TRIAGING SEMINAR

PESENTER:DR BALEMLAY HAILU(ECCM R1

MODERATOR:DR YONAS (ASSISTANT PROFESSOR OF ECCM

APRIL 2023
OUTINE
• Definition
• Historic back ground
• Introduction
• Triage systems
• Field and disaster triage
• Ethiopian moh triaging
definition
• Triage originates from the French word "trier," which is used to describe the
processes of sorting and organization.
• Triage is utilized in the healthcare community to categorize patients based on the
severity of their injuries
Historical back ground
• The history of the emergency triage originated in the military by field
doctors.
• As early as the 18th century, documentation shows how field
surgeons would quickly look over soldiers
•  The triage system was first implemented in hospitals in 1964
•  Today, triage is still deeply integrated into healthcare
introduction
• Triage can be broken down into three phases:
 prehospital triage,
 triage at the scene of the event,
 triage upon arrival to the emergency department.
Triage systems
• There are various triage systems implemented around the world,
• but the universal goal of triage is to supply effective and prioritized care to
patients while optimizing resource usage and timing
• the most known triage systems are USA ,Australia,machester,canadianand
chines four level
ED TRIAGING IN USA
• The most common triage system in the United States is the START (simple triage
and rapid treatment) triage system.
• This algorithm is utilized for patients above the age of 8 years.
• Using this algorithm, triage status is intended to be calculated in less than 60
seconds
CON,T
 Various criteria are taken into consideration, including
 the patient's pulse
 respiratory rate
 capillary refill time,
 presence of bleeding, and
 the patient's ability to follow commands.
.
START TRIAGE ALGORITHM
Cont.
•  For children, a commonly used triage algorithm is the Jump-Start
• This algorithm is based on the START but it considers the increased likelihood for
children to experience respiratory failure, their inability to follow verbal
commands and different breath rate
cont
•  It is important to understand that triage is a dynamic process,
meaning a patient can change triage statuses with time.
•  This will be discussed further in the field and disaster triage section
of this article.
Emergency Severity Index (ESI) Triage
Algorithm 
• ESI is a five-level ED triage algorithm that uses stratification of patients into five
groups from 1 to 5 on the basis of acuity and resource needs
• The first question in the ESI triage algorithm is whether "the patient requires
immediate life-saving interventions
• The nurse evaluates the patient by checking pulse, rhythm, rate, and airway
patency, and breathing
Con,t
• if patient have pulselessness, apnea, severe respiratory distress, oxygen
saturation below 90, acute mental status changes, or unresponsiveness should
be marked as level 1
• If the patient is not categorized as a level 1, the nurse then decides if the patients
should wait or not.
Con,t
This is determined by three questions;
 is the patient in a high-risk situation, confused, lethargic, or disoriented?
 is the patient in severe pain or distress?
Is the patient at-risk of easily deterioration
if the one of this present mark as level 2
Con,t
• Differentiating between levels 3,4, and 5 are determined by how many hospital
resources the patient will most likely need 
• If the patient requires two or more hospital resources, the patient is triaged as a
level 3.
• If the patient needs one hospital resource, the patient would be labeled a 4.
• If the patient does not need any hospital resources, the patient would be
labeled a 5
The Australasian Triage Scale 
• Originally named the international triage scale (ITS),
• the Australasian triage scale or ATS is based on a 5-level categorical scale.
• ATS incorporates looking at presenting patients' problems, appearance, and
overview of pertinent physiological findings.
• These pertinent physiological findings are based on 79 clinical descriptors
The Canadian Triage System
• Also known as the Canadian triage and acuity scale or CTAS, is based on the NTS
of Australia.
• CTAS is a 5-level triage system based on the severity of the illness or time needed
• Unique to CTAS is the first and second-order modifiers that are used after an
initial acuity level is given to a patient that changes that patient's acuity level.
Chinese Four-level and Three District
Triage Standard
• The Chinese four-level and three district triage standard or CHT was drafted in
2011 by the Chinese Ministry of Health 
• Based on the level of acuity, the triage nurses sort the patients into three distinct
treatment areas.
Con,t
• These areas are the red zone, which is considered a resuscitation zone for
category one patients, and a rescue room for category two patients.
• The next two areas are the yellow and green zone, which treat category three
and four patients. 
Manchester Triage System
• The Manchester triage system (MTS) is one of the most common triage systems
used in Europe.
• What is unique about this particular system is that it utilizes 52 flowcharts based
on patients presenting complaints.
Con,t
•  The urgency categorization is tied to a maximum waiting time, with immediate
maximum waiting time being 0 minutes, very urgent is 10 minutes max.
• Urgent waiting time is maxed at 60 minutes, standard 120 minutes, and non-
urgent waiting time is maxed at 240 minutes.
Field and Disaster Triage
• The World Health Organization defines a disaster as a sudden ecologic
phenomenon of sufficient magnitude to require external assistance.
• a hospital disaster may similarly be defined as an event that overwhelms the
resources of the receiving hospital
Con,t
• The approach to patient evaluation and treatment is quite different
when dealing with disaster situations that result in high casualties.
• Patient care at triage should be limited to manually opening airways
and controlling external hemorrhage
• Another algorithm of triage is called the SALT triage or sort, assess,
life-saving interventions, and treatment/transport.
Con,t
• The benefit of the SALT method vs. the START method is that there is
a grey area that is provided for the population affected and allows
providers to be more flexible with their decision making.
Con,t
Triage categories
Ethiopian triage system
Con,t
Con,t
Reverse triage

• There are a number of concepts referred to as Reverse Triage,

• the first is concerned with the discharge of patients from hospital.
• 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.
CON,T
• 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).
Under triage and over triage

• Under triage 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).
• Historically, acceptable under triage rates have been deemed 5% or less.
Con,t
• Over triage 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).
CON,T
• Acceptable over triage rates have been typically up to 50% in an effort to avoid
under triage.
• Some studies suggest that over triage is less likely to occur when triaging is
performed by hospital medical teams, rather than paramedics or EMS
REFERENCE
• Emergency Department Triage Stat Pearls(internet
• Tintinalli,s 9th edition
• Mass casualty triage guideline(internet
THANK YOU
• any questions???