Triage Categories for Accident and Medical Practice PROPOSED AMPA TRIAGE SYSTEM A suggested triage scale of three levels relevant to community based facilities 1Urgent Assessment required stat. Patients in this category are critically ill, they will be suffering multitrauma, be shocked, unconscious, convulsing, in extreme dyspnoea, or in cardio respiratory arrest. (ACEM 1) OR Patients considered "at risk' of critical illness, and patients with very severe pain from any cause. (ACEM 2) Examples are: Chest pain or other symptoms suggestive of myocardial ischaemia, pulmonary embolism or aortic dissection Severe abdominal pain or other symptoms suggestive of ruptured aortic aneurysm Severe dyspnoea from any cause Altered consciousness or motor function Fever, rash, headache, etc suggestive of sepsis or meningitis Severe skeletal trauma such as femoral fracture, dislocated knee, amputations, etc Patients in very severe pain from any cause Head injury, with transient loss of consciousness

2 Serious Assessment required within 15 minutes Patients in this category have significant illness or injury. (ACEM 3) Typical patients include: Patients with moderately severe pain from any cause, but not suggestive of critical illness (e.g. abdominal pain, acute headache, renal colic) Patients with Symptoms of significant infections (e.g. pyelonephritis, pneumonia) Moderate injury (e.g. colles fracture, severe laceration without active haemorrhagic, etc)

3Non urgent or non serious Assessment expected ideally within 30 minutes. ( acceptable up to 60 minutes when busy or if higher acuity patients are being attended to) - As well as close monitoring of the waiting room to visually or verbally check for any change in patient status Patients in this category have only minor symptoms, symptoms of prolonged duration or acute symptoms of low risk pre-existing conditions. (ACEM 4) Corneal foreign body - Minor trauma (sprained ankle) Migraine headache (moderate severity, previously diagnosed) Earache OR Presentions with symptoms of chronic disease, symptoms with duration of greater than one week, or acute symptoms of minor illness. (ACEM 5) Examples include: Chronic lower back pain Dysmenorrhoea Most skin conditions (acne, keratosis, dermatitis, etc) URTI, flu etc ( Adults only - children should not be acuity 5) Minor dressings Clinico-administrative ( results review, certificates, repeat prescriptions, etc)

The Triage Alert System When there is no dedicated triage nurse (in a hospital ED there is usually a dedicated triage nurse) there must be a system for identifying patients who need immediate triage. Because patients cannot be triaged in public (ie. at the reception desk) and receptionists as a rule have no formal training to undertake triage, AMPA recommends implementing a triage alert system. Two components of such a system to be encouraged are: 1/ Self triage and 2/ Patient identifiers for front desk personnel to recognise and process serious presentations as Triage Alerts ( need to be triaged immediately ). 1Self-Triage By Patient Reception staff should familiarise themselves with the sign in the waiting room starting for example with... “ if you have any of the following serious symptoms please identify yourself to the front desk.....” Patients may present and identify themselves immediately as having obvious potentially serious symptoms. This may take the form of a bleeding patient arriving at the reception desk and identifying themself. A patient sitting unnoticed in the waiting room with eg chest pain may see the sign and then identify themselves to the reception staff. The correct action for the receptionist to take at this point is : Call for assistance from a nurse or a doctor immediately and, Assist the patient to a treatment area with the nurse

Self-triage forms These are the patient registration forms that patients are requested to fill out on arrival at the reception desk In addition to having details of name, date of birth etc there is a section where the patient briefly describes the reason for the visit There can also be a section where the patient is asked to circle yes or no to a list of potentially serious symptoms There is also an area for triage category (this is done by the nursing and medical staff ) to be recorded following triage by a nurse as well as recording the times the patient is seen by the nurse and by the doctor. Patient waiting times and acuity levels are to be recorded in the patient notes to enable ongoing assessment of appropriate waiting times.

If a patient lists any of the following as reasons for a visit: Bleeding Chest pain Vomiting Shortness of breath Abdo pain Severe headache Or: Circles “ yes” to any of the symptoms listed as serious on the registration form then : THE PATIENT IMMEDIATELY BECOMES A “TRIAGE ALERT” AND THE RECEPTIONIST MUST NOTIFY THE NURSE (OR DOCTOR IF UNABLE TO CONTACT THE NURSE) THAT THERE IS A “TRIAGE ALERT” THAT NEEDS TO BE SEEN AS A PRIORITY

2 Patient Identifiers Reception/front line staff should be trained to identify the following presentations as Triage Alerts Bleeding SOB/Wheezing Pale/ faint/sweaty patients Distressed patients Language barriers Non responsive or decreased responsiveness to direct questioning Difficulty mobilising or obvious severe pain when mobilising Under 3 months of age