Republic of the Philippines

Central Mindanao University

University Town, Musuan, Maramag, Bukidnon
COLLEGE OF NURSING

TRIAGE

Submitted to:
CEASARLICA S. MINGUITA, MAN, RN

Submitted by:
ODING, NORAYA
RESMEROS, EUNICE

November 6, 2018
Objectives:

1. Rapidly identify patients with urgent, life threatening conditions

2. Assess/determine severity and acuity of the presenting problem

3. Direct patients to appropriate treatment areas

What is triage?

The term triage refers to the sorting of injured or sick people according to their

need for emergency medical attention. The term trier is French for “sort” or “select”

and is the base for the word triage. A method of quickly identifying victims who have

immediately life-threatening injuries and who have the best chance of surviving or

process of prioritizing patients based on the severity of their condition.

It’s the process by which patients classified according to the type and urgency

of their conditions to get the Right patient to the Right place at the Right time with

the Right care provider.

Historically, triage is believed to have arisen from systems developed for

categorization and transport of wounded soldiers on the battlefield. Over time, triage

systems have evolved into a very well-defined medical process. Specific medical

training is required for the utilization of the multiple types of triage systems available.

Whether the scenario is an inner-city emergency room, a battlefield in a war zone, or

a natural or man-made disaster, wherever mass injuries or casualties are present, the

triage process is critical for the highest rate of recovery and treatment of patients.

Three phases of triage:

 Pre-hospital triage- in order to dispatch ambulance and pre-hospital care

resources
  At the scene of the trauma

 On arrival at the receiving hospital

Triage categories:

1. Non disaster - To provide the best care for each individual patient.

2. Multi casualty/disaster - To provide the most effective care for the greatest

number of patients

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 physicians, nurses 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 tags.

A triage tag is a prefabricated label placed on each patient that serves

to accomplish several objectives.

Black- (Deceased or Expectant) no or small chance of survival, no spontaneous

breathing after clearing of airway or dead. Expected not to reach higher medical

support if alive. If dead, collection and guarding of bodies, identification if possible.

Red- (immediate) acute danger for life, life threatening injuries that requires

immediate medical attention and will not survive if not seen soon

Yellow- (Delayed) severe injury. Life threatening but can wait until the immediate

casualties are stabilized and evacuated. Needs constant observation

Green- minor injury or no injury. “Walking wounded”. Requires medical attention

when all higher priority patients have been evacuated.

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 for others with higher

likelihoods. 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. This has

happened in disasters such as terrorist attacks, mass shootings, volcanic

eruptions, earthquakes, tornadoes, thunderstorms, and rail accidents.

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 (i.e., M.A.S.S. triage)

-M.A.S.S. Triage is a disaster triage system that utilizes US military

triage categories with a proven means of handling large numbers of

casualties in a mass casualty incident (MCI).

 M – Move

A – Assess

S – Sort

S – Send

 Physiologic (Individual) Triage (i.e., S.T.A.R.T.)

-is a triage method used by first responders to quickly classify victims

during a mass casualty incident (MCI) based on the severity of their injury

S- Simple

T-Triage

A- And

R- Rapid

T-Treatment

 Hospital Triage (i.e., E.S.I. or Emergency Severity Index)

- The Emergency Severity Index (ESI) is a five-level emergency

department (ED) triage algorithm that provides clinically relevant

stratification of patients into five groups from 1 (most urgent) to 5

(least urgent) on the basis of acuity and resource needs

4. Reverse triage

Usually, triage refers to prioritizing admission. A similar process can be applied

to discharging patients early when the medical system is stressed. This process

has been called "reverse triage". During a "surge" in demand, such as

immediately after a natural disaster, many hospital beds will be occupied by

 regular non-critical patients. In order to accommodate a greater number of the

new critical patients, the existing patients may be triaged, and those who will

not need immediate care can be discharged until the surge has dissipated, for

example through the establishment of temporary medical facilities in the region.

Over-triage occurs when non-critical patients are sent to facilities offering the highest

level of care. Under-triage occurs when critically injured patients are treated at the

local level or sent to facilities that are not properly equipped to meet their needs. This

may result in increased morbidity and mortality among patients with otherwise

treatable injuries

Advantages of Triage

• Streamlines patient flow.

• Reduces risk of further injury/deterioration.

• Improves communication and public relations.

• Enhances teamwork.

• Identifies resource requirements.

• Establishes national benchmarks.

Importance of Triage

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 and especially in

emergency department are crowded with long waits for physician evaluation. And

patients must be assigned with acuity level of who needs to be seen immediately and

who is safe to wait.

Conclusion

Using triage is effective in dealing mass casualty disasters and even in

emergency department hospital. It will not only give prioritization to patients, but it will

organize the situation with collaboration of the team with giving care to the highest

priority patient to the less priority patient. Protocols must also be followed to prevent

over triage or under triage to happen.

Reference

Graham, T. (2015). Triage Systems – What Type Is Best for Your Hospital? Retrieved

from https://www.wphealthcarenews.com/triage-systems-type-best-hospital/.

Retrieved on October 29, 2018

Stoppler, M. (n.d). Medical triage, code tags and triage terminology. Retrieved from

https://www.medicinenet.com/medical_triage_code_tags_and_triage_terminol

ogy/views.htm. Retrieved on October 29, 2018

Wikipedia (2017). Triage. Retrieved from https://en.wikipedia.org/wiki/Triage.

Retrieved on November 5, 2018