Rapid Triage in Healthcare: Overview and FAQ

Rapid triage can help nurses, physicians, and other care providers prioritize and make decisions in life-threatening situations. Who should receive care first — an infant with a high fever or a middle-aged man who fell off a ladder? A triage system helps standardize patient evaluation so that clinical decisions like this one are clearer.

The word triage means sorting or organizing in French. Emergency triage systems were first documented by French military doctors in Napoleon Bonaparte’s imperial guard and were first used in hospitals in 1964. Today, triage systems are an essential element of emergency care, helping to support timely assessment, intervention, and treatment.

Triage is a part of every nurse’s shift, whether they’re aware of it or not. You take report from the outgoing nurse, and your first thought is, Which of these patients do I need to see first? No matter which nursing unit you’re on, the skills of triage are essential in determining who is in immediate danger and who can wait.

Some nurses work specifically as a triage nurse — often the first person a patient sees when they enter the ED. These nurses begin rapid triage assessment the minute a patient walks through the door. It’s up to them to determine who needs care most urgently, and who can wait for now.

What Is a Rapid Triage System?

Triage systems are protocols that help providers make quick, appropriate decisions about who needs help first. The goal of these systems is to prioritize care while optimizing the use of resources. Different countries and hospital systems use their own processes for triage, and certain specialties — such as pediatrics, military nursing, and disaster care — have their own systems as well.

Examples of triage systems include:

• South African Triage Scale (SATS): A scale developed for use across South Africa, it organizes patients into four triage groups, and can be used in emergency departments, clinics, and in non-clinical settings.
• Australasian Triage Scale (ATS): Used throughout New Zealand and Australia, this is a 5-point scale for prioritization outlining timelines for care interventions for each category.
• Emergency Severity Index (ESI): Promoted by the Emergency Nurses Association and the American College of Emergency Physicians, ESI is a 5-level scale focusing on physiological stability that is designed for the hospital setting.
• Tactical Triage: Military organizations, such as the U.S. Marine Corps, have their own triage training protocols for determining how care is prioritized in combat situations.

3 Mass Triage Systems to Know About

In the event of a large motor vehicle accident, natural disaster, or act of violence, local medical resources may be strained. In these instances, clinicians are challenged to create order in chaos. The following mass triage systems were developed to quickly evaluate patients and determine the level of care they need.

1. START Triage

The START triage acronym stands for Simple Triage and Rapid Treatment. Developed in California in 1983, START is the most common system for mass casualty events in the United States. Prioritizing simplicity and speed, this algorithm is designed for use by paramedics, first responders, and more.

But what is Simple Triage and Rapid Treatment like in practice? This protocol breaks down an adult triage assessment into five areas: the ability to walk, spontaneous breathing, respiratory rate, perfusion, and mental status.

From this information, the START system puts patients into four categories:

• Immediate (Red): The patient needs immediate intervention and medical attention within minutes to survive.
• Delayed (Yellow): The patient has potentially life-threatening injuries but is not expected to worsen over the next several hours; delay transport.
• Minor (Green): The patient has relatively minor injuries and may be able to assist in their own care.
• Expectant (Black): The patient is unlikely to survive; prioritize palliative care.

2. JumpSTART Triage

JumpSTART is the pediatric version of the START protocol and is used in pediatric mass casualty events. It uses the same urgency categories as START, but evaluates patients using slightly different assessment parameters:

• Able to walk? If yes, label as Minor.
• Spontaneous breathing: If not, give limited lifesaving interventions. If the patient has a pulse or spontaneous breathing, label as Immediate. If they have neither pulse nor respirations, label as Expectant.
• Respiratory rate: If the rate is less than 15 or greater than 45, label as Immediate.
• Palpable pulse: If there is no palpable pulse, label as Immediate.
• Neurological assessment: Assess and categorize the patient using the parameters below. P or U signs should be labeled as Immediate, A and V should be labeled as Delayed.
  • A: Alert
  • V: Responsive to verbal stimuli
  • P: Responsive to painful stimuli
  • U: Unresponsive

3. SALT Triage

SALT is a triage system used for mass casualty events, and it can be used on adults, children, and infants. It stands for Sort, Assess, Lifesaving Interventions, and Treatment/Transport. SALT is newer than START, and includes the following steps:

• Sort: Prioritize patients for initial assessment based on whether they have obvious, life-threatening issues, can wave, and can walk.
• Assess: Evaluate the ABCs (Airway, Breathing, Circulation) and perform limited lifesaving interventions.

Using assessment information, the clinician then puts patients into one of five categories. SALT uses the same categories as START, with the addition of a category for patients who are deceased.

SALT protocol also outlines actions for patients who are alive but have massive injuries or conditions that are likely fatal. These patients are not given immediate care, but may receive care in the future if resources become available.

Rapid Triage FAQ

What is advanced triage?

This relatively new system uses nurse practitioners as triage clinicians in an attempt to reduce wait times in EDs. Emergency nurse practitioners (ENPs) have a broader scope of practice than RNs, allowing them to order tests and perform interventions to shorten hospital stays.

Is rapid response the same thing as rapid triage?

No. A rapid response team, or RRT, is a group of critical care clinicians (including RRT nurses) who come to the bedside when a patient in the hospital is growing sicker. A rapid triage is an individual assessment that determines whether a patient needs immediate attention.

Is triage good or bad?

Triage is an area where a clinician does a quick assessment to determine next steps. It’s obviously a good thing to be seen when you’re waiting in the emergency department, but going through triage doesn’t necessarily mean you’re about to receive treatment.

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