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Definition

The term triage, derived from the French word meaning “to sort,” in its military application involves prioritizing victims into categories based on their severity of injury, likelihood of survival, and urgency of care.

The goal of civilian prehospital triage is to identify high-risk injured patients who would benefit from the resources available in a trauma center.

Goal

The ideal tool to accomplish these two divergent tasks does not exist. Assessment must be made quickly, often under difficult conditions with limited resources, and current schemes are of limited accuracy.

Although it is easy to identify patients with severe injuries based on abnormal physiology, a more difficult problem is identification of high-risk patients whose initial physiologic status is normal.

Perhaps the most useful currently available system is that advocated by the Committee on Trauma of the American College of Surgeons, which assesses four components simultaneously:

1. Physiologic response

2. Injury anatomy

3. Injury biomechanics

4. Comorbid factors.

The goal of a trauma system is to prevent unnecessary death, and thus a certain degree of over-triage is acceptable and even desirable.

Under-triage, however, is always to be avoided because the benefits of trauma center care are withheld from a patient who is thus misclassified. Many studies have tried to determine and adjust the optimal ratio of under- and over-triage. Conventional wisdom suggests that a 50% over-triage rate may be required to minimize under-triage.

Triage can take on differing forms as the situation demands. As medical care resources become limited, alternative triage schemes may be used so that the greatest number of patients may be treated.

Such schemes may be seen in situations of multiple or mass casualties. In these cases the “most good is applied to the greatest number of patients.” This is different from our present triage scheme, whereby the most seriously injured patient receives the majority of the medical care while the less seriously injured wait for care.

Classification

The military uses a triage scheme in which patients are classified for transport as immediate, delayed, or expectant.

The method of triage widely used by municipalities is the START triage scheme, which stands for simple triage and rapid treatment. This is accomplished by color tagging of patients.

· The color red is first priority and signifies a critical patient.

· Yellow (urgent) is second priority.

· Green (minor) is a third-priority patient.

· Black represents expectant or dead patients.

The initial triage assessment components include the ability of the patient to :

· Ambulate

· Respiratory function

· Systemic perfusion

· Level of consciousness.

Patients are classified into transport categories on the basis of these assessments.