Dr. Mithrajee Premaratne Lady Ridgeway Hospital

1. Triage
Dr. Mithrajee Premaratne
Lady Ridgeway Hospital

2. Outline
• Aims of Triage
• Types of Triage
• ATS Scale
• Case study
2

3. 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

4. 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

5. 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

7. CC
DM

8. 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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9. CC
DELAYED DM
PRIORITY 3
DEAD
WALKING
INJURED
NOT
INJURED
SURVIVOR
RECEPTION CENTRE
OPEN
AIRWAY
YES
BREATHING BREATHING
YES
YES
NO
NO
RESPIRATORY
RATE
IIMMMMEEDDIIAATTEE
PPRRIIOORRIITTYY 11
PULSE
RATE
URGENT
PRIORITY 2
NO
10 or less
30 or more
11 - 29
over 120/min
under 120/min
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
Keep a record of the NUMBER and PRIORITY of
casualties you triage
Pass this to the AMBULANCE COMMANDER on
completion

10. 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

11. 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

12. TRIAGE SCALE CATEGORY Australia
Maximum waiting time
Sri Lanka
Maximum 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

13. ATS 1
Immediately Life Threatening
• Cardiac/Respiratory Arrest
• Immediate Risk to airway
• Extreme respiratory distress
• RR <10/min
• BP < 80mmHg (adult)
• GCS <9
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14. ATS 2
• AirwImay mrisiknently life-threatening
• Severe respiratory distress
• Circulatory compromise
• GCS < 13
• Major multi trauma
• Cardiac Chest pain
• Severe pain ( Pain > 7/10 ) 14

15. ATS 3
• Head injury with short LOC- now alert
• Moderately Potentially severe pain– Life-any cause Threatening
– requiring analgesia
• Chest pain -non-cardiac
• Abdominal pain without high risk features
• Behavioural/Psychiatric: very distressed, risk of self-harm
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16. ATS 4
• Vomiting or diarrhoea without dehydration
• Eye inflammation Potentially or foreign body serious
– normal vision
• Minor limb trauma – sprained ankle, possible fracture,
uncomplicated
• Behavioural/Psychiatric: no immediate risk to self or others
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17. ATS 5
• Vomiting or diarrhoea without dehydration
• Eye inflammation Potentially or foreign body serious
– normal vision
• Minor limb trauma – sprained ankle, possible fracture,
uncomplicated
• Behavioural/Psychiatric: no immediate risk to self or others
17

23. What Have You learned?