By Chidera Mordi

Right resource allocation and proper prioritization are vital during emergencies, particularly medical emergencies where lives are at stake. A triage system provides a structured method for prioritizing patient treatment according to the urgency of their condition (Lidal et al., 2013).

Several triage systems were developed in the 1990s and 2000s. However, systematic triage assessment in pre-hospital settings remains limited. For example, in Sweden, the Medical Emergency Triage and Treatment System (METTS) was developed specifically for ambulance services after a 2002 national survey revealed that about half of Emergency Departments did not use a triage system at all (Lindberg et al., 2011). Similarly, in Denmark, 40% of Emergency Departments relied on non-validated systems (Göransson, 2005).

Triage can take place at different points in the emergency medical chain—by telephone responders, ambulance crews, primary care physicians, emergency clinics, or hospital emergency departments. However, in medical emergencies, effective pre-hospital triage is particularly critical. Sahlin et al. (2010) emphasized that attention should extend beyond hospital processes to include the pre-hospital phase.

An effective triage system ensures patients are directed to facilities equipped to deliver definitive care. By identifying severity early, critically ill patients avoid being transported to hospitals lacking advanced resources. Ortolani et al. (2007) found that patients who received pre-hospital triage had higher survival rates at one-year follow-up, underscoring the life-saving impact of accurate triage.

Triage also supports streaming, which divides patients based on their condition to improve flow. Stable patients can be transported to general hospitals, while those needing specialized interventions—such as advanced trauma, surgical, or cardiac care—are routed directly to centers of excellence. This reduces delays, prevents unnecessary secondary transfers, and improves outcomes. Studies show that direct transportation to intervention laboratories significantly shortens treatment delays and enhances clinical results.

Effective triage strengthens decision-making in the field. Involving physicians or specialist input in pre-hospital triage has been shown to improve accuracy, reduce unnecessary waiting, and minimize the number of patients leaving without care. For instance, suspected stroke patients can be assessed quickly and sent directly to stroke-ready centers, ensuring appropriateness of destination as well as urgency.

Conclusion

Triage is essential for ensuring timely, efficient, and effective emergency medical intervention. While both in-hospital and pre-hospital triage matter, pre-hospital triage plays a decisive role in aligning patient needs with facility capabilities. By ensuring patients reach the right facility the first time, effective triage improves survival, reduces delays, and strengthens emergency care systems.

Reference

Lidal, Ingeborg Beate, Hilde H. Holte, and Gunn Elisabeth Vist. “Triage systems for pre-hospital emergency medical services-a systematic review.” Scandinavian journal of trauma, resuscitation and emergency medicine 21.1 (2013): 28.

Lindberg, Soren Ostergaard, et al. “The use of triage in Danish emergency departments.” Dan Med Bull 58.10 (2011): A4301.

Göransson, Katarina E., Anna Ehrenberg, and Margareta Ehnfors. “Triage in emergency departments: national survey.” Journal of clinical nursing 14.9 (2005): 1067-1074.

Sahlin, Nils-Eric, et al. “Triage and flow processes in the emergency department: A systematic literature review.” (2010).

Ortolani, Paolo, et al. “Usefulness of prehospital triage in patients with cardiogenic shock complicating ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.” The American journal of cardiology 100.5 (2007): 787-792.