Triage
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Triage at Major Incidents
Purpose: Sort patients rapidly so the right patient reaches the right place at the right time—ideally first time to avoid secondary transfers. Triage → Treatment → Transport is a linear process.
Where and How Often?
- Everywhere along the evacuation chain: point of wounding, Casualty Clearing Point/Station, ambulance loading, hospital arrival, and within hospital pathways.
- Dynamic: patients are re-triaged because conditions change.
Primary vs Secondary Triage
- Primary (Triage Sieve): performed at scene to identify immediate priorities and stream patients to CCP/ALS or direct P3s to distant facilities or on-site P3 areas.
- Secondary (Triage Sort): at CCP/CCS using TRTS (respiratory rate, systolic BP, GCS) and clinical judgement to refine categories.
Priority Categories
- P1 – Red (Immediate): Life-saving intervention needed now/within 1 hour.
- P2 – Yellow (Urgent): Surgery/intervention can wait ~2–4 hours.
- P3 – Green (Delayed): Treatment can safely wait ~4–6 hours—must be reviewed to catch deterioration.
- P4 – Blue (Expectant): Only used if declared at strategic level (e.g., Medical Director) when system is overwhelmed; P4 are alive and distinct from the deceased.
Deceased (Not a Triage Category)
- Diagnosed as deceased per algorithm; move to a Body Holding Area (on-scene) before transfer to a Temporary Mortuary (off-site forensic location).
Primary Triage Sieve – Key Steps
- Catastrophic haemorrhage? Control (tourniquet/haemostatic) → P1.
- Uninjured? Route to Survivor Reception Centre (police-led), not medical triage.
- Walking injured? P3.
- Not breathing? Open airway. Still apnoeic → Deceased. Breathing but unconscious → P1 (recovery position).
- Breathing rate <10 or >30 → P1. If 10–29, check pulse: >120 → P1, ≤120 → P2.
- Paediatrics: use a Paediatric Triage Tape. If unavailable, adult sieve may over-triage (acceptable until secondary triage).
Secondary Triage (Triage Sort)
- Score RR, SBP, GCS (0–4 each; total 0–12). Accuracy matters (1-point steps define categories).
- Allows clinical upgrading despite a benign score (e.g., signs of airway burn → upgrade to P1).
- In extreme surge, secondary triage may be delayed; document rationale.
Standards, Reproducibility & Training
- Use approved algorithms (board-endorsed) to reduce legal risk and ensure consistent outcomes regardless of clinician grade.
- Train higher-skilled staff to apply Sort judiciously; teach when to upgrade/downgrade.
Triage Labelling & Tracking
- Avoid single-card/tear-off-only systems that can’t adapt as patients change.
- UK practice: multi-fold A6 triage cards with barcodes, highly visible colour fascias (one visible at a time), treatment record, tear-off transport tag (vehicle, time, destination), unique ID, and CBRN pocket; waterproof and durable (night ID aided by red light sticks).
- Keep survivors out of medical triage flows; place a small medical capability at the Survivor Reception Centre to catch late presenters.
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