Triage Systems
Emergency Severity Index (ESI): 5-level system most commonly used in US. Level 1: immediate, life-saving intervention. Level 2: high-risk, cannot wait. Level 3: needs multiple resources, stable vitals. Level 4: one resource, stable. Level 5: no resources, stable. Other systems: Canadian Triage and Acuity Scale (CTAS), Manchester Triage System.
ESI 5-Level System
ESI 1: requires immediate life-saving intervention (intubation, CPR, emergent IV meds). ESI 2: high-risk situation, severe pain/distress, or potential for rapid deterioration (chest pain with abnormal vitals, stroke symptoms). ESI 3: requires ≥2 resources (labs + x-ray). ESI 4: requires 1 resource. ESI 5: requires no resources. Goal: 5-minute triage time.
Rapid Assessment
Across-the-room assessment: general appearance, breathing, circulation, level of consciousness. ABCDE: Airway, Breathing, Circulation, Disability, Exposure. Primary survey: identify life threats. Secondary survey: head-to-toe, SAMPLE history (Symptoms, Allergies, Medications, Past medical, Last oral intake, Events leading).
Reassessment
ESI 2: q15 min. ESI 3: q30 min. ESI 4–5: q60 min. Any change in condition = re-triage. Waiting room patients must be reassessed at least q2h. Document reassessment with time and findings. High-risk complaints: chest pain, abdominal pain, headache, shortness of breath, altered mental status — never let wait without reassessment.
Special Populations
Pediatric triage: Pediatric Assessment Triangle (PAT) — appearance, work of breathing, circulation. Elderly: atypical presentations (infection without fever, MI without chest pain). Pregnant: right lateral displacement of uterus after 20 weeks. Psychiatric: risk assessment, security presence if needed. Frequent flyers: reassess fresh each time, do not assume "social admit."
Important Notes
- ESI 1 patients require IMMEDIATE provider presence — zero wait time.
- Never send a chest pain or stroke symptom patient to the waiting room — ESI 2 minimum.
Clinical Tips
- "Treat the patient, not the number" — vital signs guide but clinical judgment overrides. A calm-appearing patient may be in compensated shock.
Summary
Emergency triage requires rapid, systematic assessment to prioritize care. The ESI 5-level system is the standard — but clinical judgment and frequent reassessment are essential.
