Triage

1. Military Triage: the oldest method of triage.

Category	Description
Emergent	Patients who require medical attention immediately.
Urgent	Patients who are able to wait for 12 to 24 hours.
Non-urgent	Patients who are able to wait for days or weeks.

2. North Atlantic Treaty Organization (NATO) Triage

Category	Description
Minimal	Minor injuries.
Delayed	Serious but not life-threatening.
Immediate	Life-threatening.
Expectant	Less likely to survive. This includes patients with cardiac arrest and respiratory arrest in cases of disaster due to the requisite efforts to perform resuscitation.

3. Simple Triage and Rapid Treatment (START) Protocol:
   1. Start with the victim nearest to you upon entering the scene.
   2. Determine the victim’s ability to walk. If they are able to, tag them as green and assist them to the treatment.
   3. Otherwise, determine if the victim is breathing. If the victim is not breathing, reposition the patient and open the airway (via jaw thrust).
      • If they continue to fail to breathe, tag them as black.
      • If they resume breathing, tag them as red.
   4. If the victim is breathing, assess the respiratory rate. The normal emergency respiratory rate is 12 to 30 RPM. Beyond this, the patient is tagged as red.
   5. If respirations are normal, proceed to assessing circulation. This is done by (a) checking the pulse, and more importantly, (b) capillary refill time that should be 2 seconds or shorter. If abnormal, tag the victim red.
   6. If circulation is normal, assess the level of consciousness. If they are disoriented or confused, tag the victim as red.
   7. If the level of consciousness is normal, tag the victim as yellow.

Category	Description
Green; Walking Wounded	Victims that are able to walk on their own.
Yellow	Coherent but unable to walk.
Red	Patients whose breathing is dependent on position or airway assistance, abnormal respiratory rate, abnormal perfusion, or abnormal LOC.
Expectant	Respiratory or cardiac arrest

4. Emergency Severity Index (ESI): a method of triage done in the emergency room when many victims arrive from a disaster. It also employs an algorithm:
   1. Assess the patient immediately if they are in need of life-saving interventions. If they require such interventions, they are classified as ESI Level 1.
   2. Otherwise, assess the patient if any of the following are present: (a) high clinical symptoms such as difficulty of breathing, (b) altered level of consciousness, and (c) in severe distress.
   3. If none of these are present, assess the patient for the number of resources required by the patient. These include the requirement of IV lines, catheters, bandages, etc.
      • If the patient requires multiple resources, assess for danger zone vitals: PR >100 BPM, RR >20 BPM, or an Oxygen Saturation of <92%. If these are present, Categorize the patient as ESI Level 2.
      • If the patient requires multiple resources but no danger zone vitals were present, categorize the patient as ESI Level 3.
      • If the patient requires only one resource for treatment, categorize the patient as ESI Level 4.
      • If the patient requires no resources for treatment, categorize the patient as ESI Level 5.

Category	Description
ESI Level 1	Patients who require life-saving interventions.
ESI Level 2	Patients who exhibit any of (a) high clinical symptoms, (b) altered LOC, (c) severe distress, or (d) danger zone vitals.
ESI Level 3	Patients who require many resources for management but does not have any danger zone vitals.
ESI Level 4	Patients who only require one resource for treatment.
ESI Level 5	Patients who do not require any resources for treatment.

5. Reverse Triage: an inversion; prioritization of identifying the minimal cases rather than the immediate/emergent ones. This is done to efficiently remove cases that do not require emergent care to free up hospital bed space, and to leave behind the cases that are life-threatening.