Triage

From Wikipedia, the free encyclopedia

This article is about the concept of triage as it occurs in medical emergencies
and disasters. For other uses, see Triage (disambiguation).

Typical triage tag. Note 'tear-off' sections for decontamination and patient
tracking.
Triage (pronounced /ˈtriːɑːʒ/) is a process of prioritizing patients based on the
severity of their condition. This rations patient treatment efficiently when
resources are insufficient for all to be treated immediately. The term comes from
the French verb trier, meaning to separate, sort, sift or select. [1] Two types of
triage exist: simple and advanced.[2] The outcome may result in determining the
order and priority of emergency treatment, the order and priority of emergency
transport, or the transport destination for the patient, based upon the special
needs of the patient or the balancing of patient distribution in a mass-casualty
setting.

Note: Triage has multiple meanings: The term may also hold true on a priority
basis for patients arriving at the emergency department, or to nurse-driven
telephone medical advice systems,[3] among others. This article deals with the
concept of triage as it occurs in medical emergencies, including the prehospital
setting, disasters, and during emergency room treatment.
Contents
[hide]

1 History and origin

2 Types of triage
o 2.1 Simple triage
 2.1.1 S.T.A.R.T. model
o 2.2 Advanced triage
o 2.3 Continuous integrated triage
o 2.4 Reverse triage
o 2.5 Labelling of patients
o 2.6 Undertriage and overtriage
3 Regional variation
o 3.1 United States Military
o 3.2 Canada
o 3.3 United Kingdom
o 3.4 Finland
o 3.5 France
o 3.6 Germany
o 3.7 Israel
o 3.8 Japan
4 Triage outcomes
o 4.1 Evacuation
o 4.2 Alternative care facilities
o 4.3 Secondary (in-hospital) triage
o 4.4 Hospital triage systems in the United States
5 Bioethical implications in triage
o 5.1 Ventilator rationing
6 See also

7 References
[edit]History and origin

Triage station, Suippes, France, World War I.

Only immediately life-saving treatment takes priority over triage.

Triage originated and was first formalized in World War
I by French doctors treating the battlefield wounded at the aid stations behind the
front. Much is owed to the work of Dominique Jean Larrey during the Napoleonic
Wars. Historically, a broad range of attempts occurred to triage patients, and
differing approaches and patient tagging systems used in a variety of different
countries. Triage has existed for a very long time, albeit without a particular
appellation applied to the practice. Until recently, triage results, whether
performed by a paramedic or anyone else, were frequently a matter of the 'best
guess', as opposed to any real or meaningful assessment. [4] In fact, triaging used
to be taught with an emphasis on the speed of the function, rather than the
accuracy of the outcome. At its most primitive, those responsible for the removal
of the wounded from a battlefield or their care afterwards have always divided
victims into three basic categories:


1) Those who are likely to live, regardless of what care they receive;

2) Those who are likely to die, regardless of what care they receive;

3) Those for whom immediate care might make a positive difference in
outcome.[5]

For many Emergency medical services (EMS) systems, a similar model can
sometimes still be applied. Once a full response has occurred and many hands
are available, virtually every paramedic will use the model included in their
service policy and standing orders. In the earliest stages of an incident, however,
when one or two paramedics exist to twenty or more patients, practicality
demands that the above model will be used. As in virtually all aspects of EMS,
there are times when 'back to basics' is the only approach that will be effective.

