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What are the three levels of triage

Several schemes exist to define levels of triage. The Advanced Disaster Medical Response course 37 is field oriented and outlines the following: . Level 1 triage occurs at the point of injury. . Level 2 triage occurs at the scene (or nearby) by the most experienced medical provider. . Level 3 triage is performed to determine evacuation priorities Streaming: Streaming is a predetermined method of allocating patients to People who need to have treatment within 30 minutes are categorised as having a potentially life-threatening condition. Triage nurses are specially trained professionals and use Schmitt-Thompson protocols along with their nursing training to assist in deciding for the appropriate triage level. A triage nurse will. Triage at an accident scene is performed by a paramedic or an emergency physician, using the four-level scale of Can wait, Has to wait, Cannot wait, and Lost. France [ edit ] In France , the Prehospital triage in case of a disaster uses a four-level scale Using the triage method, a Tier 1 situation may only be assigned a limited set of engineering resources with one or two admins to deal with it, whereas a Tier 4 event requires a massive response of multiple teams and expertise sets. Applying Tier 4 and 5 methodologies to a Tier 1 event causes delays, cost overruns and wasted time

Triage - an overview ScienceDirect Topic

  1. Level 3: Urgent - Serious conditions that require emergency intervention. What is basic triage? Simple triage and rapid treatment (START) is a triage method used by first responders to quickly classify victims during a mass casualty incident (MCI) based on the severity of their injury
  2. Used as a triage tool in a pre-hospital setting. It is a common physiological scoring system based on the first data sets of three specific physiological parameters obtained from the patient. The three parameters are: the GCS, systemic blood pressure (SBP), and the respiratory rate (RR)
  3. or trauma areas of the ED. The triage policy may also allow for some level-3 patients to be sent to urgent care (UC), such as patients needing simple migraine headache treatment
  4. Triage systems are activated in medical emergencies. There are also different types of triage systems that can be utilized for specific situations. Telephone triage, for example, is often used by operators on medical hot lines. Hospital triage is a secondary form of simple triage that is used in emergency reception rooms, often while receiving.
  5. ation is made based on an increase in the complication of care. Patients placed at level 3 may be someone who: • is 80-years old. • has a urinary catheter. • has a fever and cough. • needs blood and urine tests. • needs a chest X-Ray. • needs two or more resources
  6. g
  7. The most common triage systems use color-coding that works similar to this: ed: Needs immediate attention for a critical life-threatening injury or illness ; transport first for medical help. Yellow: Serious injuries needing immediate attention
This mass casualty decontamination plan is based on the

what are the 3 categories of triage

  1. Patients triaged to the acute emergency department with the 3L system were either level 1 or 2; now there are 3 levels to clearly delineate resuscitation patients (level 1) from those who are high risk, acutely ill, or both (level 2) and those that require complicated evaluation but are otherwise stable (level 3)
  2. utes are categorised as having a potentially life-threatening condition. People in this category are suffering from severe illness, bleeding heavily from cuts, have major fractures or are severely dehydrated. Triage category
  3. The main differences between these two triage types are the level of skill required to split the red and yellow tagged patients up. An untrained person may not be capable of differentiating the.
  4. A triage level is the appropriate level of care based on the patient's symptoms and medical history. Levels usually include dispositions such as call 911, go to the emergency room, urgent care visit, primary care or telemedicine visit within 24 to 48 hours, or most commonly home care. Why is it important to get to the proper triage level as quickly as possible? Patient safet
  5. Level Name Description Examples 1: Resuscitation: Immediate, life-saving intervention required without delay: Cardiac arrest Massive bleeding 2: Emergent: High risk of deterioration, or signs of a time-critical problem: Cardiac-related chest pain Asthma attack 3: Urgen
  6. Currently, 5-level triage systems, including the Australasian Triage Scale (ATS) [ 2 ], Canadian Triage and Acuity Scale (CTAS) [ 3 ], Manchester Triage System (MTS) [ 4 ], and Emergency Severity Index (ESI) [ 5 ], are the most studied and widely adopted in developed countries [ 6, 7 ]
PPT - Emergency Department Triage System PowerPoint

