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 Trier (French), meaning “to sort”

 sort out, or prioritize, based on need
 Dynamic process of rapidly classifying
patients on the basis of the urgent treatment
that is needed – County Hosp.

 Brief clinical assessment that determines the

time and sequence in which patients should
be seen in ED, or the speed of transport and
choice of hospital destination - eMedicine

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Tindakan - pemilihan kes / pesakit mengikut
manifestasi klinikal pesakit utk membolehkan
prioriti dinilai berdasarkan keperluan
masalah perubatan , rawatan dan pemindahan
(disposal).

Sistem triage digunakan oleh setiap ED untuk

menilai , mendiagnos, melakukan resusitasi dan
merawat mangsa sebaik mungkin.

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 Triage assessments are brief and systematic.
 Effective triage relies on three fundamental
skills:
1. Assessment (Hx, vital signs),

2. Knowledge (mechanism of injury, injury

assessment & disease process), and

3. Skill of Intuition (experience, sensitivity

& observation).

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1. Prehospital triage
2. Trauma triage
3. Disaster triage
4. Telephone triage
5. Triage in Emergency Department

Triage occurs in the field prior to a patient's

arrival at the ED
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 A degree of triage occurs at the dispatch level /
centre (at ED)
 Based on assigned protocols, dispatchers
may routinely send an ambulance (with or
without lights and sirens) to the scene of ill or
injured patients.
 Once arriving at the scene, the paramedics
reassess the patient and place him or her in a
higher or lower triage category.

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Untuk melicinkan ‘triaging’

Pesakit datang / di bawa

Anggota Penyelamat

Di tempatkan Boleh lihat / nampak

Kaunter / Pusat
‘Triage’ Pt. dihantar ke hospital
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 Progressively increasing respiratory difficulty
 Incipient shock with progression to be
anticipated
 Rising CVP and decreasing pulse pressure
 Rapidly deteriorating LOC or sudden coma
following lucid period
 Airway or chest wall problems
 Sudden hypotension with possibility of occult
bleeding
 Penetrating wounds of chest, abdomen, or head

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 A dynamic process occurring at several levels
in the system to rapidly identify patients with
critical injuries from the total number of
presenting casualties.

 Traditionally, triage systems have attempted

to sort victims into categories to determine
treatment and transport priorities.

 Simple triage and rapid treatment (START)

categorizes victims based on their ability to
walk, their mental status, and the presence or
absence of ventilation or capillary perfusion.
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 Patients generally are tagged.
 Red - Emergent
 Yellow - Urgent
 Green - Nonurgent
 Black / White - Dead or very severely
injured and not expected to survive

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 Tempat
Kejadian

Ambulans

Pusat ‘Triage’

Zon Hitam / Putih

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Konsep triage di Hospital / Jabatan Kecemasan

Untuk melicinkan ‘triaging’

Pegawai ‘triage’ Pesakit datang

Di tempatkan

Boleh lihat / nampak

Kaunter‘Triage’

Ambulance datang
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 Triage is done by categorizing patients into
different acuity levels.
Triage Level I or emergent
Triage Level II or urgent
Triage Level III or non- urgent, and fast track

 Triage specificity and sensitivity increases as

a function of time spent performing triage on
each individual patient.

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Klasifikasi

3 Proriti utama (keutamaan)

A. Prioriti I (Kritikal) – ‘Tagging’ Merah
B. Prioriti II (Sederhana) – ‘Tagging’ Kuning
C. Prioriti III (Bukan kecemasan) – ‘Tagging’ Hijau

Zon Merah
Jab. Kecemasan
Zon Kuning

Zon Hijau
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 According to Lanros (1988), a condition requiring
immediate medical attention; time delay would
be harmful to the patient; disorder is acute and
potentially threatening to life or function
 Airway and breathing difficulties

 Cardiac Arrest

 Cervical spine compromise

 Chest pain and acute dyspnea and/or

cyanosis
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 Seizure states
 Uncontrolled or suspected severe bleeding
 Severe head injuries or comatose state
 Severe medical problems, such as poisoning,
overdose, cardiac, and diabetic complications
 Open chest or abdominal wounds
 Severe shock
 Obvious multiple injuries
 Excessively high temperatures (over 1050 F or
40.50 C)
 Emergency childbirth, complications of
pregnancy, hemorrhage, or indications of
eclampsia
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 Chest pain associated with URI
 Burns
 Major multiple fractures
 Dulled or obtunded level of consciousness
(LOC)
 Back injuries with or without spinal cord
damage
 Persistent nausea, vomiting, or diarrhea
 Severe pain
 Temperature of 390 - 40.50C
 Acute panic states, drug overuse, apparent or
suspect poisoning
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 Chronic backache
 Moderate headache
 Minor fractures or other injuries of a
minor nature
 Obviously mortal wounds where
death appears reasonably certain (this is
a rarely followed criterion)
 Obviously dead on arrival (DOA)

