Prioritization: The Art of Psychological

Triage

George S. Everly, Jr, PhD, ABPP

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The Johns Hopkins RAPID PFA Model: Five Core Elements

1.  Rapport and reflective listening (RL)

2.  Assessment

3.  Prioritization

4.  Intervention

5.  Disposition and follow-up

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Prioritization

■  Prioritization is really an extension of assessment—which represents the application of

basic triage principles
■  That is, attention is focused upon those people and those needs which require
emergent care

■  Emphasis is placed upon assessing basic functional capacity

■  That is, can the person in crisis actually do what he or she needs to do?

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According to
Maslow: Meet
Basic Medical and
Physical Needs
First!

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Maslow’s Hierarchy of Needs

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Two Approaches to Triage

■  Evidence-based

■  Risk-based

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Acute Crisis Triad (Everly and Mitchell, Integrative Crisis Intervention and
Disaster Mental Health, 2008)

■  Evidence-based triage
■  Diminished cognitive capabilities (insight, recall, problem solving), but most
importantly a diminished ability to understand the consequences of one’s actions
■  An impulsive urge to act in a self-defeating, self-injurious manner; an acute loss of
future orientation, or a feeling of helplessness, hopelessness
■  Diminished functional capacity: inability to perform necessary functions of living (self-
care, caring for others, working, personal hygiene, logistics of disaster recovery)

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Risk-Based Triage: 3 D’s for Sub-Acute Concern

1.  Death
■  Did the person see human remains?
■  Did the person think s/he was going to die?

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Risk-Based Triage: 3 D’s for Sub-Acute Concern

1.  Death
■  Did the person see human remains?
■  Did the person think s/he was going to die?

2.  Dislocation
■  Is the person separated from family/loved ones?
■  Does the person have a place to stay?

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Risk-Based Triage: 3 D’s for Sub-Acute Concern

1.  Death
■  Did the person see human remains?
■  Did the person think s/he was going to die?

2.  Dislocation
■  Is the person separated from family/loved ones?
■  Does the person have a place to stay?

3.  Disabling impact

■  Was the person physically injured in such a manner that required immediate care?
■  Did the person experience peri-traumatic dissociation?

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Note

■  Risk-based triage should never be used in the absence of evidence-based triage to

formulate your triage plan/approach

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Triage

=
Recognizing and
prioritizing dysfunctional
inclinations/behaviors

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