Triage

Triage is a medical process used to prioritize patient care. It is essential when medical resources are limited. This often happens during a mass casualty incident. In these events, there are more injured people than available doctors or supplies. Triage helps providers decide the order of treatment. The goal is to ensure limited supplies go to those who can benefit most.

To perform triage, providers use a rapid assessment called the ABCDE approach. This method checks bodily functions in a specific order of importance. First, they check the airway for any obstructions. Next, they assess breathing to ensure it is normal. Then, they check circulation by looking at heart rate and capillary refill time. They also check for disability by testing alertness and response to pain. Finally, they check for exposure to look for bleeding, trauma, or temperature changes.

During simple triage at an accident scene, patients are sorted into specific groups. One group needs critical attention and immediate transport to survive. Another group requires low-intensity care to survive. Some patients may be uninjured, while others are deceased or will die imminently. In the United States, the START model is a common system. Canada uses the CTAS model, and Australia uses the ATS model.

Medical workers often use triage tags to manage these patients. A triage tag is a premade label placed on each person. It identifies the patient and records their assessment findings. It also shows their priority level for treatment and transport. Some advanced tags include markers for hazardous material contamination. They may even have tear-off strips to track patient movement. Common commercial systems include METTAG, SMARTTAG, and the E/T LIGHT system.

The history of triage spans thousands of years. The Edwin Smith Papyrus, an Egyptian document from the 17th century BCE, describes early sorting.

It divided injuries into three categories: those that could be healed, those to fight, and those that could not be healed. Modern triage began to take shape in the 1800s. Baron Dominique-Jean Larrey, surgeon for Napoleon, laid the groundwork for modern methods. He believed in treating wounds based on gravity and urgency, regardless of rank or nationality.

During World War I, triage became even more organized. In 1914, Antoine Depage developed the five-tiered Ordre de Triage. This system used staged evacuation to move wounded soldiers through different levels of care.

The process moved patients from casualty clearing stations to mobile surgical centers. Eventually, the most severe cases reached permanent hospitals. This structured movement helped manage the massive number of casualties on the battlefield.

Triage is an imperfect and sometimes subjective practice. Providers must balance many difficult factors like the likelihood of death and the efficacy of treatment. They must also consider ethics, religion, and a patient's remaining lifespan. Errors can occur, such as undertriage or overtriage. Undertriage happens when a provider underestimates the severity of an injury. A 2014 review found in-hospital undertriage occurred 34% of the time in the United States. Overtriage is overestimating severity, which can happen up to 50% of the time.

Different settings require different triage strategies. Advanced triage involves doctors or nurses using tools like CT scans for deeper assessments. Reverse triage can involve discharging stable patients to prepare for an incoming mass casualty. It can also involve treating those who appear dead, such as in lightning injuries, because they can often be resuscitated. In some cases, hospitals may use alternative care facilities. These include schools or stadiums to create surge capacity. This prevents local hospitals from becoming overwhelmed during a crisis.