The sudden influx of a large number of casualties into a hospital's emergency department is an event which taxes the resources of the hospital and its staff. In July, 1963, a commercial airplane carrying 43 persons crashed during takeoff from the Rochester-Monroe County Airport. Seven individuals were instantly killed, and shortly thereafter the remaining 36 passengers arrived at Strong Memorial Hospital. These patients presented a wide variety of medical problems and, not unexpectedly, a number of them had multiple injuries. All patients admitted to the hospital survived and were discharged convalescing satisfactorily. Despite this successful outcome the difficulties which arose in managing the emergency point out problems to be anticipated in similar disasters.
With a group of this size suffering from multiple and varied injuries (Fig 1), it was necessary to set up a priority system for dealing with the patients as they arrived. Initially, an effort was