**5. Triage principles**

The Federal healthcare resilience task force kept the trauma triage principles unchanged, with just the addition of the awareness of COVID 19 and the prehospital use of PPE [21]. This was also the case within our facility. A common theme prehospital and within hospital resus is the decreased number of healthcare personnel involved in the resus and airway management was by the most senior first responder [7, 21]. With specific reference to the covid pandemic and MCIs, crowd control becomes important [21].

It has been stated that during the current pandemic, it is unable to "discern the likelihood of survival of trauma patients relative to the potential for having concomitant COVID 19 is not possible [21]. One would disagree with this statement, there are many trauma scores that relate burden of injury to mortality and therefore concomitant COVID or the suspicion of covid played no role in our triage process. The burden of injury and the survivability of the injury enabled our triage process according to trauma principles.

Supportive and palliative care is an ethical principle that forms part of any MCIs [13, 15]. During this pandemic this has come to the fore due to shortages of ICU beds, ventilators and even Oxygen and the overwhelming demand [16]. Palliative care has become integral to triage during this longstanding MCIs that is the COVID Pandemic [22].

At our facility, most of our trauma patients are young males and were incidental or asymptomatic covid positive results. During the pandemic in a trauma setting, we still focused on the principles of triage according to the trauma burden and was more focused on the survivability of the injuries sustained and not the patients covid status [1]. Their covid status may have complicated their surgical course and lead to unexpected deaths or morbidities but it did not hamper their treatment. If at all, it might have given them resources which would not have been otherwise available. Our unit only has a nine bed Trauma ICU, but with the COVID pandemic a general ward was converted to a thirty seven bed COVID ICU, so if not for their COVID status some patients may not have received the critical care that they needed. We have discussed

the covid pandemic with regards to PPE, MCIs and resuscitation, extrapolating principles from surgery, but **what has been the surgeon's role in the pandemic?**