Examples of level 3 acuity patients: Abdominal pain; Headache/migraine; Fatigue with stable vitals; Fractured ortho injuries; ESI Level 4 & 5. This category is mostly made up of lower acuity patients that are similar to urgent care patients. These patients require one or no resources in order to provide treatment and obtain a diagnosis 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 Based on the search done in these databases, twenty different systems were identified in the primary adult triage field including START, Homebush triage Standard, Sieve, CareFlight, STM, Military, CESIRA Protocol, MASS, Revers, CBRN Triage, Burn Triage, META Triage, Mass Gathering Triage, SwiFT Triage, MPTT, TEWS Triage, Medical Triage, SALT, mSTART and ASAV

A number of published research studies demonstrate the poor interrater reliability of the three-level triage acuity rating system. 16. 29. and 30. Interrater reliability is the level of agreement or consistency among users of the system. As triage has evolved, there has been an increasing recognition that high interrater reliability is a. The ATS utilises five categories from Category 1 - an immediately life-threatening condition that requires immediate simultaneous assessment and treatment - to Category 5 - a chronic or minor condition which can be assessed and treated within two hours The 3-level systems divide patients into the groups emergent (cannot safely wait until a space in the clinical area becomes available), urgent (can safely wait a short amount of time until a space in the clinical area becomes available), and non-urgent (can safely wait a long time until a space in the clinical area becomes available)

Triage - Wikipedi

Level 2 - Emergent. Level 3 - Urgent: Level 4 - Less Urgent. Level 5 - Non-Urgent: CTAS Five Level Triage This document describes the Emergency Severity Index (ESI) triage algorithm, Implementation Handbook, and DVDs. The Emergency Severity Index (ESI) is a five-level emergency department (ED) triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resource needs Initial versions of triage guidelines had three levels of categorization mostly termed as emergent, urgent and non-urgent . Studies have revealed that five-level triage systems are more effective, valid and reliable [ 25 , 26 ]

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Disaster Recovery Planning - the 5 Levels of Triag

  1. 2. Spot-Check Triage: Quick-look 3. Comprehensive Triage: ENA standard 4. Two-Tiered Triage: Quick-look, then triage
  2. Multiple Injury Triage: Tier 3. Mild injuries that are not life threatening and in which the medical care can be deferred safely belong in Tier 3. Minor bleeding (flow of blood is easily contained using pressure). Minor fractures (dislocated joints would also fall in the category). Erratic behaviour or shock of a psychological nature (as long.
  3. The three levels of urgency include emergency status for immediate care, priority status for immediate care right behind emergencies and non-urgent status. Additional Concepts of Triage Borrowing the term from the healthcare setting, the concept of triage can easily apply to different business work flow situations
  4. The main differences between these two triage types are the level of skill required to split the red and yellow tagged patients up. An untrained person may not be capable of differentiating the.
  5. There are three levels of triage, and as system pressures increase, triage criteria will become proportionately more strict (see Figure). The degree of triage will be prompted by the degree of demand, in order to limit the possibility that anyone will be denied critical care resources unnecessarily
  6. The 3-Step Security Event Triage Process. Security teams often follow linear triaging processes where one system or artifact is investigated at a time. But, as we've talked about before, linear processes can be dangerous. If you only work from a list of predefined tasks, you can easily miss key pieces of information

What are the principles of triage

Changes to Triage . Triage systems have been changing due to technology.   There is increased use of telephones, cell phones, the Internet, and closed teleconferencing systems between trauma centers and rural hospitals that cannot afford the latest equipment or high-level specialties Introduction: The Study Objectives Were To Compare Reliability And Validity Of A 3-LEVEL (3L) Triage System With A New 5-LEVEL (5L) Triage System And Determine The Effect Of Nursing Experience On Triage Reliability.Methods: The Study Was Conducted In A Southeastern Tertiary Emergency Department. With A Stratified Random Sample, Reliability Of 3L Triage Ratings Was Measured With Weighted Kappa. Because triage systems are ordinal scales, we dichotomised the urgency categories into a high-urgency and low-urgency group. High urgency was defined as triage urgency level 1 (three-level systems) or triage urgency level 1 and 2 (four-level and five-level systems) Security Incidents: Types of Attacks and Triage Options. Understanding whether an event is an actual incident reminds me of that common expression, I know it when I see it made famous by US Supreme Court Justice Stewart Patients assigned to Level 2 were more likely to utilize cardiac monitoring, electrocardiogram, medications, and specialty consultation than patients assigned to Level 3. It is critical that nurses in the triage setting be aware of possible patient factors and resource needs that could influence assignment to specific triage levels

