Abstract
At the healthcare facility or setting and particularly in the emergency department patients will present with different or varying needs. Considering the chronic scarcity of resources or personnel within the settings, healthcare providers have to prioritize the needs foe the patients. That means determining those that require urgent care, those that can be managed in the mid-term and those that can wait for much longer periods of time before being managed (Hoyt, 2016). There are ethical issues that make the triage system a case for worry; on one hand, the probability that patient’s status may rapidly change and how responsive the triage systems can adapt to such unforeseen changes in health status (Parker, 2013). On the other hand, the ranking of patients based on severity of potential benefits could significantly impact on the psychological status of the patient or their family members based on how they would interpret the situation (Hoyt, 2016). Even amidst these ethical issues, the success of the systems over time and the adaptability and dynamism of the triage nurses has meant that the healthcare system cannot let go this system rather they are to modify it (Parker, 2013).
In a time of increasing healthcare cost and government budget cuts, as well as understaffed medical institutions and overcrowded emergency departments, questions have been asked regarding the nation’s triage system. According to Riverside Publishing Company (1984), the triage system refers to the screening and classification of wounded, sick, or injured patients during war or another disaster to determine priority needs and thereby insure the most efficient use of medical and surgical manpower, equipment, and facilities. This system of treating patients by means of importance has been used in hospital emergency rooms, on the battlefield, after a natural disaster, and anywhere a medical emergency may occur. In today’s culture of uber sensitivity, is the triage system politically correct? No, as it shouldn’t be. However, if asked if it was fair, one might have a different answer. The word triage derives from the French language, meaning to sort.
As a matter of fact, the birth of triage happened to be due to a French surgeon, “Baron Dominique Jean Larrey, [who] pioneered the use of ambulances and triage in the 19th century” (Parker, 2013). Larrey, who happened to be Napoleon Bonaparte’s army doctor, initiated some of the first recorded triage methods in history. It was due to his innovations that the world as a whole abides by these methods today. Triage, which classifies and categorizes the ill or injured, takes place in emergency clinics or departments, and hospitals, and also at any mass disaster or tragedy. Norcross (2016) posits that, depending on where the injured, sick or disaster is, triage is used to describe the process by which groups of patients are prioritized for treatment and transport. According to Stoppler (2016), at medical institutions such as an emergency room or clinics, an interview with a triage nurse is a common first step to receiving care. She further posits that the care provider generally takes a brief medical history of the complaint and measures vital signs (heart rate, respiratory rate, temperature, and blood pressure) in order to identify seriously ill persons who must receive immediate care.
There are numerous triage systems and methods that are used by different agencies and groups. One of the most widely used methods is called START. It is in acronym that stands for Simple Triage and Rapid Treatment, the primary goal of the START triage system is to do the greatest good for the greatest number (Owens, 2016). This method allows for the sick or injured to be assessed and then ranked by significance of injury. The START program divides patients into four groups, which can also be identified by colors:
Immediate patients are tagged “RED.” These patients experience problems with respirations, perfusion, and mental status. They require immediate medical attention and are the first to be transported from the incident. Delayed patients are tagged “YELLOW.” These patients often suffer from burns and do not have airway problems, multiple bone or joint injuries, and back or spinal injuries.
They will survive if definitive medical care is not received immediately. Minor patients are tagged “GREEN.” They are often considered the “walking wounded” and may suffer from cuts, scrapes, and sprains and respond to the request to walk from the scene. These patients would often be considered for refusals if they weren’t part of a mass-casualty incident. Deceased/non-salvageable patients are tagged “BLACK.” They are not breathing. According to Owens (2016), although they would be resuscitated in a “normal” situation, the resources necessary for that effort are not available.
The methods of triage systems are numerous and used globally. As with most programs in today’s world, technology and digital advancements have enhanced triage methods and will continue to do so. Government agencies, law enforcements, medical facilities,and local organizations are trained in a triage method that is tailored to their specific needs. Having a triage type protocol in treating injuries and illnesses in a person’s family home is a valuable tool as well. Adopting a ‘breathing, bleeding, broken bones, and burns’ order of importance in treating is simple to remember and follow. However, as vital and beneficial as the triage system is, and regardless of which method is in place, whether it is in a hospital, in law enforcement, used by first-responders, are in a family home, it is not perfect. Dr. Batchelor of Children’s Healthcare of Atlanta at Scottish Rite explains.
As with any issue, there are two sides that have differing opinions regarding the credibility of the triage system. Many believe that it poses an unfair situation to those who may have minor injuries compared to others, yet still require a doctor’s treatment. While these people may seem self-centered for thinking this, it is still a valid point to consider. The other side would likely argue that the current way of dealing with ghastly injuries has proven to be a healthy contribution to hospitals and distress centers worldwide. Be that as it may, the fact still remains that the lengthy history of triage undeniably proves how successful the system is: Those who need immediate care will receive it, and those with lesser injuries or illnesses can wait a tad longer while these severe cases are catered to. It is due to this logic that the triage system is not only a beneficial system, but a necessary one.
References
Hoyt, A. (2016). How Triage Works | HowStuffWorks. Retrieved from http://health.howstuffworks.com/medicine/triage.htm
Norcross, D. (2016). Field Triage of the Injured Patient - The American Association for the Surgery of Trauma. Retrieved from http://www.aast.org/GeneralInformation/FieldTriageoftheInjuredPatient.aspx
Owens, K. (2016). EMS TRIAGE: SORTING THROUGH THE MAZE-How various triage systems work and their pros and cons. Fire Engineering, 161(3), 155.
Parker, S. (2013). Kill or Cure: an illustrated history of medicine. Penguin.
Riverside Publishing Company. (1984). Webster's II new Riverside university dictionary. Riverside Pub. Co..
Stoppler, M. C. (2016). Medical Triage (Color Tags, START) Terminology by MedicineNet.com. Retrieved from http://www.medicinenet.com/script/main/art.asp?articlekey=79529
