TRIAGE

INTRODUCTION

The word triage is derived from the French word “trier”, which means “to sort out or
choose”. The Baron Dominique Jean Larrey, who was the Chief surgeon for Napolean, is credited
with organizing the first triage system.. It is the process by which patients 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 . Triage is a practice invoked when acute care cannot be provided for
lack of resources .
The process rations care towards those who are most in need of immediate care , and who
bebefit most from it. More generally it refers to prioritisation of medical care as a whole. In its
acute form it is most often required on the battlefield, during a pandemic like COVID-19, or at
peacetime when an accident results in a mass casualty which swamps nearby healthcare facilities'
capacity.

Fig – A triage situation of an incident at the Pentagon .

DEFINITION
“Triage is a process which places the right patient in the right place at the right time to receive the
right level of care” ( Rice and Abel, 1992).

The process of sorting victims, as of a battle or disaster, to determine medical priority in order to
increase the number of survivors. ( Thesarus )
 TRIAGE CATEGORIES
- NON DIASTER : To provide the best care for each individual patient .
- DISATER – To provide the most effective care for the greatest number of patients .

NON DIASTER TRIAGE

1. Identify patients requiring immediate care .

2. Determine the appropriate area for treatment .
3. Facilitate patient flow and avoid unnecessary congestion .
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.

DIASTER TRAIGE

Triage is defined as" a dynamic

decision-making process that
prioritizes the patient’s need for
12
medical care when arrive EDs" .
Oxford English Dictionary has
defined triage as ‘The
assignment of degrees of
urgency to illnesses or wounds in
order to decide the order of
 13
treatment’ . Now, it is defined
as the process of sorting and
categorization of patients
according to the degree of
severity of condition, and the
availability of medical and
transport
facilities14. The purpose of triage
is to give prompt care and
adequate treatment to all
patients
arriving to the ED.
Triage is defined as" a dynamic
decision-making process that
prioritizes the patient’s need for
 12
medical care when arrive EDs" .
Oxford English Dictionary has
defined triage as ‘The
assignment of degrees of
urgency to illnesses or wounds in
order to decide the order of
treatment’13. Now, it is defined
as the process of sorting and
categorization of patients
according to the degree of
severity of condition, and the
availability of medical and
transport
facilities14. The purpose of triage
is to give prompt care and
 adequate treatment to all
patients
arriving to the ED.
Disaster triage is defined as a dynamic decision making process that prioritizes the patient ‘s need
for medical care when arrive at emergency department .

It ia also defined as the process of sorting and categorization of patients according to the degree of
severity of condition and the availability of medical and transport facilities . The purpose of triage
is to give prompt care and adequate treatment to all patients arriving to the emergency department .

AIMS OF THE TRAIGE

- To sort patients based on needs for immediate care.

- To recognize futility.
- Medical needs will outstrip the immediately available resources.
- Additional resources will become available at given enough time.

PRINCIPLES OF TRIAGE

 Every patient should receive and triaged by appropriate skilled health-care professionals.
 Triage is a clinic-managerial decision and must involve collaborative planning.
 The triage process should not cause a delay in the delivery of effective clinical care.

ADVANTAGES OF TRIAGE

 Helps to bring order and organization to a chaotic scene.

 It identifies and provides care to those who are in greatest need.
 Helps to make the difficult decisions easier.
 Assure that resources are used in the most effective manner.

TYPES OF TRIAGE

1. Simple triage.
2. Advanced triage.
 Simple triage is used in a scene of mass casualty, 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.
 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.
 Triage separates the injured into four groups:
a) RED- MOST URGENT ( 1ST PRIORITY)

These clients have reasonable chance of survival only if they received immediate treatment.
Emergency treatment is initiated immediately and continued during the transportation. These
include victims with:

 Respiratory insufficiency.
 Cardiac arrest.
 Hemorrhage.
 Severe abdominal injury.
b) YELLOW ( 2ND PRIORITY)
These victims can wait for transportation after they receive initial emergency treatment. Victims
include:
 Immobilized closed fracture.
 Soft tissue injury without hemorrhage.
 Burns less than 40% of the body.
c) GREEN ( 3RD PRIORITY)
Victims in this category are ambulatory have minor tissue injuries and may be dazed. They can be
treated by non-professionals and held for observations if necessary.

d) BLACK ( DYING/ DEAD)

At the disaster site or primary triage point simple support measures can alleviate the psychological
trauma experienced by survivors. These measures include the following.
 Keeping families together, especially children with parents.
 Provide adequate shelter, food and rest.
 Establishing and maintaining a communication network to reduce rumors.
 Encouraging individuals to share their feelings and support each other.
 Isolating victims who demonstrate hysterical or panic behavior.

