From the Guidelines
Medical emergency triage typically consists of four main levels that help healthcare providers prioritize patient care based on severity, as outlined in the guidelines for field triage of injured patients: recommendations of the national expert panel on field triage, 2011 1.
Triage Levels
The main triage levels are:
- Level 1: Patients with immediately life-threatening conditions requiring immediate intervention, such as cardiac arrest or severe trauma.
- Level 2: Patients with high-risk conditions that could rapidly deteriorate, like chest pain or severe breathing difficulties, with treatment needed within a short timeframe.
- Level 3: Patients with serious conditions requiring treatment within a moderate timeframe, such as moderate pain or mild respiratory distress.
- Level 4: Patients with minor injuries or illnesses who can safely wait for treatment.
Decision Scheme
The decision scheme for field triage involves assessing vital signs and level of consciousness, anatomy of injury, mechanism of injury, and special patient or system considerations 1.
- Step One: Measure vital signs and level of consciousness, and assess for severe injuries such as penetrating injuries to the head, neck, torso, and extremities.
- Step Two: Assess anatomy of injury, including amputations, pelvic fractures, and flail chest.
- Step Three: Assess mechanism of injury, including high-risk auto crashes, falls, and motorcycle crashes.
- Step Four: Assess special patient or system considerations, including age, anticoagulation, and burns.
Transportation
Patients who meet certain criteria should be transported to a trauma center, which may depend on the trauma system and the patient's condition 1.
- Patients with severe injuries or high-risk conditions should be transported to a Level I or Level II trauma center.
- Patients with less severe injuries may be transported to a lower-level trauma center or community emergency department.
Key Considerations
The guidelines emphasize the importance of accurate triage decisions to ensure that patients receive the appropriate level of care in a timely manner 2.
- Undertriage can result in patients not receiving the specialized trauma care they require, while overtriage can consume scarce resources unnecessarily.
- The risk of death for severely injured patients is 25% lower if they receive care at a Level I trauma center 2.
From the Research
Triage Levels
The main triage levels in a medical emergency can be categorized into different systems, including:
- The Australasian Triage Scale (ATS) which allows categorization based on symptoms using specific descriptors 3
- The Manchester Triage System (MTS) which uses defined presentational flow charts combined with indicators 3
- The Canadian Triage and Acuity Scale (CTAS) which is based on the ATS, but also includes diagnoses 3
- The Emergency Severity Index (ESI) which first excludes life-threatening and severe disease before stratification according to estimated resource utilization 3
Triage Systems
These triage systems are internationally accepted and facilitate the categorization of emergency patients according to their disease severity, determining both treatment priority and treatment location 3. The goal of all triage systems is to reduce in-hospital mortality and to minimize time to treatment, length of stay, and resource utilization 3.
Triage Categories
Some studies also mention an "expectant" triage category, which identifies patients for whom further resuscitation is delayed due to a poor chance of survival and significant resource requirements 4. Additionally, triage groups can be divided into those returning to fighting role and those who have to be evacuated to a higher level of care 5.
Triage Levels Comparison
A comparison of 4-level and 5-level triage systems found that introducing a 5-level triage system improved emergency department performance and patient care, with a decreased trend in under-triage and a slight rise in over-triage 6. However, the experiences of pre-hospital emergency medicine triage performed by General Practitioners (GPs) in a community setting showed that downgrading of patients between notification of events and actual patient examination occurred in a substantial proportion of cases, while upgradings were fewer but warranted individual scrutiny 7.