Жарақат алғандарға көмек көрсетуді анықтау жүйесі

Process of determining the priority of patients' treatments based on the severity of their condition
the concept of triage as it occurs in medical emergencies and disasters

In medicine, triage ('/t//r//iː//ɑː//ʒ/, /t//r//i/'/ɑː//ʒ/) is a process by which care providers such as medical professionals and those with first aid knowledge determine the order of priority for providing treatment to injured individuals Triage is usually relied upon when there are more injured individuals than available care providers (known as a mass casualty incident), or when there are more injured individuals than supplies to treat them. it itself coming from the Old French verb trier, meaning to separate, sort, shift, or select; with trier in turn came from late Latin tritare, to grind. Although the concept existed much earlier, at least as far back as the reign of Maximillian I, it was not until the 1800s that the Old French trier was used to describe the practice of triage. That year, Baron Dominique Jean Larrey, the Surgeon in Chief of Napoleon's Imperial Guard laid the groundwork for what would eventually become modern triage introducing the concept of "treat[ing] the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of their rank or nationality".

Simple triage is usually used in a scene of an accident or "mass casualty incident" (MCI), in order to sort patients into those who need critical attention and immediate transport to a secondary or tertiary care facility, those who require low intensity care, those who are uninjured, and those who are deceased or will be so imminently. In the United States, this most commonly takes the form of the START triage model, in Canada, the CTAS model, and in Australia the ATS model. Assessment often begins with asking anyone who can walk to walk to a designated area, labeling them the lowest priority, and assessing other patients from there. patients are generally labelled with their available information, including "patient’s name, gender, injuries, interventions, care provider IDs, casualty triage score, and an easily visible overall triage category".

An ABCDE assessment (other variations include ABC, ABCD, ABCDEF, and many others, including those localized to non English) is rapid patient assessment designed to check bodily function in order of importance. while in other countries commercially available triage tags are used, which vary by jurisdictional choice. In some cases, international organizations also have standardized tags, as is the case with NATO. the SMARTTAG, E/T LIGHT and the CRUCIFORM systems. More advanced tagging systems incorporate special markers to indicate whether or not patients have been contaminated by hazardous materials, and also tear off strips for tracking the movement of patients through the process.

In advanced triage, those with advanced training, such as doctors, nurses and paramedics make further care determinations based on more in depth assessments, and may make use of advanced diagnostics like CT scans. This can also be a form of secondary triage, where the evaluation occurs at a secondary location like a hospital, or after the arrival of more qualified care providers.

There are a three primary concepts referred to as Reverse Triage. The first is concerned with the discharge of patients from hospital often to prepare for an incoming mass casualty. The third is the concept of treating the least injured, often to return them to functional capability. This approach originated in the military, where returning combatants to the theatre of war may lead to overall victory (and survivability).

Undertriage is underestimating the severity of an illness or injury. An example of this would be categorizing a Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal). The rate of undertriage generally varies by the location of the triage, with a 2014 review of triage practices in emergency rooms finding that in hospital undertriaging occurred 34% of the time in the United States, while reviews of pre hospital triage finding undertriage rates of 14%. Overtriage is the overestimating of the severity of an illness or injury. An example of this would be categorizing a Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate). Acceptable overtriage rates have been typically up to 50% in an effort to avoid undertriage. Some studies suggest that overtriage is less likely to occur when triaging is performed by hospital medical teams, rather than paramedics or EMTs.

In telephone triage, care providers like nurses assess symptoms and medical history, and make a care recommendation over the phone. A review of available literature found that these services provide accurate and safe information about 90% of the time.

In triage, palliative care takes on a wider applicability, as some conditions which may be survivable outside of extreme circumstances become unsurvivable due to the nature of a mass casualty incident. For these patients, as well as those who are deemed to be unsavable, palliative care can mean the difference of a painful death, and a relatively peaceful one. During the COVID 19 pandemic issues of palliative care in triage became more obvious as some countries were forced to deny care to large groups of individuals due to lack of supplies and ventilators.

In the field, evacuation of all casualties is the ultimate goal, so that the site of the incident can ultimately be cleared, if necessary investigated, and eventually rendered safe. Additional considerations must be made to avoid overwhelming local resources, and in some extreme cases, this can mean evacuating some patients to other countries.

Alternative care facilities are places that are set up for the care of large numbers of patients, or are places that could be so set up. Examples include schools, sports stadiums, and large camps that can be prepared and used for the care, feeding, and holding of large numbers of victims of a mass casualty or other type of event. Such improvised facilities are generally developed in cooperation with the local hospital, which sees them as a strategy for creating surge capacity. While hospitals remain the preferred destination for all patients, during a mass casualty event such improvised facilities may be required in order to divert low acuity patients away from hospitals in order to prevent the hospitals becoming overwhelmed.

In the first order of triage, the injured would be evacuated to clearing stations in the night, when darkness offered maximum protection from the German forces.

