Claire Dawson
Triage is a method used in emergency departments to assess a patient's condition and determine the appropriate level of care. The word triage comes from the French word trier, which means to sort or select. It involves sorting and allocating treatment to patients based on a system of priorities, with the goal of maximising the number of survivors. Triage systems are designed to rapidly identify and prioritise patients based on the severity of their illness or injury and their need for emergency care. Factors such as a patient's age, signs and symptoms, medical history, physical examination, and vital signs are considered in the triage process. Hospitals use triage systems to determine the order and priority of treatment, ensuring that patients who require lifesaving treatment are seen before those with less serious conditions.
| Characteristics | Values |
|---|---|
| Purpose | To sort patients by level of acuity to inform care decisions and maximize the number of survivors |
| History | Originates from the French word "trier", meaning "to sort" or "select"; first used by military field doctors in the 18th century |
| Who performs it | Emergency medical technicians (EMTs), hospital emergency room gatekeepers, soldiers, or anyone with knowledge of the system during an emergency |
| Factors considered | Patient's age, signs and symptoms, medical history, physical examination, and vital signs (heart rate, blood pressure, breathing rate, oxygen level, pain score, etc.) |
| Types | Emergency department triage, incident (multicasualty) triage, reverse triage, undertriage, overtriage, telephone triage, palliative care triage |
| Tools | eCTAS, NHS 111, S.T.A.R.T. (Simple Triage and Rapid Treatment), ESI (Emergency Severity Index) |
| Wait times | Determined by the patient's triage level and the levels of other patients; dynamic process that can change if symptoms or vital signs worsen |
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Triage history
The term "triage" is derived from the French word "trier," meaning "to sort." While the term was initially used for sorting food products, its first known medical use was during World War I, when French medical professionals used it to sort casualties according to the severity of their wounds. The British soon adopted this system, classifying casualties into three levels: minimally wounded, seriously wounded but treatable, and mortally wounded.
During the Napoleonic Wars, a similar system was in place, although it was not yet called triage. Baron Dominique-Jean Larrey, who was made a Baron by Napoleon due to his work, sorted casualties according to the severity of their wounds, giving first priority to those who were most seriously wounded as they would die first without immediate treatment. He also introduced the concept of a "flying ambulance," or "Ambulance Volante" in French, which referred to rapidly moving ambulances.
In the 19th century, developments in weapons technology caused mass casualties on battlefields worldwide, leading to the further development of triage systems. By the onset of World War II, American and British forces had adopted and adapted triage, with increased availability of airplanes allowing for rapid evacuation to hospitals outside of war zones.
Today, triage is a well-established process in emergency departments, used to assess patients' conditions and determine the appropriate level of care. It is particularly crucial in mass casualty incidents or when there are more injured individuals than available care providers or supplies. The specific methodologies may vary by institution, locality, and country, but the underlying concepts remain universal, focusing on prioritizing treatment for those with the most severe injuries who can most benefit from immediate attention.
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Triage systems and levels
Triage systems are used to assess, classify, and sort patients based on the severity of their injuries or illness and the urgency of their need for medical attention. The term "triage" comes from the French word "trier," which means "to sort" or "to select."
There are various triage systems used around the world, and they can vary between hospitals, regions, and countries. Some common triage systems include:
- The Emergency Severity Index (ESI): This system is used by over 70% of emergency departments in the United States. It uses a five-level triage algorithm, with Level I being the most urgent and Level V being the least urgent.
- The Australasian Triage Scale (ATS): This scale is used in Australia and New Zealand and consists of five levels, with Level 1 being the most critical (resuscitation) and Level 5 being the least critical (non-urgent).
- The Chinese Four-Level and Three-District Triage Standard (CHT): This system categorizes patients into four categories based on the level of acuity. Category 1 is for critically ill patients who need immediate life-saving intervention, while Category 4 is considered non-emergent.
- The Manchester Triage System: Developed in Manchester, UK, this system uses 54 clinical presentation algorithms and discriminators based on the patient's condition, clinical history, and initial assessment. The discriminators are grouped into five triage categories: red (immediate), orange (very urgent), yellow (urgent), green (standard), and blue (non-urgent).
- The Sistema Estructurado de Triaje (SET): Used in Spain, this system is an adaptation of the Model Andorrà de Triatge (MAT). It uses 32 symptomatic categories and patient information to classify emergencies within five levels of urgency.
- The START and JumpSTART Triage Systems: These are used in mass casualty incidents and are designed to sort patients quickly and efficiently. The JumpSTART system is specifically designed for triaging children in disaster settings.
Triage levels or categories are typically based on the severity of a patient's condition and the urgency of their need for medical attention. Common categories include:
- Red or Critical: Patients in this category have severe or life-threatening injuries or illnesses and require immediate medical attention.
- Yellow or Semi-Critical: Patients in this category have urgent medical needs that require timely attention but are not immediately life-threatening.
