When used in medicine and healthcare, the term "triage" refers to a sorting of injured or sick people according to their need for emergency medical attention. Used to determine priority for who gets care first, triage may be performed by anyone from emergency medical technicians (EMTs) to emergency room gatekeepers, from soldiers on a battlefield to anyone with knowledge of the system who finds himself or herself in an unusual emergency situation.
The word "triage" comes from the French word trier, which means to sort or select. Its historic roots for medical purposes go back to the days of Napoleon, when triaging large groups of wounded soldiers was necessary. Over the centuries, triage systems have evolved into a very well-defined priority process, sometimes requiring specific training depending on the setting or organization that uses the system.
Triage is used when the medical-care system is overloaded, meaning there are more people who need care than there are available resources to care for them. There may be mass casualties in a war zone or in an earthquake or other natural disaster that results in many injuries. There may be need for triage when a school bus accident or a large pile-up of cars on a highway results in too many injured people for too few ambulances or EMTs.
In the United States, emergency rooms are full of people who need immediate attention, plus people who have just shown up because they can't get care any other way (see EMTALA). Hospitals, hoping to save money, often do not have enough staff on duty. With too many patients and not enough personnel or other resources, triage is used to determine who gets care first.
As such, triage may be considered a form of rationing. It may also be a short-term need (for example, in a car accident situation until enough ambulances eventually show up for all the injured people) or a long-term need (as in a hospital that is constantly understaffed and is always full of people who need care.)
How does triage work?
Triage systems run the gamut from verbal shouting in an unusual emergency (for example, a tornado hits a school and the school nurse must manage too many injured children before EMTs arrive), to well-defined colored tagging systems used by soldiers and EMTs when they arrive on the scene of a mass casualty accident or a battlefield with many wounded soldiers.
There is a variety of defined triage systems used. Each organization has its own variation. They all create priorities for who gets care or is transported for care.
The most common triage systems use color coding that works similar to this:
- red: needs immediate attention - critical life-threatening injury or illness; transport first for medical help
- yellow: serious injuries needing immediate attention. In some systems, yellow tags are transported first because they have a better chance of recovery than red-tagged patients.
- green: less serious or minor injuries, non-life-threatening, delayed transport; will eventually need help but can wait for others
- black: deceased or mortally wounded
- white: no injury or illness (not used in all systems)
Note: Black may not mean the person has already died. It may mean that he or she is beyond help and, therefore, is a lower priority than those who can be helped.
The biggest changes to triage systems in recent years have been due to technology. These include the use of telephones and cell phones, the Internet and closed teleconferencing systems between trauma centers (a designation used in hospitals that cater to emergencies) and rural hospitals that cannot afford the latest equipment or high-level specialties.