Triage is the process of determining the priority of patients' treatments based on the severity of their condition.

Triage is used in a number of situations including: In mass casualty situations, triage is used to decide who is most urgently in need of transportation to a hospital for care (generally, those who have a chance of survival but who would die without immediate treatment) and whose injuries are less severe and must wait for medical care. Triage is also commonly used in crowded emergency rooms and walk-in clinics to determine which patients should be seen and treated immediately. Triage may be used to prioritize the use of space or equipment, such as operating rooms, in a crowded medical facility. Triage may also be used for patients arriving at the emergency department, or telephoning medical advice systems, among others. This article deals with the concept of triage as it occurs in medical emergencies, including the prehospital setting, disasters, and emergency room treatment. The term triage may have originated during the Napoleonic Wars from the work of Dominique Jean Larrey. The term was used further during World War I by French doctors treating the battlefield wounded at the aid stations behind the front. Those responsible for the removal of the wounded from a battlefield or their care afterwards would divide the victims into three categories: Those who are likely to live, regardless of what care they receive; Those who are likely to die, regardless of what care they receive;

Those for whom immediate care might make a positive difference in outcome.

In emergency department, an interview with a triage nurse is a common first step to receiving care. He or she generally takes a brief medical history of the complaint and measures vital signs in order to identify seriously ill persons who must receive immediate care.

TYPES OF TRIAGE 1. Simple Triage Simple triage is usually used in a scene of an accident or "mass-casualty incident" (MCI), in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available. Upon completion of the initial assessment by medical or paramedical personnel, each patient may be labelled which may identify the patient, display assessment findings, and identify the priority of the patient's need for medical treatment and transport from the emergency scene. At its most primitive, patients may be simply marked with coloured flagging tape or with marker pens. Pre-printed cards for this purpose are known as a triage tag. 2. Advance Triage In advanced triage, doctors and specially trained nurses may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. 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. 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. The treatment being prioritized can include the time spent on medical care, or drugs or other limited resources. 3. 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), the manner in which a hospital or healthcare facility deals with that surge (surge capacity) and the overarching medical needs of the event. 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. Continuous integrated triage employs: Group (Global) Triage Physiologic (Individual) Triage Hospital Triage

4. Reverse Triage In addition to the standard practices of triage as mentioned above, there are conditions where sometimes the less wounded are treated in preference to the more severely wounded. This may arise in a situation such as war where the military setting may require soldiers be returned to combat as quickly as possible, or disaster situations where medical resources are limited in order

to conserve resources for those likely to survive but requiring advanced medical care.[15] 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. In cold water drowning incidents, 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 support and often those who are rescued and able to breathe on their own will improve with minimal or no help. 5. Undertriage and Overtriage Undertriage is the underestimating the severity of an illness or injury. An example of this would be categorizing a Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal). Historically, acceptable undertriage rates have been deemed 5% or less. Overtriage is the overestimating of the severity of an illness or injury. An example of this would be categorizing a Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate). Acceptable overtriage rates have been typically up to 50% in an effort to avoid undertriage. Some studies suggest that overtriage is less likely to occur when triaging is performed by hospital medical teams, rather than paramedics or EMTs. 6. Secondary (in-hospital) triage In advanced triage systems, secondary triage is typically implemented by emergency nurses, skilled paramedics, or battlefield medical personnel within the emergency departments of hospitals during disasters, injured people

7. S.T.A.R.T. model S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by lightly trained lay and emergency personnel in emergencies.[22] It is not intended to supersede or instruct medical personnel or techniques. It has been taught to California emergency workers for use in earthquakes. It was developed at Hoag Hospital in Newport Beach, California for use by emergency services. It has been field-proven in mass casualty incidents such as train wrecks and bus accidents, though it was developed for use by community emergency response teams (CERTs) and firefighters after earthquakes. CATEGORIES RED Immediately: Priority One (Life-Threatening Conditions) The condition is life-threatening and the patient requires immediate attention and transport. The following conditions should be present for a Mass Casualty Incident (MCI) victim to be classified Priority One: Obstruction or damage to airway Disturbance of breathing Disturbance in circulation Does not follow command or altered level of consciousness Need for life

Victims who injuries demand definitive treatment in the hospital but which treatment may be delayed without prejudice to ultimate recovery

YELLOW Urgent: Priority Two Patient has passed primary survey but with major system injury, may delay transport to one hour. Any one of the following conditions could place a victim in to Priority Two category: Needs to be treated within one hour, otherwise they become unstable Severe burns involving hands, feet or face (not including the respiratory tract; burns complicated by major soft tissue trauma Hospital admission is required Moderate blood loss, back injuries, head injuries with a normal level of consciousness

GREEN Delayed: Priority Three An injury exists but treatment can be delayed for four to six hours. Generally, anyone who can walk (walking wounded) to a designated area for treatment will be a Priority Three. The following injuries are examples: Minor injuries not threatened by airway, breathing and circulatory instability Minor fractures, minor soft tissue injuries, minor burns May or may not be admitted

BLUE Near Dead: Priority Four

Victims who are clinically dead. Those tagged blue in the field are to be returned for retriaging when time and physical conditions of area allow. BLACK and WHITE Dead: Last Priority Patient is dead Those who die while awaiting treatment and those in cardiac arrest following trauma.