What is triage?
The word triage originates from the French word ‘trier’, meaning to sort. In the medical context, this sorting is of patients, by priority, for initial treatment and subsequent transport to a facility where more definitive care is available. (1) Triage is a common feature of Emergency Departments (EDs) in their provision of day-to-day emergency care, where RCEM guidelines suggest that patients have a brief assessment within 15 minutes of arrival in order to be prioritised appropriately (2).
What is a mass casualty incident (MCI)?
A medical MCI is any situation in which medical resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties (3). This may be a relatively small incident in a resource-limited environment, but is more commonly considered in the context of larger-scale disasters such as the 2017 fire at Grenfell Tower or the Manchester Arena bombing.
Why is triage so important in MCIs?
Where demand for medical assistance and resources is greater than that available, the priority must be to identify those who are most in need of medical attention. Effective triage is therefore paramount in these situations aiming to allow ordered prioritisation in what is likely to be a chaotic situation.
Within the UK, triage at a major incident is performed in two stages. The initial primary triage assessment will take place at the scene of the incident and should take no more than 30 seconds per patient. The purpose of this primary process is to rapidly identify those patients who need a life-saving intervention. It is usually executed using an algorithm such as the Modified Triage Sieve – MPTT-24. This is designed to be rapid, reliable and reproducible irrespective of the provider performing it. It is followed by a secondary triage process, which typically takes place in a more permissive environment (e.g. casualty clearing station) and is performed by a more experienced clinician. A number of different secondary triage processes exist, including the MIMMS Triage Sort, Anatomical Triage and Clinician Gestalt (1).