Modern approaches to triage are more scientific. The outcome and grading of the
victim is frequently the result of physiological and assessment findings. Some
models, such as the START model, are committed to memory, and may even
be algorithm-based. As triage concepts become more sophisticated, triage
guidance is also evolving into both software and hardware decision support
products for use by caregivers in both hospitals and the field.[6]
[edit]Types of triage
[edit]Simple triage
Simple triage is usually used in a scene of a "mass-casualty incident" (MCI), in
order to sort patients into those who need critical attention and immediate
transport to the hospital and those with less serious injuries. This step can be
started before transportation becomes available. The categorization of patients
based on the severity of their injuries can be aided with the use of printed triage
tags or colored flagging.[7]
[edit]S.T.A.R.T. model
Main article: Simple triage and rapid treatment
S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple triage system that
can be performed by lightly-trained lay and emergency personnel in
emergencies.[8] It is not intended to supersede or instruct medical personnel or
techniques. It may serve as an instructive example, and has been (2003) taught
to California emergency workers for use in earthquakes. It was developed at
Hoag Hospital in Newport Beach, California for use by emergency services. It
has been field-proven in mass casualty incidents such as train wrecks and bus
accidents, though it was developed for use by community emergency response
teams (CERTs) and firefighters after earthquakes.

Triage separates the injured into four groups:

 0 The deceased who are beyond help

 1 The injured who can be helped by immediate transportation
 2 The injured whose transport can be delayed
 3 Those with minor injuries, who need help less urgently

[edit]Advanced triage
In advanced triage, doctors may decide that some seriously injured people
should not receive advanced care because they are unlikely to survive.
Advanced care will be used on patients with less severe injuries. Because
treatment is intentionally withheld from patients with certain injuries, advanced
triage has ethical implications. It is used to divert scarce resources away from
patients with little chance of survival in order to increase the chances of survival
of others who are more likely to survive.

In Western Europe, the criterion used for this category of patient is a trauma
score of consistently at or below 3. This can be determined by using the
Triage Revised Trauma Score (TRTS), a medically-validated scoring system
incorporated in some triage cards.[9]
Another example of a trauma scoring system is the Injury Severity Score (ISS).
This assigns a score from 0 to 75 based on severity of injury to the human body
divided into three categories: A (face/neck/head), B(thorax/abdomen),
C(extremities/external/skin). Each category is scored from 0 to 5 using the
Abbreviated Injury Scale, from uninjured to critically injured, which is then
squared and summed to create the ISS. A score of 6, for "unsurvivable", can also
be used for any of the three categories, and automatically sets the score to 75
regardless of other scores. Depending on the triage situation, this may indicate
either that the patient is a first priority for care, or that he or she will not receive
care due to the need to conserve care for more likely survivors.
The use of advanced triage may become necessary when medical professionals
decide that the medical resources available are not sufficient to treat all the
people who need help. The treatment being prioritized can include the time spent
on medical care, or drugs or other limited resources. This has happened in
disasters such as volcanic eruptions, thunderstorms, and rail accidents. In these
cases some percentage of patients will die regardless of medical care because of
the severity of their injuries. Others would live if given immediate medical care,
but would die without it.

In these extreme situations, any medical care given to people who will die
anyway can be considered to be care withdrawn from others who might have
survived (or perhaps suffered less severe disability from their injuries) had they
been treated instead. It becomes the task of the disaster medical authorities to
set aside some victims as hopeless, to avoid trying to save one life at the
expense of several others.

If immediate treatment is successful, the patient may improve (although this may
be temporary) and this improvement may allow the patient to be categorized to a
lower priority in the short term. Triage should be a continuous process and
categories should be checked regularly to ensure that the priority remains
correct. A trauma score is invariably taken when the victim first comes into
hospital and subsequent trauma scores taken to see any changes in the victim's
physiological parameters. If a record is maintained, the receiving hospital doctor
can see a trauma score time series from the start of the incident, which may allow
definitive treatment earlier.
Typical triaging systems

SMART TAG system. Note METTAG system in Japanese. Even simple tape can
the bar code for patient be used as a last
tracking. resort.
[edit]Continuous integrated triage
Continuous Integrated Triage is an approach to triage in mass casualty situations
which is both efficient and sensitive to psychosocial and disaster behavioral
health issues that affect the number of patients seeking care (surge), the manner
in which a hospital or healthcare facility deals with that surge (surge capacity)
[10]
and the overarching medical needs of the event.