PPT - Utilitarianism PowerPoint Presentation, free

The Triage System in Action. While most hospitals follow a similar process for evaluating clients, each has a unique system for assigning a color, numeric, or other type of code to patients depending on the level of severity. The categories below are the most typical assessments that we use when triaging patients here at UPMC Western Maryland The presence of one or more risk factors may result in allocation of triage category of higher acuity. Developed by a project team for the 'Consistency in Triage Project' (2001). Contributors: Emergency Nurses Association, Triage Working Party and Royal Children's Hospital emergency nursing staff

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales 2.2 The CTAS Levels 17 2.3 Determining The CTAS Level 21 2.4 First Order Modifiers 22 2.5 Second Order Modifiers 29 2.6 Support Quality Standards 32 2.7 The Triage Decision 32 2.8 Reassessments In Waiting Areas 32 2.9 Group Exercise - Case Scenarios 32 Module Three: Paying Attention To Special Groups - Paediatrics 34 3.1 Triage Guidelines For.

Telephone Triage Nurses are trained to ask very specific questions to accurately assess their condition and determine the level of care needed and how quickly. The 3 Levels of Triage. Utilizing the three levels of triage is very important in determining the medical needs of the caller. These three levels of triage are Search and selection of studies. The American College of Emergency Physicians /Emergency Nurses Association Five-Level Triage Task Force recommended the use of five-level triage scales as they generally showed better reliability compared with three-level or four-level ones.6 Travers et al showed that a five-level triage system was more reliable and discriminative than a three-level one.7 A.

Triage comes in many forms, and hospitals across the globe approach it differently. Triage can involve one or two stages or go up to even five levels. The most common approaches to triage in the US are the traffic director or quick look, spot check and comprehensive methods, which cover a range of intensity Technology Trends n Triage Nursing. One of the biggest trends in the triage nursing profession is the use of automation. Automated machines like BeWell's WellPoint self-service kiosk takes a patient's weight, blood pressure, and oxygen levels and update the patient's medical health record START Triage Assess, Treat, (use bystanders) When you have a color STOP - TAG - MOVE ON: M I N O R-- Move Walking Wounded D E C E A S E D -- No RESPIRATIONS after head tilt: I M M E D I A T E -- Breathing but UNCONSCIOUS -- Respirations - over 30 -- Perfusion Capillary refill > 2 or NO RADIAL PULS

Using the tiers template above, determine what sorts of topics and issues might fit into each tier. Note that some companies use fewer tiers than the five levels (0 through 4) listed above. If you only have enough staff to support three levels, that is a fine approach What Do You Know About Emergency Severity Index? This post-test is used to evaluate your understanding, at a more advanced level, the Emergency Severity Index, and the triage practices in your triage department. This index helps you understand the patients you may come across and the urgency of their conditions. Please complete the testing as indicated, and the system will score the results

Trauma Triage and Scoring; about Trauma Triage Patien

Step 1 - Triage. Triage is the process of determining the severity of a patient's condition. Patients with the most severe emergencies receive immediate treatment. That is why some patients may receive medical care before you, even if they arrived at the ED after you. When you arrive at the ED, emergency technicians determine the reason for. How to Triage. It is vitally important that the Triage process does not involve treatment (with three exceptions explained below). It is far too easy to get drawn into dealing with the first casualty you come acrossat the expense of other casualties. Triage is an objective, emotionless process. Almost ruthless If a patient does not meet high acuity level criteria (ESI level 1 or 2), the triage nurse then evaluates expected resource needs to help determine a triage level (ESI level 3, 4, or 5). Inclusion of resource needs in the triage rating is a unique feature of the ESI in comparison with other triage systems To use the Triage Sort, three physiological variables are assessed and given a score; the sum of these three scores is then used to derive the triage category. Fig 4: Triage Sort Tool (8) It is obvious that the triage sort aims to consider the casualty's condition in more detail These mental and physical effects are the body's reaction to stressors as a form of defense. The three stages of stress include the following: 1. Alarm. The first stage of stress is your body's immediate reaction. Anything can trigger the response, and each person has different levels of tolerance and sensitivity

