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This article is about the concept of triage as it occurs in medical emergencies and disasters. For other uses, see Triage (disambiguation).
Typical triage tag, with 'tear-off' sections for decontamination and patient tracking.
disasters. Only immediate life-saving treatment takes priority over triage. were frequently a matter of the 'best guess'.  Triage may result in determining the order and priority of emergency treatment. The term comes from the French verbtrier. Until recently. Those who are likely to die. among others.: /ˈtriːɑːʒ/ (UK English) or /triːˈɑːʒ/ (US English)) is the process of determining the priority of patients' treatments based on the severity of their condition. regardless of what care they receive. Two types of triage exist: simple and advanced. as opposed to any real or meaningful assessment.  At its most primitive. triage results. meaning to separate. or telephoning medical advice systems. whether performed by a paramedic or anyone else. regardless of what care they receive. the order and priority of emergency transport. This article deals with the concept of triage as it occurs in medical emergencies. sift or select. including the prehospital setting. Suippes. or the transport destination for the patient. France. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. Triage originated in World War I by French doctors treating the battlefield wounded at the aid stations behind the front. and emergency room treatment.World War I.Triage station. Much is owed to the work ofDominique Jean Larrey during the Napoleonic Wars. those responsible for the removal of the wounded from a battlefield or their care afterwards have divided victims into three categories: • • Those who are likely to live. Triage may also be used for patients arriving at the emergency department. . Triage (pron.
3 France . model 1.6 Labelling of patients 1.2 Finland 2.1 S. Modern approaches to triage are more scientific. more "primitive" model will be used.3 Continuous integrated triage 1.5 Reverse triage 1. The outcome and grading of the victim is frequently the result of physiological assessment findings. paramedics will usually use the model included in their service policy and standing orders. practicality demands that the above. In the earliest stages of an incident. triage guidance is also evolving into both software and hardware decision support products for use by caregivers in both hospitals and the field.A. are committed to memory.T. however.1 Canada 2.2 Advanced triage 1. such as the START model.1. when one or two paramedics exist to twenty or more patients.1 Simple triage 1. As triage concepts become more sophisticated. and may even be algorithm-based.T. a similar model can sometimes still be applied. Some models.• Those for whom immediate care might make a positive difference in outcome.  Contents [hide] 1 Types of triage o o o o o o o 1.  For many emergency medical services (EMS) systems.7 Undertriage and overtriage 2 Regional variation o o o 2.R.4 Practical applied triage 1. However once a full response has occurred and many hands are available.
4 Hospital triage systems in the United States 4 Limitations of current practices 5 Bioethical implications in triage 6 See also 7 References Types Simple of triage triage Simple triage is usually used in a scene of an accident or "mass-casualty incident" (MCI).T.A.5 Hong Kong 2. model Main article: Simple triage and rapid treatment .R.1 Evacuation 3. in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries.9 United States military 3 Triage outcomes o o o o 3.o o o o o o 2. The categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or coloured flagging.T. This step can be started before transportation becomes available.7 Japan 2.6 Israel 2. S.8 United Kingdom 2.2 Alternative care facilities 3.3 Secondary (in-hospital) triage 3.4 Germany 2.
It was developed at Hoag Hospital in Newport Beach. Because treatment is intentionally withheld from patients with certain injuries. This can be determined by using the Triage Revised Trauma Score (TRTS). Triage separates the injured into four groups: • • • • The expectant who are beyond help The injured who can be helped by immediate transportation The injured whose transport can be delayed Those with minor injuries. though it was developed for use by community emergency response teams (CERTs) and firefighters after earthquakes. In Western Europe.R.T.A. advanced triage has ethical implications.S. . A triage sign at a Mexican emergency room indicating the waiting time for patients based on the severity of their condition Another example of a trauma scoring system is the Injury Severity Score (ISS). It has been (2003) taught to California emergency workers for use in earthquakes. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances of survival of others who are more likely to survive.  It is not intended to supersede or instruct medical personnel or techniques. This assigns a score from 0 to 75 based on severity of injury to the human body divided into three categories: A (face/neck/head). doctors may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. It has been fieldproven in mass casualty incidents such as train wrecks and bus accidents. who need help less urgently Advanced triage In advanced triage. the criterion used for this category of patient is a trauma score of consistently at or below 3.T. Advanced care will be used on patients with less severe injuries. (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by lightly trained lay and emergency personnel in emergencies. California for use by emergency services. a medically validated scoring system incorporated in some triage cards.
