In medicine, triage (, ; French: [tʁiaʒ]) is a process by which care providers, such as medical professionals and those with first aid knowledge, determine the order of priority for providing treatment to injured individuals and/or inform the rationing of limited supplies so that they go to those who can most benefit from it. Triage is usually relied upon when there are more injured individuals than available care providers (known as a mass casualty incident) or when there are more injured individuals than supplies to treat them.
The methodologies of triage vary by institution, locality, and country, but have the same universal underlying concepts. In most cases, the triage process places the most injured and most able to be helped as the first priority, with the most terminally injured the last priority (except in the case of reverse triage). Triage systems vary dramatically based on a variety of factors, and can follow specific, measurable metrics, like trauma scoring systems, or can be based on the medical opinion of the provider. Triage is an imperfect practice, and can be largely subjective, especially when based on general opinion rather than a score. This is because triage needs to balance multiple and sometimes contradictory objectives simultaneously, most of them being fundamental to personhood: likelihood of death, efficacy of treatment, patients' remaining lifespan, ethics, and religion.
Etymology and origin The term triage comes directly from French triage, meaning the action of picking or sorting, it itself coming from the Old French verb trier, meaning to separate, sort, shift, or select; trier in turn came from late Latin tritare, to grind. Although the concept existed much earlier, at least as far back as the reign of Maximillian I, it was not until the 1800s that the Old French trier was used to describe the practice of triage. That year, Baron Dominique-Jean Larrey, the Surgeon in Chief of Napoleon's Imperial Guard, laid the groundwork for what would eventually become modern triage, introducing the concept of "treat[ing] the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of their rank or nationality".
Concepts in triage
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 a secondary or tertiary care facility to survive, those who require low-intensity care to survive, those who are uninjured, and those who are deceased or will be so imminently. In the United States, this most commonly takes the form of the START or SALT triage models, in Canada, the CTAS model, and in Australia the ATS model. Assessment often begins with asking anyone who can walk to walk to a designated area, labeling them the lowest priority, and assessing other patients from there. Upon completion of the initial assessment by the care provider, which is based on the so-called ABCDE approach, patients are generally labelled with their available information, including "patient’s name, sex, injuries, interventions, care-provider IDs, casualty triage score, and an easily visible overall triage category".
ABCDE Assessment
An ABCDE assessment (other variations include ABC, ABCD, ABCDEF, and many others, including those localized to non-English) is rapid patient assessment designed to check bodily function in order of importance.
Tags
A triage tag is a premade label placed on each patient that serves to accomplish several objectives:
identify the patient. bear record of assessment findings. identify the priority of the patient's need for medical treatment and transport from the emergency scene. track the patients' progress through the triage process. identify additional hazards such as contamination. Triage tags take a variety of forms. Some countries use a nationally standardized triage tag, while in other countries commercially available triage tags are used, which vary by jurisdictional choice. In some cases, international organizations also have standardized tags, as is the case with NATO. The most commonly used commercial systems include the METTAG, the SMARTTAG, E/T LIGHT and the CRUCIFORM systems. More advanced tagging systems incorporate special markers to indicate whether or not patients have been contaminated by hazardous materials, and also tear off strips for tracking the movement of patients through the process.
Advanced triage In advanced triage, those with advanced training, such as doctors, nurses and paramedics make further care determinations based on more in-depth assessments, and may make use of advanced diagnostics like CT scans. This can also be a form of secondary triage, where the evaluation occurs at a secondary location like a hospital, or after the arrival of more qualified care providers.
Reverse triage There are three primary concepts referred to as reverse triage. The first is concerned with the discharge of patients from hospital often to prepare for an incoming mass casualty. The second concept of Reverse Triage is utilized for certain conditions such as lightning injuries, where those appearing to be dead may be treated ahead of other patients, as they can typically be resuscitated successfully. The third is the concept of treating the least injured, often to return them to functional capability. This approach originated in the military, where returning combatants to the theatre of war may lead to overall victory (and survivability).
Undertriage and overtriage Undertriage is underestimating the severity of an illness or injury. An example of this would be categorizing a Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal). The rate of undertriage generally varies by the location of the triage, with a 2014 review of triage practices in emergency rooms finding that in-hospital undertriaging occurred 34% of the time in the United States, while reviews of pre-hospital triage finding undertriage rates of 14%. Overtriage is the overestimating of the severity of an illness or injury. An example of this would be categorizing a Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate). Acceptable overtriage rates have been typically up to 50% in an effort to avoid undertriage. Some studies suggest that overtriage is less likely to occur when triaging is performed by hospital medical teams, rather than paramedics or EMTs.
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