Triage

Lore & Background

The concept of triage dates back at least to the reign of Maximillian I, but the term itself comes from French, meaning the action of picking or sorting. In the 1800s, Baron Dominique-Jean Larrey, Surgeon in Chief of Napoleon's Imperial Guard, laid the groundwork for modern triage by introducing the concept of treating the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of rank or nationality. The general concept was first described in a 17th-century BCE Egyptian document, the Edwin Smith Papyrus, which divided injuries into three categories: those that can be healed, those to fight with, and those that cannot be healed.

Reader's Guide

Triage is a foundational practice in emergency medicine and disaster response, balancing multiple objectives such as likelihood of death, efficacy of treatment, patients' remaining lifespan, ethics, and religion. It is an imperfect and often subjective practice, especially when based on general opinion rather than a score. Triage systems vary by institution, locality, and country, but share universal underlying concepts: the most injured and most able to be helped are first priority, with the most terminally injured last, except in reverse triage. Simple triage is used at accident scenes, often employing tags to identify patients and track their progress. Advanced triage involves more in-depth assessments by doctors, nurses, or paramedics. Undertriage and overtriage are common errors, with acceptable overtriage rates up to 50% to avoid undertriage. Telephone triage provides accurate information about 90% of the time. During the COVID-19 pandemic, palliative care in triage became more prominent as some countries denied care due to lack of supplies.

Did You Know?

• The term triage comes from the French word for sorting, derived from Old French 'trier' and late Latin 'tritare'.
• Baron Dominique-Jean Larrey introduced the concept of treating wounded based on injury severity and urgency, regardless of rank or nationality.
• The Edwin Smith Papyrus, a 17th-century BCE Egyptian document, described three categories of injuries: healable, treatable, and untreatable.
• Reverse triage includes treating those appearing dead from lightning injuries ahead of others, as they can often be resuscitated.