Triage refers to the evaluation and categorization of the sick or wounded when there are insufficient resources for medical care of everyone at once. Triage is done in emergency rooms, disasters, and wars, when limited medical resources must be allocated to maximize the number of survivors.

Triage in this sense originated in World War I. Wounded soldiers were classified into one of three groups: those who could be expected to live without medical care, those who would likely die even with care, and those who could survive if they received care.

In a disaster or mass casualty situation, different systems for triage have been developed. One system is known as START (Simple Triage and Rapid Treatment). In START, victims are grouped into four categories, depending on the urgency of their need for evacuation. If necessary, START can be implemented by persons without a high level of training. The categories in START are

  • 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.
Another system that has been used in mass casualty situations is an example of advanced triage implemented by nurses or other skilled personnel. This advanced triage system involves a color-coding scheme using red, yellow, green, white, and black tags:

Red tags - (immediate) are used to label those who cannot survive without immediate treatment but who have a chance of survival.

Yellow tags - (observation) for those who require observation (and possible later re-triage). Their condition is stable for the moment and, they are not in immediate danger of death. These victims will still need hospital care and would be treated immediately under normal circumstances.

Green tags - (wait) are reserved for the "walking wounded" who will need medical care at some point, after more critical injuries have been treated.

White tags - (dismiss) are given to those with minor injuries for whom a doctor's care is not required.

Black tags - (expectant) are used for the deceased and for those whose injuries are so extensive that they will not be able to survive given the care that is available.

Steps Of Triage Method

Step 1
Patient presents for triage.
Safety hazards are considered above all.

Step 2
Assess the following:

Chief complaint
General appearance
Limited history

Once the above assessment is completed

Quick evaluation. Is the patient stable?

If the patient is stable proceed to Step 3
If the patient is unstable, proceed to Step 5

Step 3
Differentiate predictors of poor outcome from other data collected during the triage assessment

Step 4
Identify patients who have evidence of or are of high risk of physiological instability.

Step 5
Assign an appropriate ATS category in response to clinical assessment data.


Step 6
Allocate staff to patient including brief handover to allocated staff.

Step 7
ED model of care proceeds.


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