Triage

Triage is the medical assessment of patients in an emergency as a means of prioritizing treatment. In the event of a mass casualty incident or other crisis when medical resources are limited, triage is used as way of quickly assessing patients' conditions and ensuring that those in the most serious condition receive treatment first. Triage plans typically include a color-coded system of classification used to categorize and identify each patient's level of need so that medical care can be provided as efficiently and effectively as possible. Many hospital emergency rooms also use triage as a way of prioritizing medical care even in noncrisis situations. The concept of triage has applications outside of medicine as well. In the context of information technology, for example, triage procedures are often used to prioritize various incoming system tasks as a way of determining the order in which each one should be addressed.

Background

French military physician Dominique-Jean Larrey first developed the concept of triage in the late eighteenth century. As Napoleon Bonaparte's chief medical officer, Larrey was a firsthand witness to the evolution of modern warfare and the increasing number of injuries that advanced weaponry and battle tactics produced. He also recognized that the traditional approach of waiting until the fighting was over and then providing treatment based on rank was outdated and inefficient. To improve the quality of battlefield medical care and make the best possible use of available resources, Larrey developed a system for sorting wounded soldiers according to the severity of their injuries and treating them based on their level of need. This system eventually came to be known as triage, a term taken from the French verb trier, which means "to sort."

The common approach to triage underwent further refinements in the nineteenth century. In 1846, British naval surgeon John Wilson suggested that patients with a reasonable chance of survival should be prioritized over those with mortal injuries so that as many lives as possible could be saved. The evolution of triage subsequently continued when the concept was later imported to the United States during the American Civil War (1861–1865). During the war, Jonathan Letterman, who served as medical director of the Army of the Potomac, meshed traditional methods of triage with frontline medical care and ambulance services to make battlefield medicine even more efficient.

Triage first gained widespread military use during World War I (1914–1918). Faced with an even greater number of injuries and casualties, battlefield medics again updated the triage system to allow for treatment of the largest number of patients in the shortest amount of time. Still, most triage systems were very simplistic and relied only on things like colored ribbons or simple symbols drawn on the skin with lipstick for the categorization of patients. Through the remainder of the twentieth century and into the twenty-first century, these simple methods continued to evolve and improve as triage was gradually implemented as a standard procedure in emergency medicine.

Overview

In modern medicine, triage is typically used in several different situations. Most often, triage is used during mass casualty incidents to determine which patients are in most urgent need of care and which can afford to wait until others have been treated. Similarly, triage is also used in crowded emergency rooms, urgent care facilities, and other walk-in clinics to determine the order in which patients are seen. Finally, triage can also be used to prioritize the use of equipment or space in a hospital or other medical facility.

There are many systems of triage that can be used in mass casualty situations. Among the most notable of these is a system known as Simple Triage and Rapid Treatment (START). In the START system, patients are divided into four possible categories. These include the deceased, the injured who can be saved with immediate treatment, the injured who do not require immediate treatment, and the injured who do not require emergency care at all. Other mass casualty triage systems use color-coded tags that are hung around the patient's neck. These tags typically come in five different colors, including red, yellow, green, white, and black. A red tag indicates a patient who cannot survive without immediate treatment but does have a chance of survival. A yellow tag indicates a patient who is in stable condition but requires close observation and eventual treatment. A green tag indicates a patient who is injured but does not require immediate treatment. A white tag indicates a patient with minor injuries who does not require treatment. A black tag indicates a patient who is deceased or so badly injured that he or she has no realistic chance of survival. Some tag-based triage systems also incorporate a blue tag that indicates patients who are gravely injured but have a slim chance of survival if resources unexpectedly become available.

The tags used in many mass casualty triage systems often provide medical professionals with much more information than just the patient's basic condition. Triage tags like Disaster Management Systems' (DMS) All-Risk Triage Tags, for example, also feature fields for a more specific descriptions of the patient's injuries, receipts for the patient's personal properties, extra tags for re-triaging patients as their conditions improve, patient identification wristbands, and more. There are also simpler triage tagging systems, such as the SMART Tag system. Although the SMART Tag system's foldout triage cards do provide space so medical professionals can record the patient's vital details, it mostly consists of a simple color-coded placard that indicates the patient's condition.

Triage systems used outside mass casualty situations are generally less complicated. In most emergency rooms and walk-in clinics, a triage nurse interviews and measures the vital signs of each patient to identify which individuals are most in need of immediate care. Those who are most in need are immediately admitted while others are required to wait until help is available.

Triage also has applications outside of medicine. Information technology professionals tasked with addressing various computer-related problems commonly use triage. In software testing, for example, testers rely on triage to determine which code errors need immediate attention and which can be repaired later.

Bibliography

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