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FACILITATOR-TRAINER

LEON STEYN

Leon Steyn is a Public Speaker, Facilitator-Trainer, and international Author of Books and Articles that teach personal development skills and talent development at organizations.

THE TRIAGE “TWENTY-TWENTY“ CALAMITY

Updated: Jan 9, 2021



The year 2020 is possibly, in many ways, not dissimilar to other years of uncertainty, fear, and outright anger. The only difference is that we now live in this period of the coronavirus pandemic and we are aware of the pain of these times. Pain forces things living and things operational to focus on the point of agony and to seek to address this uncomfortable (or life-threatening) phenomenon and to be free of pain.


As we find ourselves in the midst of a life-threatening medical crisis, we turn to the specialists and passionate purveyors of healing to ease our pain, uncertainty, and fear; and, to comfort us when we have had to say good-bye in absentia to a loved one. Sad.

The COVID-19 pandemic decimated most, if not all, economies across the world. The manifestation of the decimation has become evident is mass lay-offs, earlier-than-early retirements, increased rates of depression and even suicide (The World Economic Forum reports that one in four young people has considered suicide), and the closure of many businesses. Other flash changes include the dramatic increase in the use of online platforms and the proliferation of home-office workers. Let me add that not all the changes have been bad – some great and phenomenal changes took place, with positive, long-term effects.


Anaïs Nin, the creative writer, describes our situation so well when she says:


“And the day came when the risk to remain tight in a bud was more painful

than the risk, it took to blossom.”


Due to the massive increase in health-related news, across all mediums, and the exposure to medical terminology, we have been bombarded with terminology which now forms part of our daily vocabulary: think virus, infection, transmission, mask, oxygen, respirator, virologist, and many more. Many more, like “triage.”


What is triage?


According to William C. Shiel Jr., MD, FACP, FACR,

“Triage is the process of sorting people based on their need for immediate medical treatment as compared to their chance of benefiting from such care. Triage is done in emergency rooms, disasters, and wars when limited medical resources must be allocated to maximize the number of survivors. Triage in this sense originated in World War I. Wounded soldiers were classified into one of three groups: those who could be expected to live without medical care, those who would likely die even with care, and those who could survive if they received care.”


At this point, I would like to elaborate on the applicability to the business world. The business definition could read something like this:

“Business triage is the process of sorting people based on their need for immediate financial relief as compared to their chance of benefiting from such care. Triage is done in boardrooms, where limited financial resources must be allocated to maximize the number of survivors. Survival is not dependent on organizational hierarchy. Responsible owners and managers must not view the lower-ranking employees as collateral damage. Rather they should consider all options, including drawing the line vertically instead of horizontally.”


The history


The term triage originated from the French verb trier which means to sort. During the time of Napoleon, the French military used triage to serve as a battlefield clearing hospital for wounded soldiers. The U.S. military's first use of triage was during the Civil War. Triage on the battlefield was a distribution center from which injured soldiers were sorted or distributed to various hospitals. For the military during World Wars I and II, triage was the procedure that determined which injured soldiers were able to be returned to the battlefield. Military triage continued to evolve during the Korean and Vietnam wars with the tenet of doing the “greatest good for the greatest number of wounded and injured.”1 Refinement in battlefield medicine and military triage have continued during more recent conflicts, including Iraq.


Other situations in which the triage process has been employed, in addition to the battlefield, are during disasters, following mass casualty incidents (MCI), and in emergency departments (EDs). Triage during a disaster involves field triage, which sorts disaster victims into categories ranging from the walking wounded to those with injuries who are salvageable to the unsalvageable and the dead.


The treatment being prioritized can include the time spent on medical care, or drugs, or other limited resources. This has happened in disasters such as terrorist attacks, mass shootings, volcanic eruptions, earthquakes, tornadoes, thunderstorms, and rail accidents. In these cases, some percentage of patients will die regardless of medical care because of the severity of their injuries. Others would live if given immediate medical care but would die without it.


How does it work?


In these extreme situations, any medical care given to people who will die anyway can be considered to be care withdrawn from others who might have survived (or perhaps suffered less severe disability from their injuries) had they been treated instead. It becomes the task of the disaster medical authorities to set aside some victims as hopeless, to avoid trying to save one life at the expense of several others.


If immediate treatment is successful, the patient may improve (although this may be temporary) and this improvement may allow the patient to be categorized to a lower priority in the short term. Triage should be a continuous process and categories should be checked regularly to ensure that the priority remains correct given the patient's condition. A trauma score is invariably taken when the victim first comes into the hospital and subsequent trauma scores are taken to account for any changes in the victim's physiological parameters. If a record is maintained, the receiving hospital doctor can see a trauma score time series from the start of the incident, which may allow definitive treatment earlier.[ii]



There are several triage systems including the Emergency Severity Index (ESI), Australian Triage Scale, and the Manchester Triage System. All triage systems are comparable in terms of effectiveness, but the ESI, widely used in the United States, seems to produce better values for validity, reliability, and inter-rater reliability.


The latest version of the ESI triage instrument (version 4), has 5 levels as follows:

1—resuscitation,

2—emergency,

3—urgent,

4—less urgent, and

5—non-urgent. [iii]


I am of the opinion that very few people consider triage if they have not had any exposure to this enormous and tough situation. Emergency workers, doctors, and soldiers most probably deal with triage at one time or another and would definitely prefer to be at another time and place than at one where these tough decisions have to be taken.


What is the link to business?


There is a direct link to the resource and survival aspects of business triage. Firstly, business owners and their respective stakeholders are responsible for leading and managing the enterprise in a responsible manner. They usually hold, in their hands, the destiny of the employees who have a psychological contract of sorts with the organization.

Secondly, it is not unusual that salaries and wages makeup either the most or a very big part of organizational costs. So, when times are tough, the quickest route to financial survival (for the organization of course) is to reduce these costs by reducing the number of employees.

Thirdly, I have noted and experienced, that when employee numbers are reduced, it is usually the people at the bottom (read lowest paid) of the organizational structure who are terminated first. Experts, either internally or externally, are instructed to ‘do the deed’ and to ensure that the cut is done within the respective legislative regulations and laws. More often than not, the cut is made horizontally and not vertically. In other words, highly paid executives and managers, are retained in accordance with the reasons or excuses offered.


In very few, if any cases, is employee loyalty, hard work, or any other psychological reason considered when the upper echelons justify their comfortable and elaborate survival.


The right thing to do is to preserve people, within reason, by making the cut vertically so that the highly paid middle and senior managers are included. This is triage in its finest form!


By applying business triage correctly and honestly, business leaders will prevent a substantial amount of unnecessary suffering by the very people who have made the organization successful and who at least deserve some reward, in bad times, for their loyalty and hard work.


Real leaders do the right thing!


Endnotes

[i] https://www.medicinenet.com/triage/definition.htm [ii] https://en.wikipedia.org/wiki/Triage [iii]https://content.sciendo.com/configurable/contentpage/journals$002fabm$002f10$002f2$002farticle-p155.xml

Image: Jonathan Borba, Unsplash

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