- Green or Non-Critical: Patients in this category have non-urgent medical issues that can be addressed in a standard timeframe.
Some triage systems may have additional or modified categories to suit their specific needs and contexts.
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Triage roles
Triage is a process that originated from the French word "trier", which means to sort, select, or organise. It is a system used by healthcare providers to categorise patients based on the severity of their injuries or illnesses and determine the order and priority of their treatment. This process is especially important in emergency situations or when there are limited resources.
Triage nurses play a crucial role in evaluating patients, deciding on the priority of care, and updating the medical team on the patient's status. They utilise key information such as a patient's age, signs and symptoms, medical history, physical examination, and vital signs to make informed decisions. Triage nurses also provide emergency care when necessary.
In addition to nurses, doctors are also involved in the triage process. They use their clinical expertise, blood tests, and emergency radiology services to diagnose and treat patients as quickly and effectively as possible. Doctors work collaboratively with triage nurses to coordinate and deliver patient care.
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Triage tools
There are various triage tools used in hospitals and emergency departments. For instance, the JumpSTART pediatric triage MCI triage tool is a variation of the S.T.A.R.T. model, used to sort patients into categories at mass casualty incidents (MCIs). The Australasian Triage Scale (ATS), which has been in use since 1994, consists of five levels, with one being the most critical (resuscitation) and five being the least critical (non-urgent). In the United States, there is no national standard for triage systems, but the START triage method is commonly used.
AI systems are also being used as triage tools in hospitals. For example, TriageGO is an AI-based electronic triage tool that was developed at Johns Hopkins Hospital and is now used in several states. AI algorithms can predict the risk of several outcomes, recommend a triage level of care, and provide an explanation for the decision in a matter of seconds. These AI systems are proving to be invaluable triage tools, as they can triage patients more accurately than before.
In advanced triage, healthcare professionals with advanced training, such as doctors, nurses, and paramedics, make further care determinations based on more in-depth assessments and may use advanced diagnostics like CT scans. The Major Incident Triage Tool (MITT) is an advanced triage tool for emergency medical responders that includes the assessment of physiological vital signs.
The ideal triage process in a low-resource setting should be simple, not require training to perform, and use little to no equipment. The Integrated Interagency Triage Tool (IITT) was developed by the World Health Organization, the International Committee of the Red Cross, and Médecins Sans Frontières for use in resource-limited emergency departments.
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Triage in practice
Triage is a system used in emergency departments to assess a patient's condition and determine the appropriate level of care. The goal of triage is to make an initial assessment in preparation for the doctor's more in-depth medical evaluation. Triage systems are designed to rapidly identify and prioritize patients based on the severity of their condition, their need for emergency care, and the availability of resources.
In practice, triage is a dynamic process that can be performed by emergency medical technicians (EMTs), hospital emergency room gatekeepers, or nurses. They use key information, such as a patient's age, medical history, signs and symptoms, physical examination, and vital signs (heart rate, blood pressure, temperature, breathing rate, oxygen level, etc.) to determine the order and priority of treatment. For example, a 58-year-old man who requires multiple hospital resources and presents with a heart rate of 114, oxygen saturation lower than 90%, and a respiratory rate of 26/min would likely be triaged as a Level 2 patient.
Triage systems may also use colour-coded categories to indicate the severity and urgency of a patient's condition. For instance, the Simple Triage and Rapid Treatment (START) system uses red, yellow, and green to categorise patients from high to low priority. Additionally, some countries and organisations use standardised triage tags, such as the commercially available METTAG, SMARTTAG, and CRUCIFORM systems, to facilitate the triage process.
It's important to note that triage is not a static process. A patient's triage level can change if their symptoms or vital signs worsen during their visit, and they will be reassessed and reassigned a new triage level accordingly. This ensures that those who need lifesaving treatment are seen before those with less serious conditions. Furthermore, triage systems may vary depending on the setting, such as in a hospital versus at the site of an accident or disaster.
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Frequently asked questions
Triage is a method used in emergency departments to assess a patient's condition and determine the appropriate level of care. It involves sorting and allocating treatment to patients according to a system of priorities, usually based on the severity of their condition and the resources available.
Triage in a hospital is used when there are too many patients and not enough resources, such as personnel, laboratory facilities, or X-ray facilities. Hospitals use triage systems to prioritize patients according to the severity of their condition and the resources required. This ensures that patients who need life-saving treatment are seen first.
Triage may be performed by emergency medical technicians (EMTs), hospital emergency room gatekeepers, soldiers on a battlefield, or anyone with knowledge of the system during an emergency. In hospitals, triage is often performed by trained triage nurses, who assess patients' vital signs, symptoms, and response to therapy.
There are several types of triage, including emergency department triage, incident (multicasualty) triage, and reverse triage. Emergency department triage is used by hospitals when patients arrive at the emergency room. Incident triage is used for situations involving multiple casualties, such as vehicle accidents. Reverse triage involves treating the least injured or discharging patients to prepare for incoming mass casualties.
