Peace be with you!

Triage may also be used for patients arriving at the

Please review the following for Emergency Nursing: emergency department, or telephoning medical
advice systems,[2] among others. This article deals
1. CPR
with the concept of triage as it occurs in medical
2. Endotracheal Intubation emergencies, including the prehospital setting,
3. Suctioning disasters, and emergency room treatment.
4. Fracture The term triage may have originated during
5. Tracheostomy the Napoleonic Wars from the work of Dominique
6. ABG Jean Larrey. The term was used further during World
7. IV Fluid and Blood transfusion War I by French doctors treating the battlefield
8. Emergency Drug wounded at the aid stations behind the front. Those
responsible for the removal of the wounded from a
9. Triage battlefield or their care afterwards would divide the
victims into three categories:[3][4]
The exam is more on situational , please study very
hard.  Those who are likely to live, regardless of what
care they receive;
 Those who are unlikely to live, regardless of what
Triage care they receive;
From Wikipedia, the free encyclopedia  Those for whom immediate care might make a
This article is about the concept of triage as it occurs positive difference in outcome.
in medical emergencies and disasters. For other For many emergency medical services (EMS)
uses, see Triage (disambiguation). systems, a similar model may sometimes still be
applied. In the earliest stages of an incident, such as
when one or two paramedics exist to twenty or more
patients, practicality demands that the above, more
"primitive" model will be used. 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.
As medical technology has advanced, so have
modern approaches to triage, which are increasingly
based on scientific models. The categorizations of the
Triage station, Suippes, France, World War I victims are frequently the result of triage scores based
on specific physiological assessment findings. Some
models, such as the START model may 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.[5]

Triage station at the Pentagon after the impact of American

Types[edit]
Airlines Flight 77 during the September 11, 2001 attacks.
This section is for concepts in triage. See other
Triage (/ˈtriːɑːʒ/ or //triːˈɑːʒ//) is the process of sections for specific triage tools, methods, and
determining the priority of patients' treatments based systems
on the severity of their condition. This rations patient
treatment efficiently when resources are insufficient Simple triage[edit]
for all to be treated immediately. The term comes from
the French verb trier, meaning to separate, sift or
select.[1] 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.
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.[6]
Tags[edit]
Many triage systems use triage tags with specific formats
Emergency Triage (E/T) Lights – particularly useful at night
or under adverse conditions
Main article: Triage tag
A triage tag is a prefabricated 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 may take a variety of forms. Some
countries use a nationally standardized triage tag,
[7]
while in other countries commercially available
triage tags are used, and these will vary by
jurisdictional choice.[8] The most commonly used
commercial systems include the METTAG,[9] the
SMARTTAG,[10] E/T LIGHT tm[11] and the CRUCIFORM
systems.[12] 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. Some of
these tracking systems are beginning to incorporate
the use of handheld computers, and in some cases,
bar code scanners.
Advanced triage[edit]
For classifications, see the specific section for that
topic.
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. In these cases some percentage of
patients will die regardless of medical care because of
the severity of their injuries. Others would live if given
immediate medical care, but would die without it.
In these extreme situations, any medical care given to
people who will die anyway can be considered to be
care withdrawn from others who might have survived
(or perhaps suffered less severe disability from their
injuries) had they been treated instead. It becomes
the task of the disaster medical authorities to set
aside some victims as hopeless, to avoid trying to
save one life at the expense of several others.
If immediate treatment is successful, the patient may
improve (although this may be temporary) and this
improvement may allow the patient to be categorized
to a lower priority in the short term. Triage should be a
continuous process and categories should be
checked regularly to ensure that the priority remains
correct given the patient's condition. A trauma score is
invariably taken when the victim first comes into
hospital and subsequent trauma scores are taken to
account for any changes in the victim's physiological
parameters. If a record is maintained, the receiving
hospital doctor can see a trauma score time
series from the start of the incident, which may allow
definitive treatment earlier.
Continuous integrated triage[edit]
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)[13] 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)[14][15]
 Physiologic (Individual) Triage (i.e., S.T.A.R.T.)
 Hospital Triage (i.e., E.S.I. or Emergency Severity
Index)
However any Group, Individual and/or Hospital Triage
system can be used at the appropriate level of
evaluation.
Reverse triage[edit]
Usually, triage refers to prioritising admission. A
similar process can be applied to discharging patients
early when the medical system is stressed. This
process has been called "reverse triage".[16] 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.
Undertriage and overtriage[edit]
Undertriage is the 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). Historically,
acceptable undertriage rates have been deemed 5%
or less.
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.[17]
Outcomes[edit]
This section is for general concepts in triage-based
treatment options and outcomes. For specific triage
systems and methods see the sections dedicated to
that topic
Palliative care[edit]
For those patients that have a poor prognosis and are
expected to die regardless of the medical treatment
available, palliative care such as painkillers may be
given to ease suffering before they die.
Evacuation[edit]
In the field, triage sets priorities for evacuation or
relocation to other care facilities.[18]
Alternative care facilities[edit]
Alternative care facilities are places that are set up for
the care of large numbers of patients, or are places
that could be so set up. Examples include schools,
sports stadiums, and large camps that can be
prepared and used for the care, feeding, and holding
of large numbers of victims of a mass casualty or
other type of event.[19] Such improvised facilities are
generally developed in cooperation with the local
hospital, which sees them as a strategy for creating
surge capacity. While hospitals remain the preferred
destination for all patients, during a mass casualty
event such improvised facilities may be required in
order to divert low-acuity patients away from hospitals
in order to prevent the hospitals becoming
overwhelmed.
Secondary (in-hospital) triage[edit]
In advanced triage systems, secondary triage is
typically implemented by emergency nurses,
skilled paramedics, or battlefield medical
personnel within the emergency departments of
hospitals during disasters, injured people are sorted
into five categories.[20]
Some crippling injuries, even if not life-threatening,
may be elevated in priority based on the available
capabilities. During peacetime, most amputation
injuries may be triaged "Red" because surgical
reattachment must take place within minutes, even
though in all probability the person will not die without
a thumb or hand.
Specific systems[edit]