M. Others would live if given immediate medical care. for "unsurvivable". the receiving hospital doctor can see a trauma score time series from the start of the incident. The treatment being prioritized can include the time spent on medical care. any medical care given to people who will die anyway can be considered to be care withdrawn from others who might have survived (or perhaps suffered less severe disability from their injuries) had they been treated instead. triage) Physiologic (Individual) Triage (i. In these cases some percentage of patients will die regardless of medical care because of the severity of their injuries.A.. and automatically sets the score to 75 regardless of other scores. It becomes the task of the disaster medical authorities to set aside some victims as hopeless. the patient may improve (although this may be temporary) and this improvement may allow the patient to be categorized to a lower priority in the short term. this may indicate either that the patient is a first priority for care. If immediate treatment is successful.R. This has happened in disasters such as volcanic eruptions. to avoid trying to save one life at the expense of several others. Continuous Integrated Triage combines three forms of triage with progressive specificity to most rapidly identify those patients in greatest need of care while balancing the needs of the individual patients against the available resources and the needs of other patients. Each category is scored from 0 to 5 using the Abbreviated Injury Scale.) .e. which is then squared and summed to create the ISS.B(thorax/abdomen). In these extreme situations. can also be used for any of the three categories.T.S. If a record is maintained..e. C(extremities/external/skin). or drugs or other limited resources. A score of 6. S.S. Continuous Integrated Triage employs: • • Group (Global) Triage (i.T. from uninjured to critically injured. Triage should be a continuous process and categories should be checked regularly to ensure that the priority remains correct. A trauma score is invariably taken when the victim first comes into hospital and subsequent trauma scores taken to see any changes in the victim's physiological parameters. thunderstorms. The use of advanced triage may become necessary when medical professionals decide that the medical resources available are not sufficient to treat all the people who need help. and rail accidents.A. Continuous integrated triage Continuous Integrated Triage is an approach to triage in mass casualty situations which is both efficient and sensitive to psychosocial and disaster behavioral health issues that affect the number of patients seeking care (surge). Depending on the triage situation. but would die without it. or that he or she will not receive care owing to the need to conserve care for more likely survivors. which may allow definitive treatment earlier. the manner in which a hospital or healthcare facility deals with that surge (surge capacity)  and the overarching medical needs of the event.
yet maybe unable to move. From that point the first responder is quickly able to identify those in need of immediate attention. it identifies patients that are not so severely injured. or Emergency Severity Index) However any Group.  Labelling of patients . or are in need of immediate aid. the responders then ask. this further identifies patients who are responsive. Practical applied triage During the early stages of an incident. or over a loudspeaker. As those who can move. either by yelling. that they need immediate help. Individual and/or Hospital Triage system can be used at the appropriate level of evaluation. or disaster situations where medical resources are limited in order to conserve resources for those likely to survive but requiring advanced medical care. yell out or raise your hands". Using this method assumes the ability to hear. E. that "anyone requiring assistance should move to the selected area (CCP)". the responders quickly establish a casualty collection point (CCP) and advise . One valuable technique. partially deaf or victims of a large blast injury may not be able to hear these instructions. it is common to use reverse triage because drowning victims in cold water can survive longer than in warm water if given immediate basic life supportand often those who are rescued and able to breathe on their own will improve with minimal or no help. Reverse triage In addition to the standard practices of triage as mentioned above. do so. In cold water drowning incidents. first responders may be overwhelmed by the scope of patients and injuries.S. there are conditions where sometimes the less wounded are treated in preference to the more severely wounded. Now the responders can rapidly assess the remaining patients who are either expectant.. This does several things at once. This may arise in a situation such as war where the military setting may require soldiers be returned to combat as quickly as possible.e.I. it physically clears the scene. Deaf. Other possible scenarios where this could arise include situations where significant numbers of medical personnel are among the affected patients where it may be advantageous to ensure that they survive to continue providing care in the coming days especially if medical resources are already stretched. and provides possible assistants to the responders. "anyone who still needs assistance. is the Patient Assist Method (PAM). while not being distracted or overwhelmed by the magnitude of the situation.• Hospital Triage (i.
Triage tags may take a variety of forms. More advanced tagging systems incorporate special markers to indicate whether or not patients have been contaminated by hazardous materials. bar code scanners. . This will identify the patient and any assessment findings and will identify the priority of the patient's need for medical treatment and transport from the emergency scene.  The most commonly used commercial systems include the METTAG. however.Many triage systems are now computerized Upon completion of the initial assessment by medical or paramedical personnel. the SMARTTAG. patients may be simply marked with coloured tape. Note the bar code for patient tracking. when triage tags are either unavailable or insufficient. and these will vary by jurisdictional choice. Some countries use a nationally standardized triage tag. and in some cases.  while in other countries commercially available triage tags are used. each patient will be labelled with a device called a triage tag. Some of these tracking systems are beginning to incorporate the use of handheld computers. and also tear off strips for tracking the movement of patients through the process. or with marker pens. • • Typical triaging systems SMART TAG system. At its most primitive. E/T LIGHT tm and the CRUCIFORM systems.
• Emergency Triage (E/T) Lights – particularly useful at night or under adverse conditions .• METTAG system in Japanese. • Even simple tape can be used as a last resort.
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