Medical Triage: Code Tags and Triage Terminology

Medical Author: Melissa Conrad Stoppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

Triage refers to the evaluation and categorization of the sick or wounded when there are insufficient resources for medical care of everyone at once. Historically, triage is believed to have arisen from systems developed for categorization and transport of wounded soldiers on the battlefield. Triage is used in a number of situations in modern medicine, including:

• In mass casualty situations, triage is used to decide who is most urgently in need of transportation to a hospital for care (generally, those who have a chance of survival but who would die without immediate treatment) and whose injuries are less severe and must wait for medical care.

• Triage is also commonly used in crowded emergency rooms and walk-in clinics to determine which patients should be seen and treated immediately.

• Triage may be used to prioritize the use of space or equipment, such as operating rooms, in a crowded medical facility.

In a walk-in clinic or emergency department, an interview with a triage nurse is a common first step to receiving care. He or she generally takes a brief medical history of the complaint and measures vital signs (heart rate, respiratory rate, temperature, and blood pressure) in order to identify seriously ill persons who must receive immediate care.

In a hospital, triage might prevent an operation for an elective facelift from being performed if there are numerous emergent cases requiring use of operating facilities and surgical nursing staff.

In a disaster or mass casualty situation, different systems for triage have been developed. One system is known as START (Simple Triage and Rapid Treatment). In START, victims are grouped into four categories, depending on the urgency of their need for evacuation. If necessary, START can be implemented by persons without a high level of training. The categories in START are:

• the deceased, who are beyond help

• the injured who could be helped by immediate transportation

• the injured with less severe injuries whose transport can be delayed

• those with minor injuries not requiring urgent care.

Another system that has been used in mass casualty situations is an example of advanced triage implemented by nurses or other skilled personnel. This advanced triage system involves a color-coding scheme using red, yellow, green, white, and black tags:

• Red tags - (immediate) are used to label those who cannot survive without immediate treatment but who have a chance of survival.

• Yellow tags - (observation) for those who require observation (and possible later re-triage). Their condition is stable for the moment and, they are not in immediate danger of death. These victims will still need hospital care and would be treated immediately under normal circumstances.

• Green tags - (wait) are reserved for the "walking wounded" who will need medical care at some point, after more critical injuries have been treated.

• White tags - (dismiss) are given to those with minor injuries for whom a doctor's care is not required.

• Black tags - (expectant) are used for the deceased and for those whose injuries are so extensive that they will not be able to survive given the care that is available.