the hard pages

Last reviewed 2026-08-01

Checked against 8 sources
  1. Triage exists for the situation where casualties outnumber the help available, and its purpose is the greatest number of survivors from a fixed amount of help rather than a judgement of worth
  2. Triage categories are provisional and are reassessed as casualties change and as more help arrives
  3. Catastrophic haemorrhage and airway obstruction are the two reversible causes of death that untrained hands can address in seconds, and both are placed before everything else in current first aid teaching
  4. A casualty who is walking and speaking in full sentences has demonstrated a patent airway, adequate breathing and adequate cerebral perfusion, which is why sorting schemes deprioritise the walking wounded
  5. Where cure is not available, comfort care remains active treatment: pain relief, warmth, mouth care, cleanliness, presence and honest answers
  6. Hearing appears to persist late into unresponsiveness at the end of life, and speaking to an unresponsive person is standard practice in palliative care
  7. Children are generally better served by age-appropriate honesty and by inclusion, where they wish it, than by exclusion from a death in the family
  8. Moral injury, the distress that follows decisions taken under impossible constraint, is a recognised and treatable response rather than a personal failing