Triage is the name of the system that is used to sort when and where patients will be seen in an emergency department. Rather than operating on a 'first come, first served' system like you would expect at a restaurant, emergency departments use the triage system. 2 1) Define triage and mass casualty 2) Review the dynamics of START triage 3) Review use of the SMART tagging system 5) Demonstrate competency in the START triage method in a variety of scenarios 6) Demonstrate competency in the SMART triage tag and JumpStart 1-3 months of age: consider assigning ESI 2 if temp >38.0 C (100.4F) 3 months to 3 yrs of age: consider assigning ESI 3 if: temp >39.0 C (102.2 F), or incomplete immunizations, or no obvious source of feve The three levels of autism make it possible for doctors to make a specific diagnosis and also helps people who are taking care of someone with autism have a clear understanding of that person's strengths and limitations. The levels described in the DSM-5 reflect a more refined way of diagnosing autism than that of the previous DSM

Peak Week Level 2 Care Peak Week Level 3 Care Peak Week Level 4 Care STEPS YOUR MUNICIPAL LEADERSHIP TEAM CAN TAKE BEFORE THE PANDEMIC TO ENSURE TIMELY TRIAGE PLANNING INCLUDE: • Identify any existing triage plans and protocols. • Delegate authority for triage policy to an individual or a sector. • Conduct a baseline assessmen Results: A total of 57 studies examined criterion and construct validity of 14 five-level triage systems. Criterion validity was examined by evaluating (1) agreement between the assigned degree of urgency with objective standard criteria (12 studies), (2) overtriage and undertriage (9 studies) and (3) sensitivity and specificity of triage.

  1. •Recognise that you are doing triage! •60% of deaths in out of hours services last year in the UK as a result of a telephone blunder [ •Understand the skills required - just because you are an experienced/highly qualified nurse does not mean you will be good at telephone triage. Access training •Communication skills are paramoun
  2. Telephone Triage telephone triage is one of the most sophisticated and potentially high-risk forms of nursing practiced today. (p IX) Rutenberg, Greenberg, 2012 Telephone Triage Description: A component of telephone nursing practice that focuses on assessment, prioritization, and referral to the appropriate level of care. Definition
  3. Research has shown that under-triage is more common with three-level systems. If a five-level triage acuity system had been used to triage this patient, she clearly would have been classified in level 2—the level used for all patients with high-risk conditions, whether or not the patient has stable vital signs. Past medical history is an.
  4. Regardless of the level of care rendered, patient is likely to expire. Tough call to make for unit personnel. START - triage technique. Triage Officer at CCP sorts (triages) patients into separate geographic location based on tags. Performs rapid reassessment and changes triage category as required
  5. Triage is done in emergency rooms, disasters, and wars, when limited medical resources must be allocated to maximize the number of survivors. Triage in this sense originated in World War I. Wounded soldiers were classified into one of three groups: those who could be expected to live without medical care, those who would likely die even with.
  6. ESI 5 LEVEL TRIAGE A bit of history . Triage French word: means to sort Concept used on the battlefields to establish treatment priorities.. RED with temp >100.4 (38) -level 2 . 1 to 3 months. with temp>100.4 (38) -consider level 2 . 3 months to 3 years. with temp>102.2 (39) consider level 3 if incomplete immunizations and no obvious.