Once at a casualty clearing station, wounds were dressed, The increased availability of airplanes allowed rapid evacuation to a hospital outside of the warzone to become a part of the triage process. Although triage almost certainly occurred in the days after the atomic bombings of Hiroshima and Nagasaki, the pandemonium caused by the attack left records of such action non existent until after the fifth day, at which point they are largely without historical use.

In 1947, the Texas City Disaster occurred when the SS Grandcamp exploded in Texas City, Texas, killing 600 people and injuring thousands more. The entire fire department was killed in the blast, and what followed was a massive informal triage of the victims. Drug stores, clinics, and homes were opened as makeshift triage stations. As the city has no hospital, they had to evacuate casualties to area facilities, including those in Galveston and Houston,

The Korean War saw the advent of the tiered triage, wherein care providers sorted people into categories defined ahead of time. These categories, immediate, delayed, minimal and expectant are still the basis for most triage systems today. At the same time, Mobile Army Surgical Hospitals (MASH) were introduced along with helicopters for evacuation. These helicopters, however were used for evacuation only, and care was not provided in the air during the evacuation. While search, rescue and triage operations immediately following were ordinary, the attack itself represented one of the first terrorist attacks affecting the United States directly. The fact that the U. S. was no longer seen as untouchable, along with the later Oklahoma City bombing in 1995, and the September 11th attack lead to long term changes in triage practices to be more focused on operational safety and the risk of secondary attacks designed to kill care providers.

In June 1994, emergency crews began responding to calls related to symptoms of toxic gas exposure in a neighborhood. Without proper personal protective equipment, more than 253 residents were evacuated and 50 were hospitalized. 20 vehicles were called to the scene, and a mobile operating center was setup nearby, likely within the zone of contamination. Unaware of the presence of Sarin, triage was performed following the standard system of the time, which ultimately resulted in eight care givers experiencing mild sarin poisoning, and an unknown amount of additional staff experiencing general malaise. At the time, no decontamination procedures or gas masks were available for incidents involving contaminants. In response, the Japan Self Defense Forces created a decontamination team, which was then instrumental to the response of the Tokyo subway sarin attack which occurred only seven months later. Moreover, the recent development of new machine learning methods offers the possibility to learn optimal triage policies from data and in time could replace or improve upon expert crafted models.

Most simply, the general purpose of triage is to sort patients by level of acuity to inform care decisions; so that the most people possible can be saved. Although a multitude of systems, color codes, codewords, and categories exist to help direct it, in all cases, triage follows the same basic process. In all systems, patients are first assessed for injuries, the Injury Severity Score, and the Trauma and Injury Severity Score, the latter of which has been shown to be most effective at determining outcome.

In hospital settings, Australia and New Zealand rely on the Australasian Triage Scale (abbreviated ATS and formally known as the National Triage Scale). The scale has been in use since 1994. The scale consists of 5 levels, with 1 being the most critical (resuscitation), and 5 being the least critical (nonurgent).

In Japan, the triage system is mainly used by health professionals. The categories of triage, in corresponding color codes, are:
: Used for viable victims with potentially life threatening conditions. : Used for victims with non life threatening injuries, but who urgently require treatment. : Used for victims with minor injuries that do not require ambulance transport. : Used for victims who are dead, or whose injuries make survival unlikely.

Under the utilitarian model, triage works to maximize the survival outcomes of the most people possible. This approach implies that some individuals may likely suffer or die, in order for the majority to survive. Triage officers must allocate limited resources and weigh an individual's needs along with the needs of the population as a whole. Some ethicists argue the utilitarian approach to triage is not an impartial mechanism, but rather a partial one that fails to address the social conditions that prevent optimal outcomes in marginalized communities, rendering it a practical but inadequate means of distributing health resources.

There is wide discussion regarding how VIPs and celebrities should be cared for in the emergency department. It is generally argued that giving special considerations or deviating from the standard medical protocol for VIPs or celebrities is unethical due to the cost to others. However, others argue that it may be morally justifiable as long as their treatment does not hinder the needs of others after assessing overall fairness, quality of care, privacy, and other ethical implications.

A variety of logistical challenges complicate the triage and ultimate provision of care in conflict situations. Humanitarian actors acknowledge challenges like disruptions in food and medical supply chains, lack of suitable facilities, and existence of policies that prohibit administration of care to certain communities and populations as elements that directly impede the successful delivery of care.

To address the ethical concerns that underpin triage in conflict situations and humanitarian crises, new triage frameworks and classification systems have been suggested that aim to uphold human rights. Scholars have argued that new frameworks must prioritize informed consent and rely on established medical criteria only in order to respect the human rights considerations set forth by the Geneva Convention of 1864 and the Universal Declaration of Human Rights, but no comprehensive triage model has been adopted by international bodies.

Emergency veterinarian Jessica Fragola wrote in 2022 about the ethics of animal triage. She said that pressures on veterinarians having been exacerbated by staffing shortages that resulted from the Covid pandemic, coupled with growth in spending on veterinary care and on pet insurance.