Relative emergency, serious injury, vital emergency… These terms often make the headlines during news items or natural disasters. But what do they really mean? The official classification known as “Noto-Larcan-Huguenard” defines four levels of care which are absolute urgency, relative urgency, people involved or deceased patients. This principle of triaging patients is implemented in disaster medicine, during an earthquake or an attack for example.
Dr. François-Xavier Moronval, aka “Doc FX” on YouTube, is an emergency doctor in Épinal (in the Vosges). It recalls the major difference between the term absolute, vital or relative emergency. “The notion of absolute urgency is used for a victim who requires medical or surgical procedures to be carried out urgently. Without this, there is a risk of death in the hours that follow. Patients in a life-threatening emergency must in most cases be admitted to a resuscitation or intensive care unit. This is the most serious stage of gravity. In the case of relative urgency, the prognosis is not vital. However, a functional prognosis can be questioned. Sequelae are then possible such as an amputation. But life is not at stake, they are not priority patients. » The term life-threatening can be used for chest or facial trauma or haemorrhage. In the case of a relative emergency, the care to be carried out can be postponed without danger.
The term committed vital prognosis is also widely heard in the media. Wrongly, points out Dr. Moronval: “Medically, this notion makes no sense. A “committed vital prognosis” is not a correct term. It simply implies that the person concerned is in an intensive care unit because he has a failing organ. Generally, an initial triage of patients according to their condition is carried out on site just after the event. The objective is to define the patients who require immediate care and those who are not a priority. This sorting makes it possible not to saturate the hospitals and to distribute the most serious cases in several establishments. A second inventory can be made when the patients arrive at the hospital. »
In some cases, there is mention of “seriously injured”, this vague term does not mean much either. “The official classification also takes into account the patients involved. The latter are not physically injured but are psychologically shocked. For example, at the time of the terrorist attack in Nice in July 2016, 86 people died and 458 were injured. But, many passers-by were present and were marked by this attack. In this case, more than 10,000 people were involved in this event according to the classification…”
For these patients, a medico-psychological emergency cell is then set up on site with one or two psychiatrists and a nurse specialized in psychiatry. These are usually the same cells that are set up in schools, etc.
