TRIAGE

RASCHIDI ABDUL KARIM

PEN. PEG. PERUBATAN U42
TRIAGE
TRIAGE
DEFINITION
- The sorting of patients according to their
need for emergency treatment and
evacuation.
- A French word meaning ‘to sort’.

TYPES OF TRIAGE
1. Hospital Triage
2. Field Triage
1) HOSPITAL TRIAGE

• Sorting out patients according to the severity of injury and

the priority of treatment.
- Performed according to the hospital’s operation
policy and depends upon these factors :-
a) Manpower & staffing
b) Availability of facilities
c) Zoning of the area - critical,
semi-critical and non-critical
FUNCTION
• Rapidly identify
patients with urgent,
life threatening
conditions
• Most appropriate
treatment
• Reduce congestion
• Ongoing assessment
• Provide information to
patient and families
– Treatment expected
– Waiting time
 Factors that influence triage design and
operation
• Number of patients
– Visiting ED
– Requiring rapid intervention
• Availability of
– Health care providers
– Speciality
– Community care resources
• Environment, legal, administrative factors
• Computer systems
– Admissions
– Discharge
– Transfers
 Components of Triage System
• 1. Science and Medical Protocol
• 2. Art & Personality
• 3. Process & Methodology
• 4. Structure and Equipment
• 5. Quality Standards
 SCIENCE AND MEDICAL
PROTOCOL Component

• a. Medical Protocol & SOP

• b. Criteria for Various Conditions
– 1.Green (G) - Non-critical
– 2.Yellow (Y) - Semi-critical
– 3.Red (R) - Critical
• c. Prioritization Criteria
 Science & Medical Protocol
Green (G)
• G1-Green Fast Lane-Direct Entry for cases
– I.child < 2yrs
– 2.Adult > 65 yrs
– 3.OSCC cases
– 4.Psychiatric Emergencies
• G2-All cases requiring First Aid and initial treatment
prior to waiting
– -Given First Aid and Wait
 Science & Medical Protocol
• G3-All cases of Emergency who will wait according
to time-
– “First Come First Seen Basis”
• G4-All Cold cases or OPD case who can be seen by
OPD Doctors
• G5-All cases who require no immediate treatment at
Emergency Dept and an be sent home.Triage Away.
 ART and Personality of Triage
• 1.The Corporate Culture of Triage
• 2.The “Unspoken” Aspect of Triage
• 3.The Body Language & Attitude
• 4.Facial Expression
• 5.Voice-High/ Low volume
• 6.Language
• 7.Gender Sensitized Procedure
• 8.Dressing and Image of Triageur
ART and Personality of Triage Core
Components
 Voice tone–soft &
gentle
 Correct word & accent
 Empathy – feeling,
sensitivity
 Body language
 Facial expression
 Behavioral patterns
 Sitting position
 Care
 Personality of Triageur
• Image –attire,figure
& act
• Corporate image
• “Self-reflection
mirror”
• Promotes “self
discipline”
• Shows respect
• Body language
 Process & Methodology
A.PRIMARY
• 1.Proactive Response
– Rapid Response System
– Static Triage

B.SECONDARY TRIAGE
• 1.Vital signs assessment
• 2.First Aid and initial treatment
 Rapid Response System
Proactive Triageur
• 1.To act with care and commitment
• 2.Show respect and acknowledgement of
patients’ need
• 3.With Liberation and Intensity
• 4.Proper Equipment and Action
 Methodology
1.Initial Interaction
• Introduce yourself and ask gently and softly
2.Rapid Assessment
• a.Eye balling & scanning
• b.Gentle examination and touches
3.Lifting, supporting and assisting patient
 Process and Methodology
• Interact
– ask soft ,gentle question
• Touching
– soft , gentle
• Assess
– Rapid Assessment , vital
sign,first aid,
immobilize,splinting,
airway, collar
• Transportation
– Lifting, extrication
 Rapid Response Triage System
1.Proactive Triage Squad
• Attendant,Driver,Security guard
• Medical Assistant
2.Well attired
3.Fast Response Receiving Patients
4.Outside the Dept at the Front
 Rapid Response Triage Team

• Interaction- Action /
Efforts
• Sense of urgency,
being proactive and
effective
• Rapport and
committed
 Static (Counter) Triage
• 1.At the Counter
• 2.To Stand up when talking to Patient (show
respect)
• 3.Appropriate Facial Expression
• 4.Low Volume Voice
• 5.Appropriate Behaviour
 Process And Methodology
• Clinical assessment:brief but accurate
• Limited time; not to make specific diagnosis
• Aim: decide whether the patient needs to be
seen earlier
• Performed by experienced health care
provider with years of clinical judgement &
decision making
 Methodology
The way of receiving patients
• Greet them and smile
• Let the patient sits
• Soft (in-house) voice and be polite
• Ask about any difficulties and offer help
• Answer every questions politely with smile
 Structure and Equipment
‘Structure Mirrors Process & Facilitates Care’