What Are the Different Types of Triage Systems? (with

  1. e patient acuity and priority of care at triage. Mission deter
  2. A Level 3 incident involves hazardous materials beyond the capabilities of a single state or regional response team and requires additional assistance. These incidents generally pose extreme, immediate, or long-term risk to the environment and public health
  3. A Level IV trauma center is capable of providing 24-hour physician coverage, resuscitation, and stabilization to injured patients before transfer to a facility that provides a higher level of trauma care. † Inaccurate triage that results in a patient who requires higher-level care not being transported to a Level I or Level II trauma center.
  4. Initially, the triage expert analyzes only the patient's severity level and, if the patient does not have a high ESI level (ie, Level 1 or Level 2), then the nurse will evaluate the potential diagnostic and therapeutic resources needed for the patient, and ultimately the patient will be ranked at Level 3, Level 4, or Level 5

Hence in effect, the defect priority is generally set by the product manager in a defect triage meeting. Different Levels. Priority and Severity have some classifications amongst them that aid in determining how the defect must be handled. A lot of different organizations have different defect logging tools, so the levels might vary CHAPTER 4 ESI Levels 3-5 and Expected Resource Needs 27 . Resource Predictions 27 . What Constitutes a Resource? 28 . Resources in Context 29 . Summary 30 . References 30 . CHAPTER 5 The Role of Vital Signs in ESI Triage 33 . Are Vital Signs Necessary atTriage? 33 . Using Vital Signs with ESI Triage 34 . Vital Signs and Pediatric Fever 3 There are commonly three levels of ERs. The level and title dictates who they are equipped to treat. Level 1 - Highest level ER, indicating the ability to give definitive, rapid care for all critical emergency situations; usually associated with a teaching hospital

Emergency Department Triage - StatPearls - NCBI Bookshel

What Medical Triage Is in a Hospita

Scotland 2 - Very urgent (orange) Level 2 - 10 minutes 3 - Urgent (yellow) Level 3 - 60 minutes 4 - Standard (green) Level 4 - 120 minutes 5 - Nonurgent (blue) Level 5 - 240 minutes Canadian Triage and Acuity Scale Canada 1 - Resuscitation Level 1 - 0 minutes (CTAS) 2 - Emergent Level 2 - 15 minute 3 - Urgent Level 3 - 30 minutes 4 - Less. Australia has three levels of government that work together to provide us with the services we need. The three levels are: federal - Australian - Parliament, in Canberra. state and territory parliaments, in each state and territory capital city. local councils - also called shires or municipalities - across Australia The Emergency Severity Index triage system is a relatively new 5-level mode of operations created in the late 1990s. This system provides an operational model to meet the needs of all patients. This triage process segregates patients into 5 different treatment levels based on a variety of characteristics. This article discusses the Emergency Severity Index, how it works, its advantages and.

Five-level triage system more effective than three-level

Level 3 Recommendations . A two-tiered triage system in the ED by physicians can effectively reduce unnecessary resource utilization. Mechanism of injury alone may not be useful in triaging pediatric patients. A combination of physiologic and anatomic parameters with mechanism provides better triage utilizing age-appropriate vital signs The purpose of triage is therefore to look at the referral sent by your dentist and to assess the complexity and determine where you would be best be treated. The NHS provides details on the levels of complexity that are applied to referrals and our triage staff will follow these. Very briefly the levels can be considered as

Hospital triage - Going to hospita

Canadian Triage and Acuity Scale (CTAS) The 5 Levels Canadian Triage and Acuity Scale (CTAS) Are: Level 1: Resuscitation - Conditions that are threats to life or limb. Level 2: Emergent - Conditions that are a potential threat to life, limb or function. Level 3: Urgent - Serious conditions that require emergency intervention For centuries, triage has proven essential when patient demand spikes significantly, as in times of war or during natural disasters. These days, unexpected rises in patient volume, say a three-fold increase on a Sunday night, also necessitates triage. But this is rarely the case The four triage categories are separated by colors: Black, Red, Yellow, Green Black: Deceased. This is given if the patient is not breathing even after rescue breaths or aligning the airway. Red: Immediate (First priority in transport, needs immed.. • This set of telephone triage protocols covers over 90% of medical calls. Structure of Protocols . The pediatric and adult Office-Hours protocols have identical organization and structure . Each set of protocols include the following 10 components which are described further in the sections below: 1. Title (Topic Name) 2. Search Words 3 field triage stage and is performed on three levels. 21. On site Triage I On-site triage: ⚫This can be done by EMS, nurses or by ED Physician. -It can also be completed by first aid providers by getting them to only triage as red or yellow. - This classifies the victims to identify those who need t