Continuous Integrated Triage combines three forms of triage with progressive

specificity to most rapidly identify those patients in greatest need of care while
balancing the needs of the individual patients against the available resources and
the needs of other patients. Continuous Integrated Triage employs:


Group (Global) Triage (i.e., M.A.S.S. triage)[11]

Physiologic (Individual) Triage (i.e., S.T.A.R.T.)

Hospital Triage (i.e., E.S.I. or Emergency Severity Index)

However any Group, Individual and/or Hospital Triage system can be used at the
appropriate level of evaluation.
[edit]Reverse triage
In addition to the standard practices of triage as mentioned above, there are
conditions where sometimes the less wounded are treated in preference to the
more severely wounded. This may arise in a situation such as war where the
military setting may require soldiers be returned to combat as quickly as possible,
or disaster situations where medical resources are limited in order to conserve
resources for those likely to survive but requiring advanced medical care.
[12]
Other possible scenarios where this could arise include situations where
significant numbers of medical personnel are among the affected patients where
it may be advantageous to ensure that they survive to continue providing care in
the coming days especially if medical resources are already stretched. In cold
water drowning incidents, it is common to use reverse triage because drowning
victims in cold water can survive longer than in warm water if given
immediate basic life support and often those who are rescued and able to
breathe on their own will improve with minimal or no help. [13]
[edit]Labelling of patients
Many triage systems are now computerized
Upon completion of the initial assessment by medical or paramedical personnel,
each patient will be labelled with a device called a triage tag. This will identify the
patient and any assessment findings and will identify the priority of the patient's
need for medical treatment and transport from the emergency scene. Triage tags
may take a variety of forms. Some countries use a nationally standardized triage
tag,[14] while in other countries commercially available triage tags are used, and
these will vary by jurisdictional choice.[15] The most commonly used commercial
systems include the METTAG,[16] the SMARTTAG,[17] and the CRUCIFORM
systems.[18] More advanced tagging systems incorporate special markers to
indicate whether or not patients have been contaminated by hazardous
materials, and also tear off strips for tracking the movement of patients through
the process. Some of these tracking systems are beginning to incorporate the
use of handheld computers, and in some cases, bar code scanners. At its most
primitive, however, patients may be simply marked with coloured tape, or with
marker pens, when triage tags are either unavailable or insufficient.
[edit]Undertriage and overtriage
Undertriage and overtriage are two key concepts that are imperative to
understanding the triage process. Undertriage is the process of underestimating
the severity of an illness or injury. An example of this would be categorizing a
Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal).
Historically, acceptable undertriage rates have been deemed 5% or less.
Overtriage is the process of overestimating the level to which an individual has
experienced an illness or injury. An example of this would be categorizing a
Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate).
Acceptable overtriage rates have been typically up to 50% in an effort to avoid
undertriage. Some studies suggest that overtriage is less likely to occur when
triaging is performed by hospital medical teams, rather than paramedics or EMTs.
[19]

[edit]Regional variation
[edit]United States Military
Triage in a non-combat situation is conducted much the same as in civilian
medicine. A battlefield situation, however, requires medics and corpsmen to rank
casualties for precedence inMEDEVAC or CASEVAC. The triage categories (with
corresponding color codes), in precedence, are:


Immediate: The casualty requires immediate medical attention and will
not survive if not seen soon. Any compromise to the casualty's respiration,
hemorrhage control, or shock control could be fatal.

Delayed: The casualty requires medical attention within 6 hours. Injuries
are potentially life-threatening, but can wait until the Immediate casualties are
stabilized and evacuated.

Minimal: "Walking wounded," the casualty requires medical attention
when all higher priority patients have been evacuated, and may not require
stabilization or monitoring.

Expectant: The casualty is expected not to reach higher medical support
alive without compromising the treatment of higher priority patients. Care
should not be abandoned, spare any remaining time and resources after
Immediate and Delayed patients have been treated. [20]

Afterwards, casualties are given an evacuation priority based on need:

 Urgent: evacuation is required within two hours to save life or limb.

 Priority: evacuation is necessary within four hours or the casualty will
deteriorate to "Urgent".
 Routine: evacuate within 24 hours to complete treatment.

