Triage

DR NGUYEN THI HOANG ANH Emergency – Hemodynamics

Objectives
• Describe: Definition and role of triage in 5 minutes

• Describe: Triage systems based on patient flow in 5 minutes

• prehospital
• emergency
• inpatient
• ICU
History
1846
1806 • John Wilson

• Battle of Jena
1792 – 1801
• Triage system of
• Napoleonic Larrey
triage
Definition
• Optimize the use of available medical resources to provide the best
medical care possible by identifying the correct priority of patients

Right patient to the

Right place at the
Right time with the
Right care provider
Triage

EMT
MODS SOFA
SAPS

APACHE

ICU
EMD

Scene
Scene
EMD
• Critical link in the patient care

• Telephone interrogation

• Dispatch Life Support instruction

• Resource allocation

• Logistics coordination

• Field communication
Emergency Medical Dispatcher (EMD)
EMD
 EMT

• Assess & provide medical care to sustain

life in the prehospital environment:

• Safe lifting and moving the patient

• Transport and transfer of care (most

appropriate destination)
Emergency Medical Technician (EMT)
 EMT
 Non trauma:
 EMT
 Non trauma:
 Heart attack
EMT
 Non trauma:
 Stroke
EMT
 Trauma:
EMT
 Trauma: Field Triage
EMT
 Trauma: Field Triage
 EMT
 Trauma: Field Triage
EMT
• Disaster: a sudden, calamitous event that causes great damage or
loss of life exceed the community's or society's ability to cope using
its own resources.

• Battlefields, fires, pandemic, Mass casualty incidents (MCI)…

EMT
• Non disaster: provide the best care for each individual patient
• MCI/disaster: provide the most effective care for the greatest number
of patients
→ method
EMT
• Disaster triage
• START (Simple Triage And Rapid Treatment)

• SALT (Sort, Assess, Lifesaving interventions, Treatment/Triage)

• STM (Sacco Triage Method)

• Care Flight Triage

• SAVE (Secondary Assessment of Victim Endpoint)

• Child: Jump START, PTT

EMT
EMT

Triage area
Emergency
 Emergency

• ATS: Australian Triage Scale

• MTS: Manchester Triage Scale

• CTAS: Canadian Triage Acuity Scale

• ESI: Emergency Severity Index

Emergency
Category 1 Category 2 Category 3 Category 4 Category 5
ATS
Immediate 10 minutes 30 minutes 60 minutes 120 minutes

Airway Obstructed/partial Patent Patent Patent Patent

obstructed

Breathing Severe respiratory Moderate Mild No respiratory No respiratory

distress/absent respiratory respiratory disstress disstress
respiratory/hypoventilation disstress disstress

Circulation Severe haemodynamic Moderate Mild No No

compromise/absent haemodynamic haemodynamic haemodynamic haemodynamic
circulation compromise compromise compromise compromise
Uncontrolled haemorrhage

Disability GSC < 9 GCS 9 - 12 GCS > 12 Normal GCS Normal GCS
Emergency
MTS
Emergency
Emergency
ESI
Emergency
ESI
Emergency
Emergency
 Emergency
• Disposition:
• Level 0 – 1: Inpatient ward

• Level 2: HDU

• Level 3: ICU
 Inpatient ward
• Early Warning Signs

• Rapid response team (RRT), Medical emergency team (MET), High Acuity
Response Team (HART)
 Inpatient ward
Early Warning Signs
Inpatient ward
Inpatient ward
Inpatient ward

Pediatrics

Obstretics: Obstretical Triage Acuity

Scale (OTAS)

Mental Health: UK Mental Health

Triage Scale
ICU
2000 –current
• SAPS III
1996 - 2000 • APACHE IV
• SOFA
1990 - 1995 • CIS
• APACHE III
1986 - 1990 • MODS
• SAPS II • MPM II
1980 - 1985 • MPM • ODIN
• APACHE
• SAPS
• APACHE II
 ICU

APACHE II
(Acute Physiology &
Chronic Health
Condition)
APACHE II
24h
Estimates ICU mortality

number of laboratory values and patient signs taking both

acute and chronic disease
the worst value
 ICU
APACHE III APACHE IV
• Same variables as APACHE II • Same variables as APACHE III

• 0 – 299 points • Complexity 142 variables

• 18 physiological variables (252 points)
• New variables:
• Acid base disturbances
• Mechanical ventilation
• Neurological data-no longer using the GCS
• Thrombolysis
• Age (24 points)
• Impact of sedation on GCS
• Chronic Health ( 23 points)
• Re-scaled GCS
• PaO2/FiO2

• More accurate
ICU SAPS II (Simplified Acute Physiology Score)
ICU
• SAPS III:
• Scores based on data collected within 1st hour of entry to ICU

• Predict outcome before ICU intervention occurs

 ICU
MODS
(Multiple Organ Dysfunction Score)

* PAR = HR ×
ICU

SOFA (Sequential Organ Failure Assessment)

ICU
First Day Scoring Systems
APACHE (Acute Physiology & Chronic Health Condition)
SAPS (Simplified Acute Physiology Score)
MPM (Mortality Prediction Model)

Repetitive Scoring Systems

OSF ( Organ System Failure)
SOFA (Sequential Organ Failure Assessment)
MODS (Multiple Organ Dysfunction Score)
ODIN (Organ Dysfunction & Infection System)
LOD (Logistic Organ Dysfunction)
Triage is continuous…
• Continuous and repetitive at each level or site where it is required

• Constant vigilance and reassessment

Take home message

MODS SOFA
SAPS

APACHE