Larrey's triage: worst wounds first, rank ignored

Standard military medical practice treated officers first, regardless of how badly a common soldier nearby was bleeding — rank, not wound, decided the queue. Larrey had seen the cost of this from his first campaign in 1792: wounded men left on the field for a day or more, waiting not for a surgeon but for their social position to come up.

He proposed instead that the most dangerously wounded be treated first, "without regard to rank or distinction," and built light, sprung horse-drawn carriages — "flying ambulances," modelled on the speed of horse artillery — to bring surgeons to the wounded during the battle itself rather than after it ended. Napoleon personally approved the system; by the time of the Russian campaign, Larrey had used it across 25 campaigns and hundreds of battles and engagements.

Surgeon Dominique-Jean Larrey treated the wounded strictly by severity, ignoring rank, and built 'flying ambulances' to reach them during battle.

Larrey triaged by severity, not rank, and sent flying ambulances into battle, collapsing wound-to-surgeon time from a day to an hour.

Severity sorting sends limited surgical capacity to those who will die soonest, maximizing lives saved.

Flying ambulances cut wound-to-treatment time from a day to an hour, converting fatal delays into treatable ones.

Authority backing let the new rule override the old rank hierarchy.

When allocating scarce resources, sort by urgency of need, not status or arrival order, and bring the resource to the need.

The word and practice of triage; the ordering principle every emergency system since inherits.