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
- Triage is also commonly used in crowded emergency
rooms and walk-in clinics to determine which patients should be seen and
- 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
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
- 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.
Last Editorial Review: 2/21/2007
- 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.