Triage

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Triage (pronounced /ˈtriːɑːʒ/) is a process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate, sort, sift or select.[1] Two types of triage exist: simple and advanced.[2] Triage may result in determining the order and priority of emergency treatment, the order and priority of emergency transport, or the transport destination for the patient.

Triage may also be used for patients arriving at the emergency department, or to telephone medical advice systems,[3] among others. This article deals with the concept of triage as it occurs in medical emergencies, including the prehospital setting, disasters, and during emergency room treatment.

Triage originated in World War I by French doctors treating the battlefield wounded at the aid stations behind the front. Much is owed to the work of Dominique Jean Larrey during the Napoleonic Wars. Until recently, triage results, whether performed by a paramedic or anyone else, were frequently a matter of the 'best guess', as opposed to any real or meaningful assessment.[4] At its most primitive, those responsible for the removal of the wounded from a battlefield or their care afterwards have divided victims into three categories:

  • Those who are likely to live, regardless of what care they receive;
  • Those who are likely to die, regardless of what care they receive;
  • Those for whom immediate care might make a positive difference in outcome.[5]

For many Emergency medical services (EMS) systems, a similar model can sometimes still be applied. However once a full response has occurred and many hands are available, paramedics will usually use the model included in their service policy and standing orders. In the earliest stages of an incident, however, when one or two paramedics exist to twenty or more patients, practicality demands that the above, more "primitive" model will be used.

Modern approaches to triage are more scientific. The outcome and grading of the victim is frequently the result of physiological and assessment findings. Some models, such as the START model, are committed to memory, and may even be algorithm-based. As triage concepts become more sophisticated, triage guidance is also evolving into both software and hardware decision support products for use by caregivers in both hospitals and the field.[6]

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