Triage: Doing What You Can With What You Have

On the fields of war, when casualties overwhelm the combat hospital, the medical staff has to make some hard decisions about who will be treated and who won't. If there are 100 wounded soldiers and resources to treat only 10, which 10 should it be?

Triage: Doing What You Can With What You Have

The lightly wounded will be passed over, because they will survive without treatment, but the most gravely injured may also be ignored, because the resources they require are huge and they will probably die not matter what you do. Instead, the ten selected will probably come from the middle range of "savable" patients who will most benefit from the limited resources available.


This sorting process is called "triage." You may see that name on the first nurse's station you encounter in a big-city emergency room. The job of the triage nurse is to decide who needs attention immediately and who can be allowed to wait.


But triage applies far beyond medicine. Virtually any meaningful human endeavor involves some form of it, because needs almost always exceed the resources available to address them.


Do you want to save innocent children from hunger, abuse, illness or illiteracy? Sure, who doesn't? The difficult question, though, is which children? There are a lot of hungry children in the world, so who will get the food? More difficult still: Which ones will you deliberately not feed?


Humans are generally poor at these decisions, and governments are even worse. The child who gets fed is typically the one who screams the loudest or who happens to be the most visible at the time food is given out. This shortchanges all the other children, the less visible ones, who might actually benefit more from intervention.


It feels good to help others. It feels bad to not help others, which is what triage invariably entails. If you work in the combat hospital, you may be saving ten patients, but you're also rejecting 90 others, and this can be extremely stressful. Those 90 and their families are going to hate you for your decision, and you will always wonder whether you made the right call.


No one wants to look a dying patient in the eye and say, "I could treat you but I won't." No one wants to reject a needy child. We tend to evade such discomfort by closing ourselves off from the world—avoiding the patient and not seeing the child—but the dilemma is still there.


Triage is painful, but someone has to do it. If no one does and patients are taken in at random or on a first-come-first-served basis, then many more are going to die overall. In a triage situation, you have to be tough, cool and somewhat aloof, but above all you have to choose and not just let things happen.


Everything in life involves triage, even how you choose to spend your free time. Your days on earth are limited, and there are more worthwhile things to do than you can possibly get to, so you have to practice triage with your time, choosing the activities that promise the most reward for the investment.


If you’re a teacher in a crowded classroom, you must choose which students will most benefit from individual attention. If you’re a manager, you may have to decide which workers to let go so the organization as a whole works best. If you’re an author, you must choose which writing project is the most important to complete at the expense of all the others. It’s all triage.


People often justify the way they spend their resources by saying, "It's for a good cause." Unfortunately, that answers only half the question. The other half is, "Is this the best cause I can be spending my resources on?" If you don't ask that, over and over, then you're not getting the most from them.


Everything you choose implies other things you are not choosing. Hawaii may be beautiful, but vacationing there means you can't go to Europe, so which one will you give up? Every decision is like that. Is what you are choosing really the best of all the available options, or just the most visible one?


Triage is a hard, painful task, but you have to do it. If you don't, then fate will do the triage for you, which is no better than choosing patients at random. You'll end up saving only 2 patients out of 100, instead of maybe 8.


When you are a god, you have to make these fatal choices. It comes with the territory of having resources to distribute or power over others. No matter which way you go, people will suffer, so you must choose the path that minimizes the total suffering and makes the best use of the gifts you have.


All of us have to make those god-choices. We have to reject as well as accept. We have to break hearts. We have to let people down.


That's what you have to do to save the world.