LU 1.2 Emergency Triage

What are the general concepts of triage ?

• triage is a brief assessment

• it determines the time and sequence in which patients should be seen in the ED

• to manage patient flow, task, resources and space

• emphasizes on the most experienced rather than most senior

What are the aims of emergency triage ?

• to identify urgent and life threatening conditions for early interventions

• to ensure patients are treated in order according to their clinical urgency

• to ensure treatment is appropriate and timely

Triage is divided into 2 main category which are …

• Pre-Hospital Triage

• Emergency Department Triage

Pre-Hospital Triage is divided into 2 categories which are …

• Trauma / Multiple Casualty Triage

• Disaster / Mass Casualty Triage

Emergency Department Triage is divided into 2 categories which are ….

• Primary triage (Uses a triage scale of between 3 to 5 patient acuity

• Secondary triage (more detailed medical screening examination)

What is Trauma / Multiple Casualty Triage ?

• the number of patients and severity of their injuries do not exceed the capability of the facility and staff

• patients with life-threatening problems and those sustaining multiple-system injuries are treated first

What is Disaster / Mass Casualty Triage ?

• the number of patients and severity of their injuries exceed the capability of the facility and staff

• the patients with the greatest chance of survival and requiring the least expenditure of time, equipment, supplies and personnel are treated first

What are the criteria used in trauma/ multiple casualty triage?

• findings from the primary survey

• mechanism of injury (ejection from vehicle, fall>20 feet, high speed auto crash)

• anatomic criteria (pelvic fracture, flail chest, 2 or more proximal bone fractures)

• medical criteria (age <5, >55, systolic BP <90)

What does the tag colour mean during disaster ?

• red : emergent (limmediate care for life threatening situation)

• yellow : urgent (delay care, injuries not life-threatening)

• green : non urgent (little or no care needed)

• black : dead / unsalvageable (no care, mortal injuries, cannot be saved)

What is START Triage and how do you do the assessment ?

• Simple Triage And Rapid Treatment

• Assessment based on RPM (Respiratory, Perfusion, Mental status)

Who are in the incident site management in each zone ?

• Incident area (high risk zone)

• command centre (tactics zone)

• strategy zone

What is the primary triage category in emergency department ?

What are the Triage essentials ?

• visual

• verbal and listen

• touch and smell

• intuition

What are the ideal Triage interview components ?

• chief complaint

• history of current complaint

• name, age, gender

• mode of arrival

• LMP (including gravida, para and abortion history if appropriate)

• assessment data (Vital signs)

• fall risk

• pain assessment

What is the triage interview method based on SOAPIE ?

What is the triage interview method used to do thorough evaluation of a symptom ?

What is the triage “pearls” / golden rule ?

• patient should not wait longer than 5 minutes after ED arrival until being evaluated by Triage

• it is important for patient to be reassessed regularly because patient’s condition may change at any time

What is Medical screening examination (MSE) ?

• it is secondary triage

• perfomed on all patients who present to ED and request medical care

• usually performed by a doctor, trained ED nurse or medical assistant

What is the purpose of Medical Screening examination (MSE) ?

• to categorize patients into degree of urgency to be seen in ED

• to identify those patients who do not have emergency medical conditions and potentially can be referred to out-patient clinics

What is Medical screening examination (MSE) consists of ?

• to determine

• i) vital signs

• ii) mental status

• iii) general appearance

• iv) ability to walk

• v) focused physical examination

What are the pitfalls( what not to do) of ED triage ?

• failure to recognize and attend to a patient who complains of severe pain

• failure to take adequate vital signs

• failure to adequately document the triage

• failure to re-triage patients initially assigned to waiting room