Triage
Medical sorting to prioritize treatment in emergencies.
Triage is a process used in medicine to determine the order of priority for treating injured individuals, especially when resources are limited. It is relied upon in mass casualty incidents, where there are more injured individuals than available care providers or supplies. The term derives from the French word for sorting or selecting, which itself traces back to an Old French verb meaning to separate or shift, and ultimately to late Latin for grinding. Although the concept existed at least as far back as the reign of Maximillian I, it was not until the 1800s that the term was applied to medical practice. Baron Dominique-Jean Larrey, Surgeon in Chief of Napoleon’s Imperial Guard, established the foundation for modern triage by treating the wounded based on the gravity of their injuries and urgency of care, regardless of rank or nationality.
Triage methodologies vary by institution, locality, and country, but share universal underlying concepts. In most cases, the most injured and most able to be helped receive first priority, while the most terminally injured are last, except in reverse triage. Systems can follow specific metrics like trauma scoring or rely on provider opinion. Triage is imperfect and subjective, as it must balance contradictory objectives including likelihood of death, efficacy of treatment, remaining lifespan, ethics, and religion. Simple triage, used at accident scenes or mass-casualty incidents, sorts patients into categories: those needing critical attention and immediate transport, those requiring low-intensity care, the uninjured, and the deceased or imminently dying. Assessment often begins by asking ambulatory patients to move to a designated area, labeling them lowest priority, then evaluating others using an ABCDE approach. Patients are labeled with information including name, sex, injuries, interventions, and a triage category. Triage tags, which may be nationally standardized or commercially available (such as METTAG, SMARTTAG, or CRUCIFORM systems), identify patients, record findings, and track progress. Advanced triage involves doctors, nurses, or paramedics making deeper assessments, sometimes using CT scans, and can occur as secondary triage at a hospital. Reverse triage has three meanings: discharging hospital patients to prepare for a mass casualty; treating apparently dead patients first in conditions like lightning inj
- field
- Medicine
- known_for
- Prioritizing treatment based on injury severity and urgency
- origin
- French term from Old French 'trier', meaning to separate or sort
- first_modern_use
- Introduced by Baron Dominique-Jean Larrey, Surgeon in Chief of Napoleon's Imperial Guard
Lore & Background
The concept of triage dates back at least to the reign of Maximillian I, but the term itself comes from French, meaning the action of picking or sorting. In the 1800s, Baron Dominique-Jean Larrey, Surgeon in Chief of Napoleon's Imperial Guard, laid the groundwork for modern triage by introducing the concept of treating the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of rank or nationality. The general concept was first described in a 17th-century BCE Egyptian document, the Edwin Smith Papyrus, which divided injuries into three categories: those that can be healed, those to fight with, and those that cannot be healed.
Reader's Guide
Triage is a foundational practice in emergency medicine and disaster response, balancing multiple objectives such as likelihood of death, efficacy of treatment, patients' remaining lifespan, ethics, and religion. It is an imperfect and often subjective practice, especially when based on general opinion rather than a score. Triage systems vary by institution, locality, and country, but share universal underlying concepts: the most injured and most able to be helped are first priority, with the most terminally injured last, except in reverse triage. Simple triage is used at accident scenes, often employing tags to identify patients and track their progress. Advanced triage involves more in-depth assessments by doctors, nurses, or paramedics. Undertriage and overtriage are common errors, with acceptable overtriage rates up to 50% to avoid undertriage. Telephone triage provides accurate information about 90% of the time. During the COVID-19 pandemic, palliative care in triage became more prominent as some countries denied care due to lack of supplies.
Did You Know?
- The term triage comes from the French word for sorting, derived from Old French 'trier' and late Latin 'tritare'.
- Baron Dominique-Jean Larrey introduced the concept of treating wounded based on injury severity and urgency, regardless of rank or nationality.
- The Edwin Smith Papyrus, a 17th-century BCE Egyptian document, described three categories of injuries: healable, treatable, and untreatable.
- Reverse triage includes treating those appearing dead from lightning injuries ahead of others, as they can often be resuscitated.
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