Ten Second Triage: How to effectively manage multiple casualties

You’re first on the scene. Maybe it’s a road traffic collision or a sporting event gone wrong. There’s more than one casualty and for now, it’s on you to figure out who needs help first. This is where Ten Second Triage comes in. It’s a fast, practical tool designed for situations where time, information, and resources are in short supply. If you’ve ever wondered how the emergency services make quick decisions in chaotic scenes, this is how it starts.

Who do you treat first when there are multiple casualties?

When you’re dealing with multiple casualties, the goal is to do the most good for the most people. That means prioritising who needs immediate care, and who can wait. Without a system, it’s easy to get stuck helping the first person you reach, while someone else, with more urgent needs, doesn’t get the attention they need in time. Triage solves that.

The Ten Second Triage Approach

This method is simple: you spend no more than ten seconds assessing each casualty to decide who needs help right now, and who can wait. Here’s what you’re checking:

  • Can they walk?
  • Is there severe bleeding?
  • Are they conscious and talking?
  • Are they breathing?

Based on this, you can sort casualties into four broad groups (‘Priority’ 1, 2 or 3 and ‘Not Breathing’) following the flow chart and carry out quick, life saving interventions where necessary:

Can they walk? Direct them to a safe spot—they’re the lowest priority or ‘P3’ (Priority 3). If appropriate and they’re able, ask them to help or give them a task.

Severe bleeding? Apply pressure, pack the wound, apply a Tourniquet – they’re highest priority or ‘P1’. 

Can they talk? Check if they have a penetrating injury on their front or back (torso area) and if yes, they’re also highest priority or ‘P1’. If there’s no penetrating injury, they’re medium priority, or ‘P2’.

Are they breathing? Place in the Recovery/Safe Airway Position and they’re highest priority or ‘P1’. If they’re ‘Not Breathing’, also place them in the Recovery Position. 

Only start CPR if there are enough recourses (people) to hand. It might sound brutal, but CPR might not work anyway, and the Ten Second Triage tool prioritises those with a better chance of survival.

Managing a Major Incident

You’re going to want the relevant emergency services on scene as soon as possible. Getting the right services on scene as quickly as possible is made more efficient if a structured message is passed on to 999. 

The TST Tool (TST on NHS) also sets out ‘METHANE’ to create a structured message:

  • M – Major Incident
  • E – Exact Location
  • T – Type of Incident
  • H – Hazards
  • A – Access
  • N – Number of Casualties
  • E – Emergency Services (required)

A Major Incident is defined as “An event or situation with a range of serious consequences which requires special arrangements to be implemented by one or more emergency responder agency.” Check out the Jesip (Joint Emergency Services Interoperability Principles) website to read more about this.

For example, if it’s a road traffic collision, the Police will be required along with an appropriate  number of ambulances. Depending on if people are trapped, the Fire service may be required too. Remember, one ambulance can support and transport only one casualty. 

Once the call for help has been made, remember to reassess regularly. People’s conditions can change fast, especially in trauma situations. You can now start to go through the list of casualties in order of priority to provide more care. Hopefully by now other bystanders have come to help, to make matters a bit easier.

Practising for Real-World Confidence

Ten Second Triage isn’t something you want to try for the first time in a real emergency. Like any other first aid skill, it gets easier, and more instinctive, with practice. Situations with multiple casualties can happen in workplaces, especially if you work in a venue that hosts hundreds of people. It’s something you’ll want to be prepared for. 

Next Steps

Emergencies are unpredictable. But having a system like Ten Second Triage in your tool kit helps bring a bit of order to the chaos. So whether you’re a seasoned first aider or just starting out, practising this kind of rapid assessment (even if it’s just mental rehearsal) will give you confidence to make potentially life-saving choices when it matters most. We’re also here to help if you’d like to arrange bespoke training to help you and your team, to be as prepared as possible. Just get in touch for a chat!