Battlefield nurse from Ireland who helped to save many lives

The triage system of treating patients was developed by an Irish nurse on US battlefields, Robert Hume reveals.

FED up with hanging around in A&E? That’s because you’ve been given a low priority triage rating. And you’ve got a Limerick woman to thank for it. Enter A&E at University Hospital Limerick today, and you will be assessed by the triage nurse and assigned a priority rating that ensures life-threatening conditions are seen first.

The hospital uses the Manchester triage model with colour-coded categories ranging from 1-5. If you are given a red Triage 1 you will be seen immediately; an orange Triage 2 within 10 minutes; however, should you be assigned a blue Triage 5, prepare yourself for a four-hour wait.

Triage was the brainchild of Mary Murphy O’Connell who was born in Limerick 200 years ago. She didn’t come up with her bright idea in Ireland, but 3,000 miles away in US. At seven years old her family fled the “forgotten famine” engulfing Ireland, and emigrated in leaky merchant ships to Boston, where they settled in the city’s north end alongside hundreds of other impoverished Irish families.

When O’Connell left school — the Ursulime Academy in Charlestown — she wanted to help the poor and sick. Accepted into the convent of the American Sisters of Charity at Emmitsburg, Maryland, in 1835, she became a nun, taking the name Sister Anthony. Two years later she moved to Cincinnati, Ohio, where she worked at St Peter’s Orphan Asylum and School for Girls, before being promoted to manage St Joseph’s Asylum for Boys and St John’s Hostel for Invalids.

Relinquishing her post in 1861, she and other Sisters of Mercy volunteered to tend the wounded in the Civil War. In one of the deadliest combats — the Battle of Shiloh, Tennessee, 1862 — Anthony, now middle aged, braved what she described as “the terrific stench from the bodies of the dead”, torn apart by musket balls and bayonets, to help bring in the sick and console the dying — whether they be Union or Confederate soldiers, white or black.

Traditional practice was for nurses to cart off wounded soldiers as and when they found them. But this left many soldiers to die who might have been saved. Anthony identified three types of injured soldiers: those who would recover without any help; those who were going to die no matter what; and those who might recover provided they received help quickly. It was this last type that the Sisters needed to treat first.

Groping her way among the wounded, dead and dying, she gained the respect of nurses, doctors and surgeons alike by assessing and prioritising, running the nursing teams, and directing that those who had a chance of surviving were carried to the boats — the “floating hospitals”.

“Often the decks of these vessels resembled a slaughter house. At one time,” writes Anthony, “there were 700 of the poor soldiers crowded in one boat.”

They included a soldier discovered in an animal pen. His nose had been shot off, and “blood ran down his shirt and coat sleeves, down his pantaloons and into his very boots”. Many nurses would have deemed his condition as completely hopeless and left him to die, but Sister Anthony was confident he could be saved, and he was carried to the ship bound for the hospital in Cincinnati: there his father rejoiced to see him alive.

By ensuring faster hospital treatment, Anthony saved countless lives and unnecessary amputations. As one of the most active nurses in the war, having served in ten battles — in Virginia, Tennessee and Ohio — she received praise from President Lincoln. After the war she was put in charge of a brand new hospital — the “Good Samaritan Hospital” in Cincinnati.

What made Sister Anthony special was how, in the confusion of battle, she succeeded in prioritising who needed to be treated most urgently. With triage she had transformed nursing into a “science”.

She died in Ohio at 6pm on December 8, 1897.

It is tempting to compare modern A&E departments to battlefields. But at least with the aid of triage there is a system in place to cope with the horror.


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