Trauma triage is a rapid, systematic process used by emergency personnel to prioritize the treatment and transport of injured individuals during a mass casualty incident (MCI) where the number of injured patients overwhelms available medical resources. This system is designed not to provide definitive care but to quickly categorize patients based on injury severity and the likelihood of survival. The primary goal is to ensure the maximum number of lives can be saved when resources like medical staff, equipment, and transport are scarce. By quickly allocating limited resources to those who will benefit most, the system seeks to achieve the greatest good for the greatest number of people.
Understanding Triage Color Coding
The foundation of trauma categorization relies on a universally recognized color-coding system, often based on protocols like the Simple Triage and Rapid Treatment (START) or Sort-Assess-Life-saving Interventions-Treatment/Transport (SALT) methods. This color scheme provides a quick, visual shorthand for severity, urgency, and immediate resource demands. The four main categories are Red, Yellow, Green, and Black, each representing a different level of care priority.
Red tags are assigned to patients with immediate, life-threatening injuries who have a high potential for survival if they receive rapid medical intervention. Green tags denote the “walking wounded,” those with minor injuries that can be delayed for hours. Black is reserved for the deceased or those with catastrophic injuries incompatible with life. The Yellow category signifies a patient who is seriously injured but temporarily stable enough to wait for care.
Defining the Yellow Category
The “Trauma Yellow” designation, also referred to as “Delayed” or Priority 2, is assigned to patients whose injuries are serious but not immediately life-threatening. These individuals cannot tolerate an indefinite delay, but their current physiological status is stable enough to wait for treatment after Red-tagged patients have been addressed. In the assessment phase, a Yellow patient is typically breathing with a respiratory rate below 30 breaths per minute and has adequate circulation, often demonstrated by a palpable radial pulse or a capillary refill time less than two seconds.
Crucially, the patient must also be able to follow simple commands, indicating an acceptable neurological status despite their injuries. Examples of injuries that fall into this category include major fractures, such as a fractured femur, that require surgical intervention but are not causing significant hemorrhage or vascular compromise. Other examples include stable abdominal injuries or extensive burns that do not compromise the airway. While these patients would require immediate care under normal circumstances, their relative stability in an MCI setting allows for a delay, usually measured in hours.
Treatment Priority and Patient Flow
A patient tagged Yellow is given the second-highest priority, meaning they will be moved to a designated holding area only after all Red-tagged patients have been identified and transported for definitive care. This designated space is often called the Delayed Treatment Area or Yellow Zone, where patients are held and continually monitored by medical personnel. The expectation is that while their injuries are serious, the delay in receiving full medical treatment will not cause a deterioration that leads to death or significant loss of limb.
Frequent reassessment, or secondary triage, is paramount because their status is inherently precarious. Medical teams must routinely check the patient’s vital signs and level of consciousness to ensure they have not decompensated. A patient who was initially stable could quickly develop internal bleeding or respiratory distress, requiring them to be rapidly re-tagged as Red and moved to the Immediate Treatment Area. This reassessment ensures that patients with salvageable, but non-immediate, injuries are not overlooked, maximizing the overall survival rate during a high-demand situation.