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Triage is the French word that means to sort.
It was first used to categorise patients on the battlefields during World War
1. The purpose then was to treat the "most salvageable" patients and
return them to the battlefield. In addition to military situations, it has been
used in major incidents and A/E departments. It was first introduced in the
USA in the late 1950's or early 1960's (2), in the U.K. (1) and Ireland in the
1980's.
I chose to research triage facilities available in Ireland for a number of reasons. Prior to commencing the A/E Nursing Course in St. James's Hospital I had no experience of formal triage. I wanted to know more about
I what triage is
II the advantages and disadvantages of triage
III the types of triage in operation.
IV the availability of triage in Ireland.
Most of the above queries I had were answered
by the available literature. I was able to get plenty of information on triage
in the UK, USA and Australia, but I found no literature referring to triage
in Ireland.
All UK A/E departments now operate some form
of triage (3) as this is a requirement of the Patients Charter 1992 (4). In
the USA some states have passed legislation stating that emergency departments
must have triage (5.2). Most Australian A/E departments operate a triage system.
The National Triage Scale for Australian Emergency Departments (1993) states
that "all patients presenting to an emergency department for assessment
and treatment will be assessed to determine the urgency of their clinical condition"
. (6)
No such similar legislation or recommendations
are available in Ireland.
I contacted An Bord Altranais and the Department
of Health neither of which had any. recommendations that triage be provided
in A/E Departments. It is not even necessary to have triage in order to provide
an A/E Nursing Course.
I also looked at triage with regard to the
Major Incident Plan. Each health board area has a major incident plan which
is based on the patients being triaged at the scene. I contacted a representative
of either the ambulance service or health board in each region and none of the
Major Incident Planners have recommended that triage should be available in
the A/E departments. A copy of the on‑site triage system is provided for
each hospital but it is up to the hospital to draw up its own Major Incident
Plan . This plan need not necessarily contain any triage plans but common sense
dictates that it would. If triage is included in the plan it may be carried
out by either doctors or nurses who are not sufficiently familiar with the system
or indeed it may be their first encounter with triage. While written triage
protocols are necessary, practice is a huge part of becoming proficient and
confident in triaging patients. A major incident is not the time to start learning.
After researching triage I cannot understand
why no recommendations have been made to have triage available in all A/E departments.
It is not essential to have a fully equipped room, just a semi‑private
area to interview patients and record basic observations. A minimum increase
on basic staffing levels of 2.8 whole time equivalents has been recommended
for triage. I will discuss the benefits of triage at a later point. I think
it is only common sense that the benefits far outweigh the costs.
The introduction of the first emergency nurse practitioner (ENP) to Ireland, in 1996, in St. James's Hospital, further enhances the triage system. The ENP examines the patients charts post triage and selects appropriate non‑urgent patients to treat. If the patient is not triaged it is not possible for an ENP to work (7), indeed it has been suggested that the role of ENP and triage nurse maybe combined, but during busy periods the ENP/triage nurse has to revert to triaging duties only (8).