“Battlefield triage”

Battlefield triage was a label Rick Simmons and Anna Pou used to explain Memorial’s controversial choice to assist healthier patients before sicker ones during the Katrina crisis. Its force lay in its familiarity: the phrase invited a jury and the public to imagine emergency prioritization under extreme pressure. But the analogy also obscured a distinction the book stresses—the method was not typical battlefield practice, and the conditions supporting emergency rationing could change as rescue resources arrived.

The Wartime Analogy

Simmons and Pou adopted the term “battlefield triage” to describe putting healthier patients ahead of sicker ones. Simmons believed the phrase would convey their account of the conditions as Pou had perceived them, in terms a lay audience could readily understand. The label was not merely descriptive: it presented a disputed hospital decision through a recognizable image of wartime necessity.

They also used “reverse triage,” a term that captured how counterintuitive the ordering might seem to someone outside the crisis. The phrase referred, though rarely, to theoretical wartime situations in which treating the most able-bodied first could return them to the battlefield and help the group survive. That rationale supplied a survival-oriented explanation for the priority given to healthier patients, but it did not make the practice standard battlefield procedure.

A Defense Framed for the Public

The terminology became part of a deliberate defense strategy. Simmons was building a proactive case against indictment, learning about triage and end-of-life issues, gathering statements from more than one hundred potential witnesses, and preparing exhibits concerning government abandonment. In that broader campaign, battlefield triage offered a compact account of the priority decision, while the related phrase “beyond emergency care” offered another way to frame patients and choices made under crisis conditions.

The distinction between a persuasive label and a settled clinical rule matters. At Memorial, doctors had separately decided that patients with Do Not Resuscitate orders would be evacuated last. A DNR order meant that a patient whose heartbeat or breathing had stopped should not be revived; it was not itself a declaration that the patient should be denied evacuation. The DNR-last policy and the healthier-first rationale were different decisions, even as both shaped how patients were ranked in the emergency.

The Limits of the Category

The battlefield analogy could make prioritization sound more settled than the circumstances were. The book notes that this approach was not typical practice on the battlefield. Its explanatory power therefore depended less on a direct match with military procedure than on the image it offered to a jury: a group facing scarcity, making painful choices in the hope of preserving more lives.

Nor could the label resolve the separate questions raised by the medication and deaths under investigation. Postmortem toxicology was difficult to interpret because the bodies had remained in heat before sampling; experts disagreed about what drug concentrations could establish about dosing and cause of death. Calling the evacuation decision battlefield triage did not settle whether particular medications caused deaths or what conclusions could be drawn about their administration.

Changing Conditions and the Cost of Rationing

The book’s wider analysis places the terminology against a crisis that was not static. Memorial’s emergency power system had vulnerable components, and the hospital faced the consequences of a disaster for which significant protective work had not been funded. Yet helicopters eventually arrived in force, expanding the resources available. The book identifies the timing of the plan to inject patients—at the point when rescue capacity was increasing—as a central tragedy of the episode.

That changing situation exposes the weakness of treating triage as a fixed formula. Disaster standards and priority categories need to respond to shifting supplies and circumstances; otherwise, rationing may continue after the conditions that seemed to require it have changed. Battlefield triage thus names both a defense of emergency prioritization and a problem the book leaves unresolved: how to make life-and-death decisions without allowing a compelling analogy to replace reassessment, preparation, and attention to newly available options.