In a "naval combat situation", the triage officer must weigh the tactical situation
with supplies on hand and the realistic capacity of the medical personnel. This
process can be ever-changing, dependent upon the situation and must attempt to
do the maximum good for the maximum number of casualties. [21]

Field assessments are made by two methods: primary survey (used to detect &
treat life-threatening injuries) and secondary survey (used to treat non-life
threatening injuries) with the following categories:

 Class I Patients who require minor treatment and can return to duty in a
short period of time.
 Class II Patients whose injuries require immediate life sustaining
measures.
 Class III Patients for whom definitive treatment can be delayed without
loss of life or limb.
 Class IV Patients requiring such extensive care beyond medical
personnel capability and time.

[edit]Canada
In the mid-1980s, The Victoria General Hospital, in Halifax, Nova Scotia, Canada,
introduced paramedic triage in its Emergency Department. Unlike all other
centres in North America that employ physician and primarily nurse triage
models, this hospital began the practice of employing Primary Care level
paramedics to perform triage upon entry to the Emergency Department. In 1997,
following the amalgamation of two of the city's largest hospitals, the Emergency
Department at the Victoria General closed. The paramedic triage system was
moved to the city's only remaining adult emergency department, located at the
New Halifax Infirmary. In 2006, a triage protocol on whom to exclude from
treatment during a flu pandemic was written by a team of critical-care doctors at
the behest of the Ontario government.
For routine emergencies, many locales in Canada now employ the Canadian
Triage and Acuity Scale for all incoming patients. [22] The system categorizes
patients by both injury and physiological findings, and ranks them by severity
from 1-5. The model is used by both paramedics and E/R nurses, and also for
pre-arrival notifications in some cases. The model provides a common frame of
reference for both nurses and paramedics, although the two groups do not
always agree on scoring (particularly when there is a shortage of available beds
in the E/R) results. It also provides a method, in some communities,
for benchmarking the accuracy of pre-triage of calls using AMPDS (What
percentage of Delta calls have return priorities of CTAS 1,2,3, etc.)and these
findings are reported as part of a municipal performance benchmarking initiative
in Ontario. Curiously enough the model is not currently used for mass casualty
triage, and is replaced by the START protocol and METTAG triage tags. [23]
[edit]United Kingdom
In the UK, the commonly used triage system is the Smart Incident Command
System, taught on the MIMMS (Major Incident Medical Management (and)
Support) training program.[24]The UK Armed Forces are also using this system on
operations worldwide. This grades casualties from Priority 1 (most urgent) to
Priority 4 (expectant, i.e. likely to die). [25]

In the UK and Europe, the triage process used is sometimes similar to that of the
United States, but the categories are different [26]:

 Dead - patients who have a trauma score of 0 to 2 and are beyond help
 Immediate - patients who have a trauma score of 3 to 10 (RTS) and need
immediate attention
 Urgent - patients who have a trauma score of 10 or 11 and can wait for a
short time before transport to definitive medical attention
 Delayed - patients who have a trauma score of 12 (maximum score) and
can be delayed before transport from the scene

[edit]Finland
Triage at an accident scene is performed by a paramedic or an emergency
physician, using the four-level scale of Cannot wait, Has to wait, Can
wait and Lost.
[edit]France
In France, the triage in case of a disaster uses a four-level scale:

 DCD: décédé (deceased), or urgence dépassée (beyond urgency)

 UA: urgence absolue (absolute urgency)
 UR: urgence relative (relative urgency)
 UMP: urgence médico-psychologique (medical-psychological urgency)
or impliqué (implied, i.e. lightly wounded or just psychologically shocked).

This triage is performed by a physician called médecin trieur (sorting medic).

[27]
This triage is usually performed at the field hospital (PMA–poste médical
avancé, i.e. forward medical post). The absolute urgencies are usually treated
onsite (the PMA has an operating room) or evacuated to a hospital. The relative
urgencies are just placed under watch, waiting for an evacuation. The involved
are addressed to another structure called the CUMP–Cellule d'urgence médico-
psychologique (medical-psychological urgency cell); this is a resting zone, with
food and possibly temporary lodging, and a psychologist to take care of the brief
reactive psychosis and avoid post-traumatic stress disorder.