What Is Triage? - Definition & Categories - Video & Lesson

Patient's and episode's (i.e., priority level and triage category) characteristics. Characteristics of patients and of ED visits, as well as their comparisons between the two age groups are presented in Table 1.Mean age of the sample population was 78.5 ± 7.9 years (75.4 ± 5.8 years and 89.3 ± 3.4 years in younger and older age groups, respectively) Staff nurses rated the new program easier to use, and more useful as a triage instrument than previous three-level triage. They provided feedback, which resulted in significant revisions to the. Triage systems Triage systems are used at the point of entry to health services to provide a systemic way of classifying the urgency and service response requirements of clinical presentations.1,2 Triage systems are well established in emergency medicine,3,4 and have proven to be reliable in sorting patients based on clinical need to achieve optimal clinical outcomes.5,6,7 Triage is underpinned b A triage nurse plays a very important role in emergency room settings where a patient's condition is assessed and monitored. If you would like to work in nursing, but would prefer to be a specialist rather than a generalist, it is important to choose a specialty area that is high in-demand and that also interests you

China Knew Virus Was Contagious but Kept Silent for Days

Triage Levels - TriageLogic: Remote Nurse Triage Software

Triage Priority Levels The general standard for emergency departments is to have five levels of priority: code, critical, urgent, nonurgent disabled, and ambulatory. Code Victims can be quickly evaluated by emergency medical personnel. Initial findings such as vital signs (pulse rate, blood pressure, respiration, level of consciousness) are recorded on the triage tag, and then rechecked periodically thereafter to monitor the victim's status and to RETRIAGE* if their conditions becomes worse, or improves later

[/sg_popup] Triage categories separate injured individuals, victims and patients according to the severity of their existing condition that resulted from a catastrophic disaster. A special color coded tagging system is used during a mass casualty incident so that the triage category is immediately obvious A New Way of Seeing Theological Triage. HEOLOGICAL Triage is a term I first learned at Southern Seminary as developed and explained by Dr. Albert Mohler. It is a way of differentiating issues that are central to the gospel from those that are denominational distinctives, or even preferential. It has been a really helpful model for me Triage is a fluid process at all levels, with altered situations and resources requiring a change in category at any time and in any setting. In the extreme example, a casualty may be triaged from emergent to expectant during surgery, abruptly terminating the operation (on-table triage). Special Triage Consideration Theoretically, the decision of the triage level is made to determine how long the patient will wait before seeing a physician and to treat patients in a timely and appropriate manner.1 In general, hospitals all over the world use some kind of triage system such as 3-level, 4-level or 5-level scales to prioritise the patients in EDs

The location where triage nurses work has a great impact on their pay—larger hospitals and emergency rooms are likely to pay triage nurses much more than smaller hospitals, as they will be much busier. Similarly, the education level of a triage nurse is a direct indicator of their salary level The document listed three levels of critical care triage: Level 1 triage deprioritizes critical care resources for patients with a predicted mortality greater than 80 per cent

Emergency Triage, Treat, and Transport (ET3) Model. The Center for Medicare and Medicaid Innovation's (Innovation Center) Emergency Triage, Treat, and Transport (ET3) Model is a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare beneficiaries following a 911 call Tier - I Support. This is the basic level of customer support. The customer representative is a generalist with a broad understanding of the product and may not understand the inner workings. In this case, they would identify a customer's needs and provide tips on how to manage a problem. Typically, these solutions are in a FAQ or a. Triage of Patients in NSW Emergency Departments PROCEDURES PD2013_047 Issue date: December-2013 Page 1 of 10 1 BACKGROUND 1.1 About this document Triage is an essential function of an Emergency Department (ED) and must be the firs Background . Triage nurses play a pivotal role in the emergency department. However some researchers have attempted to expand triage nurse's role; remarkable discrepancies exist among scholarly communities. The aim was to develop a role description of triage nurse relying on the experts. Methods . A modified Delphi study consisting of 3 rounds was performed from March to October 2014 Triage Levels and Color Coding. A color-coded tagging method to categorize disaster victims in the field has been almost universally adopted and incorporated into existing triage systems [12]. Red Triage Tag (Immediate or T1 or Priority 1): Patients whose lives are in immediate danger and who require immediate treatment