Why Triage is Important

When you come to the ER, the first step of the process is triage. A nurse will talk to you about the reason for your visit, obtain vital signs and gather some of your information such as medical history, medications and allergies. The word triage means 'to sort.' The triage process was developed on the battlefield to quickly sort large amounts of wounded soldiers into categories, basically dead or dying, urgent and can wait. The dead or dying were set aside so as not to waste resources better spent trying to save the salvageable. Fortunately in the ER we have enough resources to attempt to save everyone we are trained and prepared for that unthinkable day when a mass casualty incident may force us to return to battlefield triage.

Even though we aren't a battlefield, we triage people to ensure that the sickest get treated first. As I have tried to explain to the angry people in the lobby, the ER is not Burger King, it's not first come, first serve and get it your way. People in the process of having a heart attack, stroke or on the verge of not breathing need attention RIGHT NOW. Your chronic back pain, migraine, twisted ankle, cold sore etc. can wait a bit.


The triage nurse spends just minutes with the patient. In those few minutes she must determine how urgently the patient needs to be seen. This is made more difficult by the fact that patients often don't tell the nurse the whole story or they embellish or outright lie. Triage is an awesome responsibility. The nurse that does triage is away from the main ER and alone with the patient, they need to be an experience nurse who possess the assessment skills to look past the story and catch the subtle clues that something sinister may be going on.

For instance: A patient comes into triage, a man in his sixties with a complaint of being unable to move his bowels and abdominal pain. An inexperienced nurse would take down the information, and probably decided that the patient is constipated and send them to the lobby. An experienced nurse would notice that the patient is pale and sweaty and huffing and puffing a little bit. The nurse will ask him if he feels short of breath and after thinking a bit he'll answer that he does. She will get a wheelchair and take the man back to a resuscitation room even though the charge nurse may think she is nuts for rushing back a 'constipation.' The EKG will show the 'tombstones' of an acute MI. He goes emergently to the cath lab and is stented. He goes home two days later with minimal residual damage.

Now imagine the same situation with an inexperienced nurse. She takes the chief complaint at face value and sends him to the waiting room where he waits over three hours until his heart, irritated by lack of oxygen, suddenly goes into a fatal arrhythmia. Despite aggressive resuscitation, he dies.

Hospital administration thinks that a nurse is a nurse. It doesn't matter if they are experienced or a new grad, in fact a new grad is better because they are cheaper. Wonder which nurse they would want triaging them?

Imagine what would have happened.............