Triage systems around the world: a historical evolution

Abstract

The process of triaging patients has come a long way. Stemming from the battlefield, it is the ability to sort casualties on the severity of their injuries that has improved the allocation of resources. In modern emergency centres, there is a constant struggle to balance limited resources against the ever-growing patient need. Since the late 1980s, when triage became the mainstream standard for sorting patients, many different systems have developed throughout the world. There was a rise in triage system design as emergency centres became more streamlined and resource-conscious. Countries around the world sought to develop triage systems that would be most effective in their given setting—giving rise to multiple variations of the triage process. This narrative review will explore the evolution of triage systems around the world by presenting: a historical perspective, how and where modern systems developed, what the main characteristics are of different systems, and a discussion of the current state of triage system evolution.

Field Triage Tools in Mass Casualty Incidents: A Narrative Review

“…During World War I, for instance, rudimentary triage methods were used to sort wounded soldiers based on the severity of their injuries and the likelihood of survival. Over time, these early triage concepts evolved into more structured protocols and algorithms designed to prioritize patients in emergency settings [9][10][11].…”

“…The Simple Triage and Rapid Treatment (START) protocol emerged as one of the first standardized triage systems, emphasizing rapid assessment and categorization of patients into four triage categories: Immediate (red), Delayed (yellow), Minor (green), and Expectant (black). START's simplicity and ease of use made it widely adopted in prehospital and disaster response settings [9,10].…”

Dynamic criticality for infrastructure prioritization in complex environments

“…Originally conceived in the 1700s out of necessity to make rapid decisions for wounded soldiers in wartime, medical systems began formally developing triage frameworks in the 1970s (Dippenaar 2019). Emergency departments require decision-making tools to prioritize groups and individuals during medical emergencies.…”

“…Worldwide triage frameworks exhibit thematic commonalities in determining criticality, despite practical application differences, often driven by culture (Dippenaar 2019). In general, medical providers quickly identify patients that require immediate care, administer life-saving interventions for stabilization, and then assess the remaining patients with less urgency.…”

“…Moreover, the individual patient assessment provides a specific checklist of critical body systems and symptoms, which points the medical team toward the type of care needed (Aacharya et al 2011). Ultimately, triage frameworks save time, energy, and lives when employed properly (Dippenaar 2019).…”