Skill Page - Triage

29 MAY 2015

Triage

Mr Arun George, Staff Nurse

OBJECTIVES

1. INTRODUCTION
2. IMPORTANCE OF TRIAGE AND TRIAGE TAG
3. TRIAGE OFFICERS
4. TRIAGE SYSTEM AND ID BANDS
5. ENTRY POINT- TRIAGE
6. TRIAGE ASSESSMENT
7. ESI TRIAGE
8. CONCLUSION

INTRODUCTION
Triage, The term comes from the French verb Trier, meaning to separate, shift or select
The term triage may have originated during the NAPOLEONIC WARS from the work of Dominique Jean Larrey.
The term was used further during World Ward  by French doctors

ADVANCED TRIAGE
In advanced triage, doctors and specially trained nurses may decide that some seriously injured patients, its used to divert scarie resources away from patients with little chances of survival of others who are more likely to survive
If immediate treatment is successful, the patient may improve and this improvement may alow the patient to be categorized to lower priority in the short term

IMPORTANCE OF TRIAGE AND TRIAGE TAG
Identify the patient
Bear record of assessment findings
Identify the priority of the patients need for medical treatment and transport from the emergency scene
Track the patients progress through the triage process
Identify additional hazards such as contamination

TRIAGE ID BANDS
BLUE : Immediate care to be given ( resuscitation bay )
RED : Within 0-5 minutes ( Priority 1)- on going monitoring to be done and documented every 15 minutes
Yellow : Within 10-15 minutes (Priority 2)- on going monitoring to be done and  documented every  15 minutes
Green : Observation- Every 2 hours reassessment to be done and documentation
Black : Dead body- ( during mass casualty only)
Fast track (OPD) : 30 Minutes to 2 hours

TRIAGE OFFICER

TRIAGE OFFICER SKILL
Communication skills are crucial. Provider must interact with patient, family, police, and visitors.
Well educated and adequate knowledge
Maintain good IPR with patient, family and team members
Must have tact, patience ,understanding and discretion.
Organizational skills- patient line-ups, inquiries etc.
Able to perform in hectic situations.
Can recognize who is sick

ENTRY POINT-TRIAGE

TRIAGE ASSESSMENT
Chief complaint: patients statement of the problem
Validation and assessment of chief complaint

Subjective:-
When did it start ? What were you doing when it started ?
How long did it last ?
Does it come and go ?
Is it still present ?
Where is the problem ? Describe character and severity if painful ?
Radiation ?
Previous history of same ?

Objective:-

1. This part of the triage assessment may be deferred to the treatment area if the patient requires rapid access to care/interventions
2. Physical appearance- colour, skin,activities
3. Degree of stress: severe distress
4. Emotional response; anxious, indifferent
5. vita;l signs
6. Physical assessment

ESI TRIAGE
The EMERGENCY SEVERITY INDEX is a five level emergency department triage algorithm, initially developed in 1999. It is maintained by the Agency for Healthcare Research and Quality.  ESI triage is based on the acuity of patients health care problems and number of resources their care is anticipated to require

Examples of ESI level 1:

1. Cardiac arrest.
2. Respiratory arrest.
3. Severe respiratory distress.
4. SpO2 < 90.
5. Critically injured trauma patient who presents unresponsive.
6. Overdose with a respiratory rate of 6.
7. Severe respiratory distress with agonal or gasping-type respirations.
8. Severe bradycardia or tachycardia with signs of hypoperfusion.
9. Hypotension with signs of hypoperfusion.
10. Trauma patient who requires immediate crystalloid and colloid resuscitation.
11. Chest pain, pale, diaphoretic, blood pressure 70/palp.
12. Weak and dizzy, heart rate = 30.
13. Anaphylactic reaction.
14. Baby that is flaccid.

Remember That:

1. Effective triage gets the patient
2. To the right place.
3. At the right time.
4. With the right care provider.

CONCLUSION
Triage is the process for sorting injured people into groups based on their need for or likely benefit from immediate medical tratment. Triage is used on battlefield, at disaster sites, and in hospital emergency rooms when limited medical resources must be allocated.