Anna Chousiada
National and Kapodistrian University of Athens
Prehospital triage, albeit decisive for the outcome of an incident, has unfortunately not been the subject of extensive study in Greece. It is mainly applied in mass casualty incidents, such as natural disasters, terrorist attacks and wars, and is carried out by rescuers. Its aim is the rational allocation of available resources, with the goal of maximizing the number of survivors. A fundamental principle governing prehospital triage is that the personal safety of rescuers takes precedence over the rescue itself.
In Greece, the process of prehospital triage has not been fully standardized, resulting in it relying largely on the intuition and experience of rescuers. The decisions made are based on internationally recognized systems such as ABCDE, START, JumpSTART, and SALT.
The ABCDE system is not a triage method per se, but a tool for rapid assessment and immediate intervention in a patient’s condition, which accompanies the triage process. The other systems provide for color-coded categorization of cases according to the severity of their condition. Despite their slight differences, they all aim at the rational use of available resources and the optimal transportation of the injured to hospital.
Special mention should be made of telephone triage, which is conducted during emergency calls. Unlike the aforementioned systems, it is not limited to mass disasters but functions as the first level of assessment in the prehospital system, contributing to the rational allocation of resources, and especially ambulances.
The triage process raises serious legal concerns, as prioritizing certain patients entails the abandonment of others who might have survived under different circumstances. Moreover, under Presidential Decree 62/2007, rescuers have a specific legal obligation to provide immediate assistance. The question that arises, therefore, is whether rescuers bear criminal liability for triage decisions. In the absence of specific legislation governing rescuer liability, their actions are evaluated under the Greek Penal Code.
The offenses that may arise from the omission of assisting a patient include exposure (Article 306 of the Penal Code), failure to provide assistance (Article 307), and obstruction of the prevention of common danger (Article 288). However, the doctrine of conflict of duties may serve as a ground for excluding unlawfulness when the rescuer must choose between competing obligations, namely saving multiple injured persons. Alternatively, the provision on the inability to avoid wrongdoing (Article 33 of the Penal Code) may apply as a ground for excluding culpability, since due to the psychological pressure exerted on the rescuer, they may be unable to act in accordance with the law.
The profession of a rescuer is one of the most demanding in the field of healthcare services, due to the intense psychological pressure of making immediate decisions that are critical for the patient. For this reason, it is necessary to establish a unified and clearly defined prehospital triage system that will reduce the risk of errors. At the same time, a specific legal framework of liability is required, one that recognizes the particularities of the profession and protects rescuers when they act in accordance with established protocols, incorporating the principle “impossibilium nulla obligatio est”, meaning that no one is obliged to do the impossible.