Triage

Before battlefield medicine, 'trier' meant sorting coffee beans in French ports—separating the premium from the mediocre. This commercial origin reveals something profound: triage has always been about making value judgments under resource constraints, whether you're rationing surgical attention or determining which beans make the export grade. The linguistic journey from commodity trading to life-or-death decisions highlights how economic thinking infiltrated medical ethics, for better or worse.

Modern triage flips Larrey's original system on its head in a counterintuitive way: he prioritized the most severely wounded who could still survive, but today's START system (Simple Triage and Rapid Treatment) often focuses first on the 'walking wounded' who can be quickly cleared from the scene. This isn't callousness—it's mathematics. By rapidly moving those with minor injuries, responders create space and reduce chaos, ultimately saving more lives than the intuitive approach of 'sickest first.' Your instinct to help the worst cases immediately might actually kill more people.

While emergency rooms have sophisticated protocols for physical trauma, psychiatric triage remains stubbornly primitive—often relying on subjective danger assessments rather than evidence-based predictive tools. Someone in a mental health crisis might wait hours in an ER while someone with a twisted ankle gets immediate attention, not because of malice but because we lack validated triage instruments for psychological emergencies. This gap has deadly consequences: suicide risk assessment tools used in most ERs predict suicide no better than chance, according to a 2017 meta-analysis in Psychological Medicine.

COVID-19 forced a disturbing evolution: triage expanded from sorting patients by severity to sorting them by survivability with explicit age and comorbidity criteria. Italian hospitals in 2020 published guidelines that essentially said 'if you're over 80 or have multiple conditions, you may not get a ventilator.' This wasn't hypothetical battlefield medicine—it was peacetime physicians making wartime choices, revealing that modern healthcare's promise of universal care is actually conditional on having enough resources. The pandemic exposed what bioethicists call 'the triage secret': we've always rationed, we just usually do it quietly through wait times and insurance barriers.

You perform information triage dozens of times daily—deciding which emails to read, which notifications warrant attention, which tasks are urgent versus important. Productivity experts like Oliver Burkeman argue that this constant micro-triage creates the same moral injury as medical triage: the exhausting guilt of always choosing what to neglect. The Eisenhower Matrix and Getting Things Done systems are essentially civilian triage protocols, suggesting that the psychological cost of sorting-to-survive has migrated far beyond emergency medicine into the architecture of modern attention itself.

The colored tag system—red for immediate, yellow for delayed, green for minor, black for deceased/expectant—transformed triage from an art into a protocol that anyone could execute under pressure. But here's the haunting part: the 'black tag' category includes not just the dead but the 'expectant'—those expected to die even with treatment, who receive comfort care only. This semantic merger reveals triage's darkest necessity: sometimes the most humane decision is to acknowledge that saving one person would cost three others their lives, making the black tag both a medical decision and a moral absolution for first responders who must walk past the dying.