In the emergency room of a hospital, the triage is performed by a physician

called MAO–médecin d'accueil et d'orientation (reception and orientation
physician), and a nurse called IOA–infirmière d'organisation et
d'accueil (organisation and reception nurse). Some hospitals and SAMU
organisations now use the "Cruciform" card referred to elsewhere.
[edit]Germany
Preliminary assessment of injuries is usually done by the first ambulance crew on
scene, with this role being assumed by the first Notarzt arriving at the scene. As
a rule, there will be nocardiopulmonary resuscitation, so patients who do not
breathe on their own or develop circulation after their airways are cleared, will be
tagged "deceased". Also, not every major injury automatically qualifies for a red
tag. A patient with a traumatic amputation of the forearm might just be tagged
yellow, have the bleeding stopped, and then be sent to a hospital when possible.
After the preliminary assessment, a more specific and definite triage will follow,
as soon as patients are brought to a field treatment facility. There, they will be
disrobed and fully examined by an emergency physician. This will take
approximately 90 seconds per patient.[28]

The German triage system also uses 4, sometimes 5 colour codes to denote the
urgency of treatment.[29] Typically, every ambulance is equipped with a folder or bag
with coloured ribbons or triage tags. The urgency is denoted as follows:

category meaning consequences examples

immediate treatment, arterial lesions, internal

acute danger
T1 (I) transport as soon as haemorrhage, major
for life
possible amputations

T2 (II) severe injury constant observation minor amputations, flesh

 and rapid treatment,
wounds, fractures and
transport as soon as
dislocations
practical

treatment when
minor injury practical, transport minor lacerations, sprains,
T3 (III)
or no injury and/or discharge when abrasions
possible

severe injuries,
no or small observation and if
uncompensated blood loss,
T4 (IV) chance of possible administration
negative neurological
survival of analgesics
assessment

dead on arrival, downgraded

collection and guarding
from T1-4, no spontaneous
T5 (V) deceased of bodies, identification
breathing after clearing of
when possible
airway

[edit]Israel
A simplified but effective description of the S.T.A.R.T. is taught in the Israeli
army to non-medical personnel: the injured who are lying on the ground silently
should be prepared forimmediate transportation; injured lying on the ground but
screaming are injured whose transportation can be delayed; and the walking
wounded need help less urgently.[30] Non-medical personnel have no authority to
tag an injured person as deceased.
[edit]Japan
In Japan, the triage system is mainly used by health professionals. The
categories of triage, in corresponding color codes, are:

 Category I: Used for viable victims with potentially life threatening

conditions.
 Category II: Used for victims with non-life threatening injuries, but who
urgently require treatment.
 Category III: Used for victims with minor injuries that do not require
ambulance transport.
 Category 0: Used for victims who are dead, or whose injuries make
survival unlikely.

[edit]Triage outcomes
[edit]Evacuation
Simple triage identifies which people need advanced medical care. In the field,
triage also sets priorities for evacuation to hospitals.[31] In S.T.A.R.T., casualties
should be evacuated as follows:

 Deceased are left where they fell, covered if necessary; note that in
S.T.A.R.T. a person is not triaged "deceased" unless they are not breathing
and an effort to reposition their airway has been unsuccessful.
 Immediate or Priority 1 (red) evacuation by MEDEVAC if available
or ambulance as they need advanced medical care at once or within 1 hour.
These people are in critical condition and would die without immediate
assistance.
 Delayed or Priority 2 (yellow) can have their medical evacuation delayed
until all immediate persons have been transported. These people are in stable
condition but require medical assistance.
 Minor or Priority 3 (green) are not evacuated until
all immediate and delayed persons have been evacuated. These will not need
advanced medical care for at least several hours. Continue to re-triage in
case their condition worsens. These people are able to walk, and may only
require bandages and antiseptic.

