By

Accident and Emergency Specialist

Dr. Mahmoud Al-Jama’ein
 History of Triage
• Probably developed in the Napoleonic
Wars, by Army Surgeons “trier” to sort
– To do the most good for the most people
– Get the soldier back fighting
• Refined during the Vietnam war
– Process of prioritizing care to ensure the
sickest is seen the quickest.
• Mid 70’s adopted into civilian emergency
dept practice.
 Triage in Civilian setting
• Dynamic process every changing
• Optimize use of emergency care
resources
• Practiced by experienced properly
trained nurses
• Must be consistent
 The primary operational objective of triage
scale is related to the time to see a physician.
( Time Objective)

 Most decisions about investigation and

initiation of treatment do not occur until the
physician sees the patient.
 Triage Skills
• Questioning mind.
• High index of suspicion.
• Understand A & P, disease process.
• Gambler.
• Interpersonal communication skills.
• Public Relations skills.
• Medico legal aspects.
Definition of Triage?
 Is a system of sorting patients
according to need when
resources are insufficient for all
to be treated.
 Some form of Triage has been in place,
formally or informally since the first ED
opened.
 EDs are frequently challenged to do more for
the “system” than they have either been
structurally designed for or have been staffed
or equipped to accomplish.
 To rapidly identify patients with urgent, life
threatening condition.
 To determine the most appropriate area for
patients presenting to the ED.
 To decrease congestion in emergency treatment
areas.
 To provide ongoing assessment of patients.
 To contribute information that helps to define
departmental acuity.
 To provide information to patients and families
regarding services expected care and waiting time.
 The triage nurses should have rapid access or
be in view of the registration and waiting areas
at all times.
 Greets client and family in a warm empathic
manner.
 Performs brief visual assessment.
 Triage clients into priority groups.
 Transports client to treatment area when
necessary.
 Gives report to treatment nurse or physician.
 Keep patients/families aware of delays.
 Reassesses waiting clients as necessary.
 Instructs clients to notify triage nurse of any
change in condition.
 1- Chief complaint
the patient statement of the problem.

 2- Validation and assessment of chief

complaint.
 SOAP
S: subjective
O: objective
A: additional information
P: plan
 - Simple Triage .
 - Simple triage and rapid treatment(S.T.A.R.T).
 - Advanced triage.
 - Reverse triage.
 Is used in a scene of mass casualty,
in order to sort patients into those
who need critical attention and
immediate transport to the hospital
and those with less serious injuries.
 - done by Dr.
 - Some seriously injured people should not
receive advanced care because they are
unlikely to survive.
 - used to divert scarce resources away from
little chance of survival to increase others who
are more likely to survive.
 - Can be performed by lightly-
trained emergency personnel.
 It has been field-proven in mass
casualty incidents.

Triage separates injured into four
groups:
 1- Deceased.
 2- Immediate.
 3- Delayed.
 4- Minor injuries.
 1- Deceased:
- Who are beyond help.
- A person is not triaged
“deceased” unless they are not
breathing and an effort to
reposition their airway has been
unsuccessful.
- They are left where they fell,
covered if necessary.
 2- Immediate:
- The injured who can be helped by
immediate transport.
{ Lying on the ground silently }
- Priority 1 (red).
- Evacuated by MEDEVAC or
ambulance.
- Need advanced medical care at
once or within 1 hour.
 3- Delayed:
- The injured whose transport can be
delayed.
{ Lying on the ground but screaming }
- Priority 2 (yellow).
- Evacuated after all immediate.
- Stable but require medical assistance.
 4- Minor injuries:
- Who need help less urgently.
{ Walking wounded}
- Priority 3 (green).
- Will not need advanced medical
care for at least several hours.
- Evacuated only after all immediate
and delayed persons have been
evacuated.
The end