Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter IX: Shock and Resuscitation

Physical Setting

United States Department of Defense
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Physical Setting

1. The facility should be a large, well-lighted expanse of uninterrupted space, allowing free movement of people and all unobstructed view of the entire room. Partitions or unnecessary structures which interfere with communication have no place. To effectively direct activities within the receiving area, the triage officer must be able to see and be seen throughout the area.
2. Such a facility should be capable of handling a large number of casualties. Its location is important in relation to the transportation which delivers the casualties, to the other supporting services, and to the overall internal patient flow. It should be immediately adjacent to the ambulance unloading area or the helicopter pad so that transfer into and out of secondary vehicles is not required. The area should be situated close to the operating room. Portable X-ray apparatus should be close at hand. These arrangements reduce the necessity of moving the patient, which is always deleterious in shock.
3. Supplies and equipment should be immediately visible and accesible without obstructing floorspace. A large number of open shelves lining the walls circumferentially about the triage area will be valuable for this purpose.
4. The blood bank and X-ray facility should adjoin the triage area. Laboratory tests other than cross-matching of blood and determination of arterial blood gases are not needed for initial resuscitation and can be set up in a laboratory closer to the wards and intensive care unit.
5. The facility should be arranged so that casualties can be moved easily and rapidly from the triage area or X-ray facility to the preoperative area and the operating rooms. After initial evaluation and treatment, the wounded should be separated according to priorities. Those most critically wounded are moved to an appropriate surgical stabilization area or, in dire circumstances, may require immediate movement into the operating room. Those that require general anesthesia and can be stabilized are managed in a preoperative area while awaiting their turn in the operating room. Those needing only debridement of minor wounds under local anesthesia may be cared for in a separate area.

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