[edit]Alternative care facilities

Alternative care facilities are places that are setup for the care of large numbers
of patients, or are places that could be so set up. Examples include schools,
sports stadiums, and large camps that can be prepared and used for the care,
feeding, and holding of large numbers of victims of a mass casualty or other type
of event.[32] Such improvised facilities are generally developed in cooperation with
the local hospital, which sees them as a strategy for creating surge capacity.
While hospitals remain the preferred destination for all patients, during a mass
casualty event such improvised facilities may be required in order to divert low-
acuity patients away from hospitals in order to prevent the hospitals becoming
overwhelmed.
[edit]Secondary (in-hospital) triage
In advanced triage systems, secondary triage is typically implemented
by paramedics, battlefield medical personnel or by skilled nurses in the
emergency departments of hospitals during disasters, injured people are sorted
into five categories.[33]

(Black / Expectant: They are so severely injured that they will die of their injuries,
possibly in hours or days (large-area burns, severe trauma, lethal radiation
dose), or in life-threatening medical crisis that they are unlikely to survive given
the care available (cardiac arrest, septic shock, severe head or chest wounds);
they should be taken to a holding area and givenpainkillers as required to reduce
suffering.

 Red / Immediate: They require immediate surgery or other life-saving

intervention, and have first priority for surgical teams or transport to advanced
facilities; they "cannot wait" but are likely to survive with immediate treatment.
 Yellow / Observation: Their condition is stable for the moment but requires
watching by trained persons and frequent re-triage, will need hospital care
(and would receive immediate priority care under "normal" circumstances).
 Green / Wait (walking wounded): They will require a doctor's care in
several hours or days but not immediately, may wait for a number of hours or
be told to go home and come back the next day (broken bones without
compound fractures, many soft tissue injuries).
 White / Dismiss (walking wounded):They have minor injuries; first aid and
home care are sufficient, a doctor's care is not required. Injuries are along the
lines of cuts and scrapes, or minor burns.

Note that this scale is more complex than simple triage. Medical professionals
should refer to professional texts and training references when implementing
advanced triage; this listing is only for a layman's understanding.

Some crippling injuries, even if not life-threatening, may be elevated in priority

based on the available capabilities. During peacetime, most amputations may be
triaged "Red" because surgical reattachment must take place within minutes,
even though in all probability the person will not die without a thumb or hand.
[edit]Hospital triage systems in the United States
Within the hospital system, the first stage on arrival at the emergency room is
assessment by the hospital triage nurse. This nurse will evaluate the patient's
condition, as well as any changes, and will determine their priority for admission
to the Emergency Room and also for treatment. [34] Once emergency assessment
and treatment are complete, the patient may need to be referred to the hospital's
internal triage system.

For a typical inpatient hospital triage system, a triage physician will either field
requests for admission from the ER physician on patients needing admission or
from physicians taking care of patients from other floors who can be transferred
because they no longer need that level of care (i.e. intensive care unit patient is
stable for the medical floor). This helps keep patients moving through the hospital
in an efficient and effective manner.

This triage position is often done by a hospitalist. A major factor contributing to

the triage decision is available hospital bed space. The triage hospitalist must
determine, in conjunction with a hospital's "bed control" and admitting team, what
beds are available for optimal utilization of resources in order to provide safe
care to all patients. A typical surgical team will have their own system of triage for
trauma and general surgery patients. This is also true
for neurology and neurosurgical services. The overall goal of triage, in this
system, is to both determine if a patient is appropriate for a given level of care
and to ensure that hospital resources are utilized effectively.
[edit]Bioethical implications in triage

