Triage

Triage[1]. Familiar with the term? It comes from the medical world. In wartime, or following a disaster, a hospital’s facilities medical capabilities can be swamped by the need. How to ration care?

Triage is one strategy. Picture a doctor or nurse giving each person coming in a first look as they are brought in for and await treatment, and quickly assigning them to one of three categories: will not survive, can wait indefinitely, can or might survive but only if receiving immediate attention. There are fine points to this scheme, and variations, but you get the idea.

Fact is, whether or not you know or use the term, chances are good that you do triage yourself. Take e-mail. Hundreds of messages are coming in a day, right? When you check it after any kind of break, there’s a new bunch. You scan the titles and senders quickly, don’t you? Some you’re never going to answer. How’d they get through your spam filter? Sooner or later, these will be deleted, but there’s no urgency. They’re goners! Some will get a response eventually, but they can also wait. Others you know you have to attend to immediately – and you do.

In the future, we’re going to be increasingly using such an approach to environmental concerns. It’s only natural to want to preserve everything, but the reality is that we have neither all the resources nor all the time in the world. Some species are probably doomed to extinction despite the most heroic measures we might contemplate. Some habitats have probably been so severely degraded as to be almost unusable going forward (think Superfund sites). Some ecosystems have been so profoundly disturbed that successive states may be headed in an entirely new direction (think old-growth forests that have been logged, or the re-growth around Mt. St. Helens following the eruption).

Here’s (just one) real-life example – one I remember from my NOAA days. Several species of salmon were on the endangered species list at the time (being cautious here; they probably still are). Salmon are anadromous; that is they spend most of their lives in the open ocean, but swim up into freshwater rivers to spawn. These particular species spent the freshwater piece of their life cycles in the Pacific Northwest. Over the years, much of these watersheds had been dammed. The damming served multiple purposes: flood control; providing water for irrigation; hydropower, etc. Unfortunately the damming had a side consequence: making life difficult for the salmon, in several respects. First, the dams impose an obstacle to the newly-hatched fingerlings trying to make their way to the sea. Some fingerlings, but relatively few, are killed going through the hydropower turbines. But that isn’t the real threat. Prior to the dams, strong river currents would carry the fingerlings from the headwaters to the sea in just a few days. This kept loss to predation to a minimum. After damming, vulnerable fingerlings now spend large amounts of time being carried along by the slow currents in manmade reservoirs behind the dams. The journey to sea can take weeks. Loss to predation is now heavy. The return trip for the mature salmon is no picnic either. Swimming up the cascading rapids (the mountain range came by its name honestly) had been bad enough. But now the dams constitute an insurmountable obstacle. Bright idea? Fish ladders running alongside the dam, replicating to some extent those natural cascades. But they’re not a total solution. Predators, human and animal, have figured out the game and hang out by the fish ladders, waiting for dinner to be served. So, several salmon species are today endangered. The policy response has included trucking the fingerlings from headwaters hatcheries to the ocean. Complicated. Labor-intensive. Expensive. And, despite all the cost and effort, only partially effective.

An alternative policy formulation has been proposed. It involves giving up on the mixed-use concept. Some watersheds would remain dammed. These watersheds would be devoted solely to electrical power generation, flood control, and water-resource management, with no regard for the preservation of the prevalent salmon species (such is the sophistication of taxonomy that analysis can often find distinguishing differences among fish from the individual watersheds). By contrast, the dams would be removed in other watersheds. Here salmon would be allowed free run; the other uses would be sacrificed.[2]

What do you think? Is this a good idea or not?

Several points here.

First, the idea of “good” depends on our value systems, doesn’t it? If you favor hard-nosed considerations of costs (including opportunity costs) and effectiveness, you might reach one conclusion. If I favor tradition and culture and my tradition is farming and ranching I might favor another. And if I favor tradition but I’m Tlingit or Chinook I might favor a different approach still.

Second, in a given context, “good” or “bad” depends not just on the concept but also on the execution, right? Think back to the medical triage. How well-trained and practiced are the doctors and nurses who are making these life-and-death decisions? What is their thought process? Is it cool and deliberative? Is it quick, almost instinctive, based on prior experience and practice? Remember, they’re weighing, on the fly, much more than the extent of any injuries. The fitness level of the injured. Their emotional state. The availability of further medical help behind that front door. What capabilities and staff are at hand? What kinds of injury, how many people, is the ER equipped to handle? What would require further evacuation to, say, a burn unit at another hospital? These are grey areas. How are the doctors and nurses handling the uncertainties? How are they themselves holding up psychologically given the gravity of the situation?

Third, medical world approaches triage with a considerable body of experience and fact. They teach to this experience. By contrast, circumstances calling for environmental triage, while unfolding more slowly, are going to be far more complex. In many instances, they will be unprecedented. The basis of knowledge and understanding necessary for effective triage in most cases is not at hand. Nor will it be easily gained. We need far more investment in all research, including not just the natural sciences but also the social sciences, including but not limited to ecology, environmental economics if we are to be well-positioned for the environmental triage of the future. We also need to do some trial-and-error learning.

Fourth, you, I – all seven billion of us – will be the nurses and doctors in this scenario. Not just about this one small example of the salmon, but about the countless millions of similar decisions that are coming at us fast. We don’t have much alternative. Geography won’t provide an escape. Many of these decisions will have to be made right where you live. Your profession won’t give you a pass either. You say you teach English literature? You’re a journeyman plumber? A patent attorney? Drive a taxi? Already retired? Doesn’t matter. You won’t be able to excuse yourself. Chances are, many of these decisions will engage your profession directly. You’ll be contributing to the perspectives and analysis that inform the discussion. And even if you aren’t, as a member of the voting public in a democracy you’ll be asked to help choose a course of action. Realistically, our futures are going to be full of these decisions. You and I all have to bone up.

Finally, to go back to its medical roots, triage is not the ideal so much as it’s a strategy for making the best of a horrific circumstances. As a future of triage looms on the horizon, we need to remember this: The aim is not just to master triage of greater scope and urgency, although that will surely need to be one goal. Rather, the object is to master those decisions and actions that will keep the environmental triage needed to a minimum.

__________

So, in that awareness, you yourself can engage in a bit of triage right now. [In fact, you can’t escape it!]You can shake your head and decide to ignore this reality. On an individual basis, depending on your age and circumstances, that might work. Alternatively, you might note that you’re in a directly-relevant discipline or profession; you might be energized by the challenge, and hop right on it. Or, you can decide this subject is important, but can wait, and return instead to all that e-mail.


[1] The Wikipedia tells us this term derives from the French word “trier,” which means to sort, to sift, to select., to pick.

[2] Curious? Want more details? You might try an interesting paper by Lackey et al., entitled Policy options to reduce the decline of wild Pacific salmon.

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