Triage

Dr. Mithrajee Premaratne

Lady Ridgeway Hospital

Outline

• Aims of Triage

• Types of Triage

• ATS Scale

• Case study

2

Aims of triage

• To ensure that patients are treated in order of their clinical urgency

• To ensure that treatment is appropriate and timely

• To allocate the patient to the most appropriate assessment and treatment area

3

What are the principles of triage?

The first patient to be managed will be:

• The patient with the most immediately life-threatening injury

AND• The patient whose injury can be managed

with the resources available

4

What types of triage do you know?

Multiple casualties• The number of patients and their severity of injuries do

not exceed the resources of the treatment facility

Mass casualties• The number of patients and their severity of injuries

exceed the capability of the treatment facility

5

CCDM

Disaster Triage

• Four categories

• IMMEDIATE (Red), Highest Priority

• DELAYED (Yellow), Second Priority

• MINOR (Green), Third Priority

• DEAD/DYING (Black), Last Priority

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CCDMDELAYED

PRIORITY 3

DEAD

BREATHING BREATHING

WALKING

OPEN

AIRWAY

YES

YESYES

NO

NO

RESPIRATORY

RATE

IMMEDIATEIMMEDIATE

PRIORITY 1PRIORITY 1

PULSE

RATE

URGENT

PRIORITY 2

NO

10 or less30 or more

11 - 29

under 120/min

over 120/m

in

Capillary refill test (CRT) is an alternative to pulse rate, but is unreliable in the cold or dark: when used, a CRT >2 secs indicates PRIORITY 1

INJURED

NOT

INJURED

SURVIVOR RECEPTION CENTRE

Keep a record of the NUMBER and PRIORITY of casualties you triage

Pass this to the AMBULANCE COMMANDER on completion

Triage in A & E

• Instead of "Who should be seen first?" should answer "How long can each patient safely wait?" when assign the triage category.

• Aim is to get the right patient to the right resources at the right place and the right time.

• The triage assessment should generally take no more than two to five minutes

Triage

• First point of public contact with the Emergency Department

• Assessment between 2-5 minutes

• Combination of general appearance and physiological observations. Always A,B,C,D

11

TRIAGE SCALE CATEGORY AustraliaMaximum waiting time

Sri LankaMaximum waiting time

Category 1 ( Red) Immediate (Resuscitation)

Immediate Immediate

Category 2 ( orange) Emergency 10 min

10 minutes

Category 3 ( Yellow)Urgent

30 min 20 minutes

Category 4 ( green)Semi urgent ( standard)

60 min 30 minutes

Category 5 ( Blue) Non Urgent

120 min 40minutes or ref to OPD

ATS 1 Immediately Life Threatening

• Cardiac/Respiratory Arrest• Immediate Risk to airway• Extreme respiratory distress• RR <10/min• BP < 80mmHg (adult)• GCS <9

13

ATS 2Imminently life-threatening • Airway risk

• Severe respiratory distress• Circulatory compromise• GCS < 13• Major multi trauma• Cardiac Chest pain• Severe pain ( Pain > 7/10 ) 14

ATS 3Potentially Life-Threatening

• Head injury with short LOC- now alert • Moderately severe pain– any cause – requiring analgesia • Chest pain -non-cardiac• Abdominal pain without high risk features • Behavioural/Psychiatric: very distressed, risk of self-harm

15

ATS 4Potentially serious

• Vomiting or diarrhoea without dehydration • Eye inflammation or foreign body – normal vision • Minor limb trauma – sprained ankle, possible fracture,

uncomplicated• Behavioural/Psychiatric: no immediate risk to self or others

16

ATS 5Potentially serious

• Vomiting or diarrhoea without dehydration • Eye inflammation or foreign body – normal vision • Minor limb trauma – sprained ankle, possible fracture,

uncomplicated• Behavioural/Psychiatric: no immediate risk to self or others

17

What Have You learned?