Bioethical concerns have historically played an important role in triage decisions,

such as the allocation of iron lungs during the polio epidemics of the 1940s and
of dialysis machinesduring the 1960s.[35] As many health care systems in the
developed world continue to plan for an expected influenza
pandemic, bioethical issues regarding the triage of patients and the rationing of
care continue to evolve. Similar issues may occur for paramedics in the field in
the earliest stages of mass casualty incidents when large numbers of potentially
serious or critical patients may be combined with extremely limited staffing and
treatment resources.
[edit]Ventilator rationing
In a potential influenza pandemic, it is anticipated that, as hospitals and
treatment centers become overwhelmed, shortages of critical equipment such
as ventilators will occur. Medications may run short. Supply chains may fail.
Methods will be required for determining who will receive access to life saving
technologies, and who will not. For example, if a hypothetical emergency
department has all three of its ventilators currently in use for elderly patients with
influenza, who will not survive without them, how should it act when paramedics
arrive with a forty year old, otherwise healthy patient who is being ventilated due
to influenza, but for whom no hospital ventilator is currently available. A similar
concern arises as to whether long-term patients in chronic care facilities should
be removed from life-support to provide their ventilators to acutely ill influenza
patients.[36]

A New York State Workgroup headed by psychiatrist Tia Powell proposed

guidelines for such triage in 1997.[37][38] The Workgroup excluded certain groups
of patients from eligibility for life support during a pandemic: those with metastatic
cancer, severe brain damage, multiple cardiac arrests and organ failure. Among
those excluded were dialysis patients. Emergency medicine expert Art Kellerman
of Emory University has argued that "[t]his kind of thinking, as scary or even
horrifying as it may seem, is absolutely critical and is much better done now than
on the fly in the middle of a pandemic." [39]

Around the world, practitioners, bioethicists and others are wrestling with these
questions. Research continues into alternative care, and various centers propose
medical decision-support models for such situations. [40] Some of these models
are purely ethical in origin, while others attempt to use other forms of clinical
classification of patient condition as a method of standardized triage. [41]
[edit]See also

 Battlefield medicine
 Combat stress reaction
 First aid
 Mass decontamination
 Remote Physiological Monitoring
 Wilderness first aid
 Mental health triage - brief overview of the Australian concept for dealing
with psychiatric emergencies, similar to physical triage.
 Field Triage
[edit]References

Wikimedia
Commons has
media related
to: Triage

Look
up triage in Wiktionary,
the free dictionary.

1. ^ "Merriam-Webster Online Dictionary". Retrieved 2008-12-05.