CHARACTERISTICS OF TRIAGE NURSE

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

ROLE OF THE NURSE IN DISASTER

1. Personal preparedness:

The following are the emergency supplies that should be prepared:

 A 3-days supply of water.

 One change of clothing and footwear per person and one blanket or sleeping per person.
 A first aid kit that includes your family prescription medications.
 Emergency tools including a battery powered radio, flash light and plenty of extra batteries.
 Candles and matches.
 An extra set of car keys and credit cards, cash or traveler’s cheques.
 Sanitation supplies, including toilet paper, soap, feminine hygiene items and plastic garbage bags.
 Special items for infant, elderly or disabled family members.
 An extra pair of eye glasses, important documents should always be kept in a waterproof container.

2. Professional preparedness:
 Copy of professional license.
 Personal equipments such as stethoscope.
 Flash light and extra batteries.
 Cash.
 Warm clothing and a heavy jacket for weather appropriate clothing.
 Record keeping materials.
 Pocket sized reference books.

ROLE OF THE NURSE IN DISASTER AT A HOSPITAL

1. PREPARATION AT THE EMERGENCY DEPARTMENT: The emergency department

nurses incharge is responsible for the following-
 Assigning them to specific areas/ rooms.
 Making sure as many nursing personnel as possible report for duty.
 Periodic checking of supplies.
 Instructing volunteers and ancillary personnel.

Emergency department nurses are assigned to work in the following treatment areas:

 Triage (Sorting area)

 Major (Resuscitation room)
 Minimal (First-aid)
 Morgue area.
 Delayed area.

Triage area:

The triage team consists of the following personnel; emergency department physicians, an
experienced emergency department nurse who is familiar with the disaster plan, an emergency
department admitting clerk, and security personnel to direct the flow of traffic. Responsibilities of
this team are:

 Assigning patients to appropriate treatment areas according to severity of their condition and
availability of the department.
 Implementing basic life support measures such as CPR and control of hemorrhage.
 Obtaining registration information about the patient.
 Transportation of victims onto a stretcher or to wheelchairs.

Major treatment area:

The following priority points should be kept in mind while carrying out the nursing assessment and
intervention in the major treatment area:

 Maintain patient airway.

 Maintain ventilation.
 Stop or control hemorrhage.
 Use available equipment and supplies wisely.
 Use personnel wisely.
 Make sure that disaster tag is always on the patient and on the patient’s valuables.
 Communicate with patients, team members and people incharge.

Minimal treatment area:

 To provide first-aid or basic nursing interventions is the goal of the minimal treatment area. Nurses
assigned to this area must reassess the patients according to their chief complaint and appropriate
nursing interventions are then instituted in order to immobilized fractures, sprains, or strains, to
administer medications, and to provide care for wounds. Appropriate documentation is also done.

Morgue area:

Ideally the morgue should be located away from the emergency department, where the deceased
can be treated with dignity.

Delayed area:

The staff working in this area need to reassess the patient’s status and to provide comfort measures
(e.g. intravenous analgesics
 CONCLUSION

Disaster is an emergency situation where the need of the victims mounts over the medical and
nursing resources or services particularly in the developing countries like India where the resources
are already short, the situation becomes worst. Disaster can be natural or man-made individuals
response in many different ways to the disaster experience, and emergency care providers are not
immune to personal responses to the experience. Community health nurses provide encouragement,
care and support to community members during a disaster and are equally qualified to meet the
challenges of disaster nursing.
 BIBLIOGRAPHY

1. Navdeep Kaur Brar, HC Rawat, Textbook of advanced nursing practice, first edition, Daryaganj,
New Delhi, Jaypee Brothers Medical Publishers (P) Ltd, 2015,1037-1040, 1043- 1056.
2. Shebeer P. Basheer , S. Yaseen Khan, Text book of advanced nursing practice, first edition,
Bangalore, EMMESS Medical Publishers, 2013, 730- 735, 737-742.
3. https://www.slideshare.net/tusharkedar2/disaster-nursing-148963278
4. https://www.slideshare.net/tulu2015/disaster-nursing-123862971
5. http://www.rajnursing.blogspot.com>disaster.
6. https://www.brainkart.com/article/Disaster-Nursing-37983/
 COLLEGE OF NURSING
MEDICAL DIRECTORATE, LAMPHELPAT

Subject- ADVANCE NURSING PRACTICE

Assignment
On
PERITONEAL DIALYSIS

Submitted to:
Ma’am Ibeyaima
Associate Professor
Department of Nursing Foundation
College of Nursing, Medical Directorate

Submitted by:
Samarita Laishram
M.Sc (N) 1st year
Roll No.-7

Date of Submission -