This presentation on Triage and transport deals with how we should we deal with the patients who are attending the emergency department and to provide best treatment for the needy patients at appropriate time. I hope this will be helpful to nurses, paramedics, graduate and under graduate students and emergency doctors and team.

1. Dr.Suresh Babu Chaduvula
Professor
Department of Obstetrics & Gynecology
King Khalid University
Abha, Saudi Arabia

2.  Triage is the term derived from the French
verb trier meaning ‘to sort’ or ‘to choose’
It’s the process by which patients are
classified according to the type and urgency
of their conditions to get the
Right patient to the
Right place at the
Right time with the
Right care provider

3.  To treat the patients in the order of their
clinical urgency appropriately and timely

4.  Non disaster: To provide the best care for
each individual patient.
 Multi casualty/disaster: To provide the most
effective care for the greatest number of
patients.

5.  Definition: an incident, either natural or
human-made, that produces patients in numbers
needing services beyond immediately available
resources. May involve a large no. of patients or
a small no. of patients requiring significant
demand on resources.
 The key to successful disaster management is to
provide care to those who are in greatest need
first. Correct triage is essential to accomplish
this goal.

6. 1. Identify patients requiring immediate care.
2. Determine the appropriate area for
treatment
3. Facilitate patient flow through the ED and
avoid unnecessary congestion.

7. 4. Provide continued assessment and
reassessment of arriving and waiting
patients.
5. Provide information and referrals to
patients and families.
6. Allay patient and family anxiety and
enhance public relations.

8.  Immediately accessible
 Sign posted
 Allow for patients examination
 Privacy
 Staff security
 Fully equipped with Emergency equipment
 Communication services

9.  Should be completed in 10 minutes
 If it is going beyond 15 minutes call for
additional nurse.
 Accurate triage is key to the efficient
operation
 Effective triage – is based on knowledge,
skills and attitude of the triage nurse.
 Pediatric cases – record vital signs every 30
mts and others – 60 mts during reassessment.

10.  Triage is an essential function of EDs
 Urgency refers to the need for time –critical
intervention.
 Patients who are not critical with low acuity
categories –safe to wait for assessment and
treatment but still require admission.

11. “The eye’s don’t see
what the mind
doesn’t know!”

12. 1. Rapidly identify patients with urgent life
threatening conditions
2. Assess/ determine severity and acuity of
the problem
3. Ensure that patients are treated in order of
clinical emergency
4. Ensure that treatment is appropriate and
timely
5. Allocate the patients appropriate and
treatment area
6. Reevaluate who are in waiting area

13. 1. Streamlines patient flow
2. Reduces risk of further injury/
deterioration
3. Improves communication and public
relations
4. Enhances team work
5. Identifies resource requirements
6. Establishes national benchmarks

15.  The triage team
 Triage of Victims
- first victims to arrive are frequently not
the most seriously injured. They are
1. Critical patients
2. Fatally Injured Patients
3. Non critical patients
4. Contaminated patients

16.  Are divided into 5 levels or categories
depending on following acuity determinants
1. Chief complaint
2. Brief triage history
3. Injury/ illness
4. General appearance
5. Vital signs
The most urgent clinical feature that is
identified will determine ALS category

17. Level 1- Resuscitation
Level 2- Emergent
Level 3- urgent
Level 4- less urgent
Level 5- Non urgent

18. Resuscitation -- threat to life
Time to nurse assessment IMMEDIATE
Time to physician assessment IMMEDIATE
 Cardiac and respiratory arrest
 Major trauma
 Active seizure
 Shock
 Status Asthmatics

19. Potential threat to life, limb or function
Nurse Immediate , Physician <10 minutes
 Decreased level of consciousness
 Severe respiratory distress
 Chest pain with cardiac suspicion
 Over dose (conscious)
 Severe abdominal pain
 G.I. Bleed with abnormal vital signs
 Chemical exposure to eye

20. Condition with significant distress
Time Nurse < 15min, physician < 30 min
Head injury without decrease of LOC but with
vomiting
 Mild to moderate respiratory distress
 G.I. Bleed not actively bleed
 Acute psychosis

21. Conditions with mild to moderate discomfort
Time for Nurse assessment < 30 minutes
Time for physician assessment < 1hour
Head injury, alert, no vomiting
Chest pain, no distress, no cardiac suspicion.
Depression with no suicidal attempt

22. Conditions can be delayed, no distress
Time for nurse 60 minutes
Physician assessment more than 2h or 120
minutes
 Minor trauma
 Sore throat with temperature < 39 degree
centigrade
 Chronic medical illnesses.
 Alcoholics

24.  An “across-the room” assessment
 The triage history
 The triage physical assessment
 The triage decision

25. To identify obvious life threat conditions
General appearance
Air way
Breathing
Circulation
Disability
(neurogenic)

26. • The triage nurse must scan the area where
patients enter the emergency door, even
while interviewing other patient.

