Triage is the systematic process of sorting patients to determine the priority of medical treatment based on the severity of their condition. This method ensures that the most time-sensitive injuries and illnesses receive attention first, particularly when the number of patients exceeds the available resources. The fundamental goal of triage is to optimize outcomes for the population of injured or ill individuals when resources are strained, making the most efficient use of medical personnel and supplies.
The Core Principles of Patient Prioritization
The underlying philosophy guiding all triage decisions is the ethical principle of providing the greatest good for the greatest number of people. This population-level perspective is especially relevant when a sudden influx of patients threatens to overwhelm a healthcare system. Decisions are based on a rapid assessment of the patient’s immediate physiological status, determining their likelihood of survival with prompt intervention.
The foundational assessment relies on evaluating the patient’s most basic life functions, often summarized by the mnemonic ABCs: Airway, Breathing, and Circulation. An open and protected airway is the first priority, followed by the quality and rate of breathing. Finally, the circulatory status, checked by pulse strength or capillary refill time, informs the urgency of managing blood loss or shock.
Triage personnel use these physiological markers to quickly identify patients with immediate life threats. Prioritization focuses on measurable signs of instability rather than the final diagnosis. A patient showing significant instability will always be prioritized over a patient with a non-life-threatening condition.
Triage in the Emergency Department Setting
The triage process in a standard hospital Emergency Department (ED) utilizes a multi-level system, typically five levels, to manage the daily flow of patients. Nurses categorize patients based on the severity of their condition, the stability of their vital signs, and the resources they are expected to require. This structured approach helps determine the maximum safe waiting time before a patient must be seen by a provider.
The highest level, Level 1 or Resuscitation, is reserved for patients requiring immediate, life-saving intervention, such as those in cardiac arrest or profound shock. These patients must be moved to a treatment area without delay and receive continuous monitoring. Conversely, the lowest classification, Level 5 or Non-Urgent, is assigned to patients with minor conditions, such as simple rashes, who are stable and require minimal resources.
Determining the appropriate level involves a detailed assessment by a trained triage nurse, including a brief history and full set of vital signs. A patient is often categorized as Level 3, or Urgent, if they present with abnormal vital signs or are expected to need multiple diagnostic tests or procedures, such as blood work and a computed tomography (CT) scan.
Rapid Assessment for Mass Casualty Incidents
Triage protocols change dramatically during a Mass Casualty Incident (MCI), where resources are severely limited, and the volume of injured people is overwhelming. The primary objective shifts to maximizing the number of overall survivors among the injured population. This rapid sorting process is designed for the field, not a detailed diagnostic assessment.
A common system for this scenario is the Simple Triage and Rapid Treatment (START) method, which relies on color-coded tags to quickly categorize victims. Non-ambulatory patients are quickly assessed for their respiratory rate, perfusion (circulation), and mental status.
The START method uses the following color codes:
- Green tags are for the “walking wounded,” indicating minor injuries that can be delayed.
- Yellow tags are for patients whose treatment can be delayed, as their injuries are serious but not immediately life-threatening, such as major bone fractures.
- Red tags are assigned to those with immediate, life-threatening injuries who have a high probability of survival with prompt intervention.
- Black tags are used for patients who are either deceased or whose injuries are so extensive they are unlikely to survive given the limited resources available.
The Importance of Ongoing Reassessment
Triage is not a static designation but a dynamic process that requires continuous re-evaluation of the patient’s condition. A patient’s physiological status can change rapidly, meaning a patient initially classified as less urgent can quickly deteriorate and require immediate, high-level intervention. Healthcare providers maintain a rigorous schedule for rechecking waiting patients to identify these changes before they become catastrophic.
If a patient’s pain increases significantly, or their vital signs show signs of instability, the triage category must be immediately upgraded. Thorough documentation of these reassessments is essential, noting the time of the check, the patient’s current status, and any changes in their assigned priority level.