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 Respiratory Arrest / Airway destruction
 Cardiac Arrest (witnessed)
 Several Artery / severe
bleeding(uncontrolled)
 Cervical Injury
 Severe head injury with L.O.C.
 Open chest / Abdominal Injury
 Major / Complicated Burns
 Severe Shock

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 Burns of respiratory tract
 Tension Pneumothoraxs
 Complication Of Med. Problems –
Obstetrics/ Cardiac / DM / Seizures /
Hyper / Hypothermia / poisoning
 Joints # with no distal pulse
 # Femur
 All Paediatric cases
 All elderly patients.

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 Multiples severe injuries
 Burns > 10% / on sensitive body area
 Inhalation injury
 Fracture of lower limbs
 Attempted suicides
 Drugs overdose
 Acute Injury with L.O.C.
 High velocity & strong impact accidents
 Fall > 2 metres
 Electrocution

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 Severe chest pain of whatever origin
 Acute breathlessness including asthma
 Acute MI
 Renal colic
 Severe gastroentritis
 Bleeding GIT
 Acute Low backache
 Terminally ill patient
 Acute abdomen including acute urine retention
 Severe dizziness/ syncope / fits
 All drowsy & Comatose pts.
 Patient unable to talk / in distress
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 Back injury with or without spinal cord
damage
 Moderate blood loss @ 2 pints.
 Severe Burns
 Open or multiple fractures
 Stable Abdominal Injury
 Eye injuries (open wound of higher priority)
 Stable drugs overdose

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 Upper limbs # / dislocations
 Multiple Superficial wd.
 Burns @ 10 %
 Joints sprains / muscular strains
 Multiple Insects stings / animals bites
 Simple lacerated wound.
 FB – ENT / soft tissues

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 Febrile conditions require critical attentions
 Mild Abdominal Injury
 Acute large skin infections & emergencies
(Cellulitis/ urticaria)
 Abscesses
 Acute infections of eyes / ears
 Acute headache / pains – require critical
care

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 Minor l/w or soft tissues injuries
 Minor / simple #
 Sprains / strains
 Casualties with less chance of survival
e.g.. Head injury with brains exposed or
Burns of 1st /2nd degree of > 40 %

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 Old scars
 Deformities of bones / limbs or spines
 Joints contractures
 Old mal-union fracture
 Old non-united fracture
 Old unreduced fracture
 Request for removal of metal piece &
screws
 Chronic discharging wound.
 Chronic sprains
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 Cold lumps & bumps in the body
 Varicose veins
 Cysts
 Request for circumcision
 Patching of ear lobes
 Removal of tatoos
 Removal of corns & warts
 Removal of keloids
 Chronic Rhinitis
 Defective hearing

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 Nasal polyps
 Wax in ears
 Cataracts
 URTI with fever
 Chronic Cough
 Social problems
 Psychosomatic problems
 Chronic Headaches
 Insomnia.

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The triage personnel must:
 Be able to make accurate assessments
regarding patient care
 Be able to function well under stressful
situations
 Be able to make rapid and sound decisions
 Possess good communication skills
 Be able to supervise others and plan for
potential occurrences
 Possess good crisis intervention skills

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 Menerima pesakit semasa ketibaannya.
 MA/SN yang bertugas harus nampak pt.
yang datang samada berjalan kaki atau
dengan kenderaan atau ambulans.

 Pt . diarah ke bilik triage

 Pastikan samada kes trauma/bukan trauma
 Tentukan ‘tagging’ atau zon untuk pesakit
berdasarkan kesnya
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 Rekod semua perkara penting seperti :-
 Tarikh, masa, nama, alamat, pekerjaan,
barang-barang kepunyaan dll

 Merekod aduan utama & sejarah penyakit

kini.

 Melakukan permeriksaan fizikal

 Mencerap tanda-tanda vital
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 Menentukan pesakit ke zon/bilik yang
sepatutnya untuk pengendalian & rawatan
 Melakukan penyiasatan makmal, EKG &
radiologi yang perlu.

 Menenangkan pesakit / keluarga pesakit

apabila keadaan memerlukan

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 Memastikan semua mangsa diberi layanan
secepat mungkin dan baik

 Pastikan pesakit ditemani (escort) apabila

dimasukkan ke wad

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