MTS

MALAYSIA TRIAGE SCORE

Anticipating Trends, Embracing Innovation

Tr i a g e C o r e Te a m E T D H TA N
OVERVIEW
MTS is a new triage system that revised on 2022,
used to change the previous MTC.

This new system using 5 different levels to

seperate patient based on patient’s severity and
treatment needs.

PLEASE SCAN THIS

The previous MTC only using 3 different zoning
concept which is RED, YELLOW,and GREEN
zone
MTS CONCEPT
Triage processes are designed to be conducted rapidly within
a few minutes in order to assign a triage level, which will
determine the triage priority, resources and treatment zones.
This is vital to facilitate patient flow through the ED and
avoid unnescessary congestion.

Although triage requires clinical judgement, it is not meant to

make specific diagnoses, nor to identify all medical needs

Key Points: • TRIAGE LEVELS

• PRIMARY TRIAGE
• SECONDARY TRIAGE
• PAEDIATRIC TRIAGE
• HAZMAT / INFECTIOUS DISEASE
 TIME TO TREATMENT
TIME TO TREATMENT STANDARD

LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 LEVEL 5

RESUSCITATION EMERGENCY URGENT EARLY CARE ROUTINE

UNDER 10 UNDER 30 UNDER 60 UNDER 90

IMMEDIATELY
MINUTES MINUTES MINUTES MINUTES

The Triage process is meant to be repeated when new symptoms develop, symptoms worsen or the patientʼs condition
appears to change. It is also recommended that patients are
reassessed every hour, if they have not been seen by doctors yet
 OVERALL TRIAGE PROCESS IN ADULT
LEVEL 1
CRITICAL FIRST LOOK
PRIMARY TRIAGE RAPID ASSESSMENT LEVEL 2
SAFETY
LEVEL 3

SECONDARY VITAL SIGNS LEVEL 4

TRIAGE COMPLAINT LISTS
INITIAL TESTS LEVEL 5

OVERALL TRIAGE PROCESS IN PEADIATRICS

LEVEL 1
CRITICAL FIRST LOOK
PRIMARY TRIAGE PEADS ASSESSMENT TRIANGLE LEVEL 2
SAFETY
LEVEL 3

SECONDARY PEADS VITAL SIGNS LEVEL 4

TRIAGE PEADS COMPLAINT LISTS
INITIAL TESTS LEVEL 5
 Primary Triage
Triaging concept used at PRIMARY TRIAGE is based on ;
1 - CRITICAL FIRST LOOK
2 - RAPID ASSESSMENT
3 - SAFETY

LEVEL 1 LEVEL 3 ISOLATE

LEVEL 2
 PRIMARY TRIAGEUR
CRITICAL FIRST LOOK

START CPR

• UNCONSCIOUS
SEND PT DIRECTLY
• ONGOING SEIZURE
• CARDIAC ARREST TO LEVEL 1 ZONE
• MAJOR TRAUMA
• SEVERE RESP
DISTRESS

NO VITAL SIGN WOULD BE DOCUMENTED FOR LEVEL 1 - LEVEL 3

BY PRIMARY TRIAGEUR FOR CRITICAL FIRST LOOK METHOD
 PRIMARY TRIAGEUR
RAPID ASSESSMENT

• RESP DISTRESS
• SPO2
• SHOCK STATE
• CRT
• ALTERED MENTAL
• HR
STATUS • RR
• ACTIVE BLEEDING
• PS
 PRIMARY TRIAGEUR
SAFETY

INFECTIOUS DISEASE HAZMAT

HARMFUL TOXINS VIOLENCE
SECONDARY
TRIAGE
 LEVEL 2 LEVEL 3
EMERGENCY URGENT

SECONDARY
TRIAGE
ALL PATIENT COME TO ED WITH NO
CRITERIA FOR LEVEL 1 - LEVEL 3 AT LEVEL 4 LEVEL 5
PRIMARY TRIAGE SHOULD BE REASSESS EARLY CARE ROUTINE
AT SECONDARY TRIAGE

PATIENT ASSESSED AT SECONDARY TRIAGE

CAN BE RETRIAGE TO LEVEL 2-LEVEL 5
BASED ON THEIR CLINICAL ASSESSMENT :
VITAL SIGN, PRIMARY COMPLAINT AND
INITIAL TEST (ECG/QUICK ASSESS)
OVERALL TRIAGE PROCESS IN ADULT
LEVEL 1
CRITICAL FIRST LOOK
PRIMARY TRIAGE RAPID ASSESSMENT LEVEL 2
SAFETY
LEVEL 3

SECONDARY VITAL SIGNS LEVEL 4

TRIAGE COMPLAINT LISTS
INITIAL TESTS LEVEL 5

OVERALL TRIAGE PROCESS IN PEADIATRICS

LEVEL 1
CRITICAL FIRST LOOK
PRIMARY TRIAGE PEADS ASSESSMENT TRIANGLE LEVEL 2
SAFETY
LEVEL 3

SECONDARY PEADS VITAL SIGNS LEVEL 4

TRIAGE PEADS COMPLAINT LISTS
INITIAL TESTS LEVEL 5
 SECONDARY TRIAGING
PROCESS

VITAL SIGN COMPLAINT LIST INITIAL TEST

 SECONDARY TRIAGE ZONING
PATIENT WILL BE RETRIAGE AT SECONDARY TRIAGE BASED ON VITAL SIGN, MAIN
COMPLAINT, AND INITIAL TEST. THEY SHOULD BE RETRIAGE TO LEVEL 2 - LEVEL 5
ACCORDINGLY

LEVEL 2 LEVEL 3 LEVEL 4 LEVEL 5

EMERGENCY URGENT EARLY CARE ROUTINE

TABLE FOR VITALS LIST AND COMPLAINT LIST CAN BE ASSESSED IN PDF
FILE (QR CODE)
PAEDIATRIC ASSESSMENT TRIANGLE

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 TAKE NOTE

Children without danger signs identified by the Paediatric

Assessment Triangle at Primary Triage should proceed to
Registration and secondary Triage. Children should not be
routinely triaged away

At Secondary triage, children may be given priority to early

assessment. They may be triaged to Level 1-4 as needed.
Generally, children especially below 8 years old should not be
triaged at Level 5 (routine).

Infants below 1 years old should be at Level 4 or higher.

 Thanks!
TRIAGE CORE TEAM ETD HTAN