2. ^ "Merriam-Webster Online Dictionary". Retrieved 2008-12-02.
3. ^ "NHS Direct website". Retrieved 2008-12-02.
4. ^ Iserson KV, Moskop JC (March 2007). "Triage in medicine, part I:
Concept, history, and types". Ann Emerg Med 49 (3): 275–
81.doi:10.1016/j.annemergmed.2006.05.019. PMID 17141139.
5. ^ Chipman M, Hackley BE, Spencer TS (February 1980). "Triage of mass
casualties: concepts for coping with mixed battlefield injuries". Mil
Med 145 (2): 99–100.PMID 6768037.
6. ^ [www.nrccnrc.gc.ca/highlights/2006/0606triage_e.html "Transforming
Triage Technology (National Research Council of Canada website)"].
Retrieved 2008-12-02.
7. ^ "Webster's ONline Dictionary". Retrieved 2008-12-02.
8. ^ Burstein, Jonathan L.; Hogan, David (2007). Disaster medicine.
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
pp. 25. ISBN 0-7817-6262-6.
9. ^ "The Field Triage (European Trauma Course)". Retrieved 2008-12-02.
10. ^ "Medical Surge Capacity and Capability". Retrieved 2008-12-04.
11. ^ "National Disaster Life Support Foundation website". Retrieved 2008-
12-04.
12. ^ "Military Triage". Retrieved 2008-12-04.
13. ^ Elixson EM (June 1991). "Hypothermia. Cold-water drowning". Crit Care
Nurs Clin North Am 3 (2): 287–92. PMID 2054134.
14. ^ Idoguchi K, Mizobata Y, et al. (2006). "Usefulness of Our Proposed
Format of Triage Tag". Journal of Japanese Association for Acute
Medicine 17 (5): 183–191.
15. ^ Nocera A, (Winter 2000). "Australian disaster triage: a colour maze in
the Tower of Babel". Australian Journal of Emergency Management: 35–
40.
16. ^ "METTAG Corporate website". Retrieved 2008-12-05.
17. ^ "Smart Triage Tag (TSG Associates Corporate website". Retrieved
2008-12-05.
18. ^ Lakha, Raj; Tony Moore (2006). Tolley's handbook of disaster and
emergency management. Amsterdam: Elsevier. ISBN 0-7506-6990-X.
19. ^ Turegano-Fuentes F, Perez-Diaz D et al. (2008). "Overall Assessment
of the Response to Terrorist Bombings in Trains, Madrid, 11 March
2004". European Journal of Trauma and Emergency Surgery 34 (5): 433–
441.doi:10.1007/s00068-008-8805-2.
20. ^ "US Army Study Guide". Retrieved 2008-12-04.
21. ^ Koehler RH, Smith RS, Bacaner T (August 1994). "Triage of American
combat casualties: the need for change". Mil Med 159 (8): 541–
7. PMID 7824145.
22. ^ "Canadian Triage and Acuity Scale (Canadian Association of
Emergency Physicians website)". Retrieved 2008-12-02.
23. ^ "METTAG Triage Tags". Retrieved 2008-12-02.
24. ^ "Major Incident Medical Management and Support Course". Retrieved
2008-12-04.
25. ^ Ryan J (2008). "Triage: Principles and Pressures". European Journal of
Trauma and Emergency Surgery 34 (5): 427–432. doi:10.1007/s00068-
008-8805-2.
26. ^ Jill Windle; Manchester Triage Group Staff; Mackway-Jones, Kevin;
Marsden, Janet (2006). Emergency triage. Cambridge, MA: Blackwell
Pub. ISBN 0-7279-1542-8.
27. ^ David L. Hoyt; Wilson, William J.; Grande, Christopher M.
(2007). Trauma. Informa Healthcare. ISBN 0-8247-2919-6.
28. ^ "Telemedical support of emergency prehospital care in mass casualty
incidents". Retrieved 2008-12-04.
29. ^ Beck A, Bayeff-Filloff M, Bischoff M, Schneider BM (November 2002).
"[Analysis of the incidence and causes of mass casualty events in a
southern Germany medical rescue area]" (in
German). Unfallchirurg 105(11): 968–73. doi:10.1007/s00113-002-0516-
2. PMID 12402122.
30. ^ "Magen David Adom: The EMS Israeli Experience". Retrieved 2008-12-
05.
31. ^ "Code Orange Plan (Assiniboine Regional Health Authority)". Retrieved
2008-12-05.
32. ^ "Chapter 8: Clinical and Public Health Systems Issues Arising from the
Outbreak of Sars in Toronto (Public Health Agency of Canada website)".
Retrieved 2008-12-05.
33. ^ Mehta S (April 2006). "Disaster and mass casualty management in a
hospital: How well are we prepared?". J Postgrad Med 52 (2).
34. ^ Slater RR (January 1970). "Triage nurse in the emergency
department". Am J Nurs 70 (1): 127–
9. doi:10.2307/3421031. PMID 5196143.
35. ^ The Coming Ethical Crisis: Oxygen Rationing
36. ^ The Coming Ethical Crisis: Oxygen Rationing
37. ^ Guidelines
38. ^ Cornelia Dean, Guidelines for Epidemics: Who Gets a Ventilator?, The
New York Times, March 25, 2008
39. ^ Cornelia Dean, Guidelines for Epidemics: Who Gets a Ventilator?, The
New York Times, March 25, 2008
40. ^ "Who dies, who doesn't: docs decide flu pandemic guidelines (CBC
News Item)". Retrieved 2008-12-02.
41. ^ Christian MD, Hawryluck L, Wax RS, et al. (November
2006). "Development of a triage protocol for critical care during an
influenza pandemic". CMAJ 175 (11): 1377–
81. doi:10.1503/cmaj.060911.PMID 17116904.