27.  Air way
Abnormal airway sounds, strider, wheezing
grunting
Unusual posture e.g.. Sniffing position,
inability to speak, drooling or inability to
handle secretion
 Breathing
Altered skin signs, cyanosis, dusky skin,
tachypnea
bradypnea, or apnea periods, retractions,
use accessory muscles, nasal flaring,
grunting, or audible wheezes

28.  Circulation
Altered skin signs, pale, mottling, flushing
Un controlled bleeding
 Disability (neuro.)
LOC
Interaction with environment
Inability to recognize family members
Unusual irritability
Response to pain or stimuli
Flaccid or hyper active muscle tone

29.  Extensive knowledge to emergency medical
treatment
 Adequate training and competent skills,
language, terminology
 Ability to use the critical thinker process
 Good decision maker

30.  Greet patients and identify your self.
 Maintain privacy and confidentiality
 Visualize all incoming patients even while
interviewing others.
 Maintain good communication between triage and
treatment area
 maintain excellent communication with waiting area.
 Use all resources to maintain high standard of care.
 Crowd control.
 Telephone.
 Communicate with team leader and seek feed back
on decisions.

31.  Reassess the patient within 1-2hours of
initial triage and continue to reassess on a
regular basis, patients who may have
presented without cardinal signs of severe
illness may develop them during long waits.
 Patients who appear intoxicated actually may
have life threatening problems such as DKA,
and should not be permitted to keep it off in
the waiting room.

32.  The last person in along line at triage may
have a serious medical problem that
requires immediate attention
 Patient should wait no longer than 10
minutes for triage
 If in doubt about a category, choose the
higher acuity to avoid under triaging a
patient

33.  With a trauma call involving a pregnant
patient, you have two patients:
 The woman
 The unborn fetus
 Any trauma to the woman has a direct
effect on the fetus.

34.  Pregnant women may be the victims of:
 Assaults
 Motor vehicle crashes
 Shootings
 Domestic abuse
 Pregnant women also have an increased
risk of falls.

35.  Pregnant women have an increased amount
of overall total blood volume and a 20%
increase in heart rate.
 May have a significant amount of blood loss
before you will see signs of shock
 Uterus is vulnerable to penetrating trauma
and blunt injuries.

36.  When a pregnant woman is involved in a
motor vehicle crash, severe hemorrhage
may occur from injuries to the pregnant
uterus.
 Trauma is one of the leading causes of
abruptio placenta.
 Significant vaginal bleeding is common with
severe abdominal pain.

37.  Cardiac arrest
 Focus is the same as with other patients.
 Perform CPR and provide transport.
 Notify the receiving facility personnel that
you are en route with a pregnant trauma
patient in cardiac arrest.

38.  Follow these guidelines when treating a
pregnant trauma patient:
 Maintain an open airway.
 Administer high-flow oxygen.
 Ensure adequate ventilation.
 Assess circulation.
 Transport the patient on her left side.

39.  Some cultures may not permit a male
health care provider to assess or examine a
female patient.
 Respect these differences and honor requests
from the patient.
 A competent, rational adult has the right to
refuse all or any part of your assessment or
care.

40.  The Golden Period is the time from injury
to definitive care.
 Treatment of shock and traumatic injuries
should occur.
 Aim to assess, stabilize, package, and begin
transport within 10 minutes (“Platinum 10”).

42.  Rapid scan assists in determining transport
priority.
 High-priority patients include those with
any of the following conditions:
 Difficulty breathing
 Poor general impression
 Unresponsive with no gag or cough reflex

43.  High-priority patients (cont’d):
 Severe chest pain
 Pale skin or other signs of poor perfusion
 Complicated childbirth
 Uncontrolled bleeding

44.  High-priority patients (cont’d):
 Responsive but unable to follow commands
 Severe pain in any area of the body
 Inability to move any part of the body

45.  Transport decisions should be made at this
point, based on:
 Patient’s condition
 Availability of advanced care
 Distance of transport

46.  Transport decision
 Provide rapid transport for pregnant patients
who:
 Have significant bleeding and pain
 Are hypertensive
 Are having a seizure
 Have an altered mental status

47.  Circulation
 If there are signs of shock, control bleeding,
give oxygen, and keep the patient warm.
 Transport decision
 If delivery is imminent, prepare to deliver at
the scene.
 If delivery is not imminent, prepare the
patient for transport.

49. Thank You