A triage sign at a Mexican emergency room indicating the
waiting time for patients based on the severity of their
condition
This section is for examples of specific triage systems
and methods. For general triage concepts, see the
sections for types of triage, treatment options, and
outcomes.
Practical applied triage[edit]
During the early stages of an incident, first responders
may be overwhelmed by the scope of patients and
injuries. One valuable technique is the Patient Assist
Method (PAM). The responders quickly establish a
casualty collection point (CCP) and advise, either by
yelling, or over a loudspeaker, that "anyone requiring
assistance should move to the selected area (CCP)".
This does several things at once, it identifies patients
that are not so severely injured, that they need
immediate help, it physically clears the scene, and
provides possible assistants to the responders. As
those who can move, do so, the responders then ask,
"anyone who still needs assistance, yell out or raise
your hands"; this further identifies patients who are
responsive, yet maybe unable to move. Now the
responders can rapidly assess the remaining patients
who are either expectant, or are in need of immediate
aid. From that point the first responder is quickly able
to identify those in need of immediate attention, while
not being distracted or overwhelmed by the
magnitude of the situation. Using this method
assumes the ability to hear. Deaf, partially deaf, or
victims of a large blast injury may not be able to hear
these instructions.
Scoring systems[edit]
Examples of scoring systems used:
 In Western Europe the Triage Revised Trauma
Score (TRTS) is sometimes used and integrated
into triage cards.[21]
 The Injury Severity Score (ISS) is another
example of a trauma scoring system. This assigns
a score from 0 to 75 based on severity of injury to
the human body divided into three categories: A
(face/neck/head), B(thorax/abdomen),
C(extremities/external/skin). Each category is
scored from 0 to 5 using the Abbreviated Injury
Scale, from uninjured to critically injured, which is
then squared and summed to create the ISS. A
score of 6, for "unsurvivable", can also be used
for any of the three categories, and automatically
sets the score to 75 regardless of other scores.
Depending on the triage situation, this may
indicate either that the patient is a first priority for
care, or that he or she will not receive care owing
to the need to conserve care for more likely
survivors.
V1 (C1) Fourth intercostal space at the right sternal bord
V2 (C2) Fourth intercostal space at the left sternal borde
V3 (C3) Halfway between leads V2 and V4
V4 (C4) Fifth intercostal space in the midclavicular line
V5 (C5) Left anterior axillary line on the same horizont
V6 (C6) Left midaxillary line on the same horizontal pla
RA (R) Right arm (inner wrist)
LA (L) Left arm (inner wrist)
RL (N) Right leg (inner ankle)
LL (F) Left leg (inner ankle)
Unbracketed letters indicate lead names under the American
letters indicate lead numbers under the International Electro
(Table adapted from Crawford and Doherty
2010a; Jevon 2010; Cable and Sensors BV
n.d.)
Precordial Lead Placement
In order to find these correctly, the ‘Angle of
Louis’ Method can be used:
 To locate the space for V1; locate the
sternal notch (Angle of Louis) at the
second rib and feel down the sternal
border until the fourth intercostal space
is found. V1 is placed to the right of the
sternal border, and V2 is placed at the
left of the sternal border.
 Next, V4 should be placed
before V3. V4 should be placed in the
fifth intercostal space in the
midclavicular line (as if drawing a line
downwards from the centre of the
patient’s clavicle).
 V3 is placed directly
between V2 and V4.
 V5 is placed directly
between V4 and V6.
 V6 is placed over the fifth intercostal
space at the mid-axillary line (as if
drawing a line down from the armpit).
 V4-V6 should line up horizontally along
the fifth intercostal space.