• Availability / Access &

Informative
• Alert System
• Ergonomics
• View ‘Fly Eye’/
• Eagle Eyes
• Equipment & Assessment
Area
• Registration Area
• Treatment Area
 TRIAGE ZONES
• RED ZONE
• YELLOW ZONE
• GREEN ZONE
– Priority 1, 2, 3
– Priority 4, 5
COLOR CATEGORY SUB CATEGORY USUAL PRESENTATION
CODE
RED CRITICAL Requaires •Cardiac Arrrest
SEEN Immediate Life •Stridor/respiration arrest/RR>30 or <10
IMMEDIATE Saving •SpO2 <90
Intervention
•Unresponsive trauma patient
•Severe bradycardiac (HR<60) or tachycardiac
(HR>150) with sign hypo perfusion
•trauma patient who requires immediate fluid
resuscitation
•Anapylactic reaction
•baby that is flaccid (unresponsive)
•Unresponsive history of poisoning
•Hypoglycemia with a change in mental status
•Severe crush injuries to limb
•Extensive burns(>than 25% BSA)or involve facial
region
•Elavated Bp systolic >220 mmHg or diastolic
>120 mmHg with systemic symptoms or
neurogical deficit.
COLOR CATEGORY SUB CATEGORY USUAL PRESENTATION
CODE

YELLOW High Risk High Risk •Altered consciouslevel but not comatose
Seen within Situation •Head injury: GCS >13 / GCS full but pupil
30 minutes or unequal
Confused/l •Fractures of long bnes of lower limbs/pelvis
ethargy/ •open fractures of upper limbs
disorientated •A suicidal or homicidal patient
or •spine injuries
severe •Eye injuries with loss or impaired vision
pain/distress •Dislocation of major joints
or •Limb amputation: total or near total
unable to walk •Vascular injuries
but airway is •uncontrollable major bleeding
secure,haemod
aynamiccally •Patient with acute abdomen
stable and on •Poisining or drug overdose with impairment of
stable concious level (severe pain:pain score 7/10-
10/10)
•Hyperventilation and unable to maintain
posture
COLOR CATEGORY SUB CATEGORY USUALY PRESENTATION
CODE

GREEN Non-critical G1 •children less than 2 years

Requires many •senior citizens ore than 65 years
resources •chest pain-no risk factor and not associated with
other symptoms,normal ecg
•abdominal pain
•abuse/neglect/assault
•mild asthma
•acute urinary retention
•closed fracture of upper limb or dislocation of small
joints
•diarrhea or vomitting with dehydration

G2 •non-aggressive psychiatric patient

Requires •foreign body
minimal •minor allergic reaction
resources •minor trauma
•diarrhea or vomiting with no dehydration
•fever >38'C for adult age
2) FIELD TRIAGE

Performed outside the hospital usually at the

incident site.
- Two factors play an important role :-
a) The number of patients.
b) The severity of injuries to the patients.
- If (a) & (b) do not exceed the capability of the
facility & staff, patients with life threatening
problems are treated first.

- If (a) & (b) exceeds the capability of the facility &

staff, patients with the greater chance of survival
are managed first.
STAGES OF TRIAGE

I. SCENE ASSESSMENT
- Check for hazards/potential
hazards.
- An idea of the ‘mechanism of
injury’.
STAGES OF TRIAGE

II. TRIAGE
- In mass casualties - ask those who can walk to
a safe area

“START SYSTEM”
STAGES OF TRIAGE

B) Triage Tag or Card

- Usually colour coded and large enough for
visualization.
- Colour codes are as follows:-

RED First Priority Victims.

YELLOW Second Priority Victims.
GREEN Third Priority Victims.
WHITE Dead Victims
FIRST UNIT ON SCENE START – Simple Triage And Rapid Treatment
What to do ?
How to begin ? 1 Call out

REMEMBER 5 S’s
Walking wounded Non Walking
&
1.SAFETY assessment Uninjured
2 RESPIRATIONS
2.SIZE UP the scene GREEN
Yes No
How big ?
How bad ? < 30/min > 30/min
3.SEND information: Position
3 PERFUSION RED Airway

4.SETUP the scene for Management

of the casualties. Capillary Refill
or Radial Pulse Yes No
5.START
Remember “RPM” Under 2 sec Over 2 sec
Or Pulse Present Or Pulse Absent RED WHITE
RESPIRATIONS
PERFUSION MENTAL STATUS RED
4
MENTAL STATUS
Colour codes:
RED -IMMEDIATE Follows simple command Can’t follow simple command
YELLOW -DELAYED
GREEN -MINOR
YELLOW RED
WHITE -DEAD
PATIENT 1
Not walking on her own
– Breathing on her own at
< 30 bpm
– + radial pulse
– Follows commands –
points to where it hurts…
YELLOW
Patient 2
• Not walking out on
own
• Initially not
breathing on own
• Breathing on own
once airway is
opened
RED
Patient 3

• Not walking out on

own
• Breathing on own
and crying
• Breathing at 40 bpm
RED
Patient 4

• Carried to you by
bystanders
• Not breathing on own
• Not breathing after
airway is opened or re-
positioned
WHITE
Patient 5
• Not walking out on own
• Breathing on own at
20 bpm
• + radial pulse
• Not following
commands
RED
Patient 6

• Not walking out on

own
• Not breathing on
own
• Not breathing when
airway is opened
WHITE