Civil War Triage Simulation

Civil War Triage Simulation

Decisions Under Fire

Start

Background

• It is 1863. You are working in a field hospital after a major battle during the Civil War. Hundreds of wounded soldiers are arriving. 
• You have limited supplies, no antibiotics, and little understanding of germs.
• You must decide who to treat first and how, knowing that every choice has consequences.

Next

Doctors used triage to decide who was most likely to survive

How Triage Worked

Many wounds became infected

Amputations were common and often lifesaving

Nurses cleaned, comforted, assisted, and managed supplies

Next

Introduction

• The air is thick with smoke, sweat, and the smell of blood and damp canvas. Cannon fire rumbles in the distance as wagons creak toward you, loaded with wounded men. Groans and shouted orders fill the tent. 
• You glance around; wooden tables are stained dark. Buckets of cloudy water sit beside piles of used bandages. Your medical kit holds a bone saw, forceps, thread, and a small bottle of chloroform—already running low. 
• There are too many wounded and not enough time. You take a breath. 
• The first decision must be made now. 

Next

Scenario 1:The First Wave of Wounded

Three soldiers are carried into your tent almost at once. You can only treat one patient immediately.

Shrapnel Wound

Gunshot Wound

Broken Leg

A man with a broken leg. The bone presses against the skin. He grips the stretcher railes, gritting his teeth. He is fully alert and watching you closely.

A young infantry man clutches his arm, blood soaking through his sleeve. He is pale, but awake...begging you to not let him die.

A soldier with a deep wound to his abdomen. His breathing is shallow. He mutters incoherently as his eyes flutter shut.

Treat Patient A

Outcome: You apply pressure and bandage the wound. The bleeding slows and the patient's breath steadies, and he weakly thanks you.  Consequence: While you work, Patient B grows still. He has died from internal bleeding. Patient C is still alive, but suffers sever pain and swelling while waiting

Info

Continue

Treat Patient B

Outcome: you do everything you can, but you have no way to repair internal organs. His breathing stops quietly. 

Consequence: Patient A loses too much blood while waiting and now faces a much more dangerous surgery

Go Check on Supplies

Info

Treat Patient C

Outcome: You decide to help the man with the broken leg. He is screaming in pain, and the injury is dramatic and distressing to look at. You splint the leg and give what comfort you can. After the leg has been splinted, the man thanks you.  Consequence: While you are working, time slips away. You turn back and see that Patient B has stopped breathing. The abdominal wound was fatal without immediate attention. Patient A is still alive, but his arm is soaked in blood. He is pale, shaking, and growing weaker by the minute.

Check on Patient A

Signs of Infection

Clean the wound and rebandage

Two days later, Patient A is brought back to you. His arm is swollen, hot, and discolored. The wound gives off a sickening smell. Flies buzz nearby despite your efforts to shoo them away.  You know infection is deadly—but you don't fully understand what causes it, but what you do know is that you need to act...what do you do?

Perform an amputation

Wait and hope

Clean the wound and rebandage

You rinse the wound with water and wrap it carefully. The swelling slows, but the infection continues to spread

Check on Supplies

Perform an amputation

Using chloroform, you remove the arm. The surgery is fast, but brutal and the patient survives.

Go Check on Supplies

Info

Wait and hope

By morning, fever has set in. Infection spreads throughout the patient's body and within days, the patient will die. Delaying action was often a deadly consequence.

Go Check on Supplies

Supplies Running Out

The shelves are nearly bare. Bandages must be reused and your chloroform bottle is almost empty. Soldiers continue to arrive faster than you can treat them.  A young assistant looks at you. "Who gets the chloroform?"

How do you use your remaining anesthesia?​

Use it on every patient so they scream less during surgery.​

Save it only for patients who need amputations.​

Use chloroform on every patient

You decide no one will be without pain relief. You soak a cloth with chloroform and place it over each patient's nose before surgery. As the chemical takes effect, muscles relax, and cries grow quieter.  Surgeries go smoother. Soldiers do not thrash for fight. Nurses are relieved.  But as the day wears on, the bottle becomes lighter in your hand, and by late afternoon, it is empty.  Just as night falls, a new wagon arrives with wounded me from the evening fighting. One requires an immediate amputation, but you have no chloroform left. The surgery must be performed while he is fully conscious.

Move to the next patient

Saving chloroform for amputations only

You look down at the small bottle of chloroform in your hand. There is very little left—if you use it freely now, it will be gone before the night is over. You make a hard decision to save chloroform only for amputations and the most severe surgeries.  Patients are brought in and you proceed to treat injuries without chloroform. Soldiers' cries and screams echo through the air—hours pass with quick surgeries, bandaging, splinting, all done as quickly as possible.  By nightfall, a stretcher arrives with a man whose leg is shattered beyond saving. You use chloroform this time to amputate and the operation is successful. When it is over, there is still a small amount of chloroform left for one more emergency.

Triage the last patient

The Hardest Choice

As night falls and darkness surrounds the field hospital, lanterns begin to flicker. With the lighting dim, you can only perform one more surgery:

Who do you choose?

A wounded officer​ He has a strong pulse and a good chance of survival​

A teenage private​ He has worse injuries and is quietly asking for his mother​

Dictionary

Triage-the process of deciding who gets medical care first Shrapnel- small pieces of metal that break off from exploded shells, cannonballs, or bombs Amputate- surgically remove a body part, most often an arm or leg Chloroform- a chemical used during the Civil War to knock patients unconscious during surgery

In Reality

Many procedures were performed without pain relief

To save chloroform for the most severe injuries, many men who did not require an amputation were treated without anesthesia. This meant that many men endured painful treatment, but it also meant that those who needed amputations had a much better chance at surviving. However, that did not mean there was no risk involved either. There was still great chance of infection regardless if treatment involved chloroform.

Historical Fact

Amputation saved lives more often than it killed.

Over the course of the Civil War, three out of four surgeries were amputations. Surgeons gained the reputation of being called "butchers", however, amputations were the quickest and most effective way to treat as many patients as possible in a short amount of time.

Amputations and the Civil War

The Reality...

Civil War doctors had to prioritize patients with the best chance of survival, not the worst injuries

The Reality...

The reality is that many injuries could not be treated during the Civil War. Doctors in the 1860s had limited medical knowledge, few tools, and little understanding of germs and infection, making some wounds impossible to heal.

A Civil War Surgeron's Tools

The limits of mid-19th-century medicine and the severity of the wounds sustained by soldiers resulted in a large number of amputations. Of all operations performed during the war, about three-quarters (approximately 60,000) were amputations.

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