MALAYSIAN TRIAGE

CATEGORY (MTC)
MOHAMMAD FIRDAUS ISKANDAR BIN MOHAMMAD ILIAS

OBJEKTIF
Am
-memahami peranan Penolong Pegawai Perubatan semasa
melakukan triage
Khursus
-mengenalpasti jenis-jenis triage
-boleh menentukan zon yang bersesuaian dengan keadaan
penyakit pesakit
-dapat mengamalkan dan mempraktikkan triage mengikut jenisjenis yang dinyatakan

PENDAHULUAN
Definasi
Triage berasal dari bahasa Perancis iaitu trier yang
membawa maksud menapis atau menyusun
Cara ini digunakan untuk menilai kecederaan dan kesakitan
pesakit dalam masa yang singkat untuk menetapkan priorities
serta zon yang bersesuian untuk mendapatkan rawatan

SITUASI DI JAB. KECEMASAN

Jumlah kemasukan ke jabatan kecemasan tidak boleh
diramalkan dengan tepat
Hanya sebahagian tertentu daripada pesakit yang
mempunyai masalah kesihatan membahayakan nyawa
atau yang memerlukan perubatan segera
Pesakit life-threatening injuries perlu dikenalpasti serta
merta
Overcrowding
Permintaan untuk rawatan perubatan melebihi limitasi
jabatan

Triage in Emergency Department

Designed to identify the most urgent (or potentially most
serious) cases.
To ensure that they receive priority treatment, followed by the
less urgent cases.
First-come, first-served basis

Triage officers routinely assess all patients who present

for treatment to sort and prioritize them.

KLASIFIKASI TRIAGE
Proactive
Static
Secondary
Surveillance
Definitive

Art of Triage
Complex and dynamic process
Mendapatkan maklumat yang berkaitan dalam masa
yang singkat
Keputusan dibuat dalam keadaan informasi yang limited
Keputusan dibuat berdasarkan garis panduan yang
sedia ada serta menilai keadaan pesakit

Roles of Triage Officer

Menentukan zon pesakit berdasarkan assessment
terhadap pesakit
First aid, analgesia.

Berhubung dengan paramedic dan profession kesihatan

yang lain
Escort patient
Pass over relevant information

Provide patient and public education where necessary

Documentation

Process of Triage
Main complaint and brief history
Vital signs
Physical findings seen, heard, felt or smelt
Setting the priority status of the patient
Decision whether treatment should be started at triage

SOAP System
Larry-Weed SOAP system
S (Subjective) main complaint and brief history
O (Objective) physical finding and vital signs
A (Assessment) setting of the priority status based on
subjective and objective finding
P (Plan) preliminary diagnostic and treatment

Malaysian Triage Category

MTC diwujudkan untuk digunakan dalam perkhidmatan
kecemasan di seluruh hospital Malaysia.
Merupakan skala untuk menilai urgency
Merupakan tahap untuk menilai keberkesanan zon
triage dengan pesakit (inpatient length of stay, ICU
admission, mortality rate) dan resource consumption
(staff time, cost).
Memberikan analisis dan gambaran terhadap prestasi di
dalam jabatan kecemasan.

MTC
Red
(Critica
l)

Yellow (Semi Critical)

Green (Non-Critical)

CRITICAL (RED)
Conditions that are threats to life (or imminent risk of
deterioration) and require immediate aggressive
intervention.
The patient's condition is serious enough or deteriorating so rapidly
that there is the potential of threat to life, or organ system failure, if
not treated within 15 minutes of arrival
The potential for time-critical treatment (e.g. thrombolysis,
antidote) to make a significant effect on clinical outcome depends
on treatment commencing within a few minutes of the patient's
arrival in the ED

 Patients with life threatening injuries or illness which

require immediate attention.
Assessment and treatment simultaneously within 5
minutes.
Subcategories:
R1 (immediate life-threatening)
R2 (life-threatening)

Semi-Critical (YELLOW)
The patient's condition may progress to life or limb
threatening, or may lead to significant morbidity, if
assessment and treatment are not commenced within thirty
minutes of arrival
There is potential for adverse outcome if time-critical treatment is
not commenced within thirty minutes

Human practice mandates the relief of severe discomfort or

distress

 Assessment and treatment starts within 30 minutes.

Usual presentation:
Unable to walk but airway is secure, hemodynamically
stable and on trolleys

Non-critical (green)
The patient's condition may deteriorate, or adverse outcome may
result, if assessment and treatment is not commenced within one hour
of arrival in ED. Symptoms moderate or prolonged.
There is potential for adverse outcome if time-critical treatment is not
commenced within hour

Likely to require complex work-up and consultation and/or inpatient

management

Humane practice mandates the relief of discomfort or distress within

one hour

 Assessment and treatment starts within 90 minutes

Usual presentation:
Airway secure, hemodynamically stable patients not in
any distress and ambulant

Subcatagories:
G1 (fast line)
G2 (require initial management or first aid before seen by
doctor)
G3 (patients who can wait)
G4 (triage away to primary care or another center)
G5 (not seen in ED)

G1 (Fast Lane)
Children < 2 years old
Senior citizen > 65 years old
Acute pain (trauma): pain score <4/10
Chest pain non-visceral, musculoskeletal and not associated with other symptoms but with history
of heart disease
Abuse/neglect/assault stable
Post seizure alert on arrival
POP complications
Elevated blood sugar without any major symptoms
Mild asthma
Closed fracture of upper limbs or ankle with major angulations
Dislocation of small joints
Foreign body
Hemodynamically stable per vaginal bleed

G2 (Require initial management or 1st aid before

seen by doctor)
Chest pain non-visceral, musculoskeletal and not
associated with other symptoms and no previous heart
disease
Minor allergic reaction

G3 (patients who can wait)

Burn < 15% of BSA regardless of depth and/or <10% 3rd degree burns
Minor trauma
Head injury alert, no vomiting
Bumps and bruises
Closed fracture of upper limbs
Controllable bleeding with closed fracture of upper limbs or ankle
without major angulations
Nail prick
Simple cut

G4 (for LOCUM or triage away to OPD or another center)

Chronic trauma injuries > 6 months
Diarrhea alone (no dehydration)
Vomiting alone (normal mental status with no dehydration)
Acute pyrexia <38C for adult < 65 years old or child between 2-12 years old
Simple skin diseases chronic
Menses related complaints
Chronic psychiatric complaints
General medicine conditions or minor illness not requiring monitoring
Sore throat no respiratory symptoms
Earache
Infective eye conditions

G5 (not seen in ED)

Missed appointment
Medications exhausted
Second opinion seeking
STO
Medical certificate
Specialist clinic cases