Medical triage is the process of sorting injured or ill individuals based on the severity of their condition and the likelihood of survival, especially when resources are limited, such as during a mass casualty incident. This systematic approach allows medical personnel to allocate resources efficiently to achieve the maximum benefit for the greatest number of people. Emergency systems worldwide employ a simple, standardized color-coding system to facilitate rapid communication and decision-making. This universal language helps quickly identify which patients require immediate attention. The color assigned is not a permanent diagnosis but a fluid designation of priority that determines the order of treatment and transport.
The Designation of Trauma Red
The designation of “Red” in emergency triage signifies the highest level of urgency, classifying a patient as Priority 1 (P1) or “Immediate.” A patient receives this tag when they have suffered immediately life-threatening injuries that are considered treatable and potentially survivable given rapid medical intervention. The core principle is that the patient’s condition will deteriorate rapidly, likely leading to death if stabilization is delayed. Therefore, Red patients receive the highest priority for on-scene life-saving interventions and immediate evacuation to definitive medical care.
This category focuses on the “salvageable critical” patient, meaning those whose physiological status is severely compromised but who are responsive to treatment. The injuries are grave, often involving major trauma that affects breathing, circulation, or neurological function. Assigning the Red status correctly is a time-sensitive decision, ensuring resources are directed toward individuals who stand the best chance of survival.
Physiological Criteria for Red Status
The determination of a Red status is often made using rapid assessment tools like the Simple Triage and Rapid Treatment (START) system, which focuses on three primary physiological categories: Respirations, Perfusion, and Mental Status (RPM). A patient is immediately classified as Red if any one of these criteria is compromised. The assessment process is designed to be completed in less than 60 seconds per patient, relying on simple “yes or no” observations rather than complex measurements.
Regarding respiration, a patient is tagged Red if they are not breathing but start breathing after their airway is opened with a simple maneuver. Any patient with a spontaneous respiratory rate exceeding 30 breaths per minute is also immediately designated as Red, indicating severe respiratory distress or compromise.
The second assessment focuses on perfusion, generally checked by assessing the radial pulse or capillary refill time. A Red status is assigned if the patient lacks a palpable radial pulse, suggesting low blood pressure or poor circulation. Alternatively, a capillary refill time greater than two seconds, indicating delayed blood flow return, also triggers the Red classification. Both findings suggest significant blood loss or shock.
Finally, the assessment of mental status checks the patient’s neurological function by asking them to follow a simple command, such as squeezing a hand. A patient unable to follow these simple commands is immediately categorized as Red. This inability indicates an altered mental status, which may stem from a severe head injury, inadequate oxygenation, or profound shock. The first observation that meets any of the Red criteria stops the assessment, and the patient is tagged immediately to expedite care.
Triage Systems and Red Patient Management
Once a patient is classified as Red, the operational response prioritizes two actions: performing immediate, life-saving interventions (LSI) and ensuring rapid transport. The LSI performed in the field are typically limited to essential measures like opening an obstructed airway or controlling life-threatening external hemorrhage, often using a tourniquet. These initial actions are quick stops intended only to stabilize the patient enough for transport, rather than providing complete treatment.
The patient is immediately marked with a Red tag or ribbon to communicate their status to all subsequent medical personnel. This designation triggers the “Load and Go” protocol, meaning the Red patient must be evacuated first. Their transport is directed to a facility capable of providing the highest level of definitive care, typically a Level I or Level II trauma center. These specialized centers possess the necessary resources, such as surgical teams and operating rooms, available around the clock to manage the complex needs of the most severely injured. The entire process is designed to minimize the time between injury and advanced medical intervention, which is directly linked to improved survival rates.
Comparing Red to Other Priority Levels
The Red designation is best understood in comparison to the other categories in the color-coded triage system. The Yellow tag, representing Priority 2 (P2) or “Delayed,” is assigned to patients with serious injuries that require treatment, but whose life is not in immediate danger. Yellow patients are stable enough that their treatment and transport can be delayed for a few hours without undue risk. These individuals are reassessed frequently, as their status can change quickly.
Green, or Priority 3 (P3), is the “Minor” category, often referred to as the “walking wounded.” These patients have non-life-threatening injuries and can typically wait for treatment until all Red and Yellow patients have been addressed. Finally, the Black tag signifies the “Expectant” or deceased category, assigned to patients who are either dead or whose injuries are so catastrophic that survival is highly unlikely given the available resources. The Red category therefore represents the narrow window of opportunity between the Yellow (serious but stable) and the Black (unsurvivable or deceased) classifications.