Can someone explain how triage in emergency works?

Just wondering if anyone here understands how triage in emergency works? Now I understand the concept of treating those of the greatest need first. I suppose I want/need to know how it is implemented.

Sometimes it is obvious to see why someone goes straight in or has less of a wait, but other times the whole waiting process seems to be backwards. I just don't get how a patient that is laughing, eating and moving well, can go ahead of someone in pain and almost collapsing.

Does anyone have first hand experience with triage who can explain? Thanks

I'd love to know too.

Mmm who knows!

I don't know much, I know there is 5 categories. 1 being the most serious, 5 the lowest...

Generally heart attacks, asthma attacks, car crashes etc those with life threatening illnesses are at a cat 1. They go in straight away.

I think 2 has to be seen in 15-30 mins. And it kinda goes like that.

Sorry cant really explain it too well. Hopefully someone else comes in

Whilst I completely understand what u are saying, there is a generic reply to this age old question.
People respond differently to pain/illness. Not all people in pain or not need of urgent care present with the typical symptoms. So the laughing smiling talkative patient could actually have a serious bowel obstruction or foreign object lodged in their head- I have seen it.
Also, these patients could have psych issues and are been seen too by psych rather than medical staff.
At my hospital we have 'fast track' where non urgent cases are seen too quickly compared to more complex presentations that usually require an admission or lengthy assessment like fractures and abdominal complaints.
Fast track deal with thing like migraines, food poisoning, wound dressings etc.
Anyway. This may not be the case at the hospital ur referring to


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Oh and to add- there are the smarties who know the system well and claim to have attempted suicide just so the are seen to mire quickly.


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Thanks for that.

Make sense Delphmoon - just a pity things like that are not explained at the time, but then at the time it all sounds like an excuse when you need to be seen.

ETA: just saw your post about faking it. Pretty bad that it happens, but to an extent I understand it.

Patients are also triaged based on potential or emergent illness. A simple example would be a 60 year old bloke comes to emergency complaining of chest pain. He has an extensive cardiac history. A 25 year old bloke comes to triage complaining of chest pain, he suffers no co-morbidities and has no cardiac history. He has had a nasty cold for the past week. The 60 year old will be seen before the 25 year old because there is greater potential that his chest pain is cardiac in nature.

Pain is subjective. Although the patient who presents with say, an isolated sprain or even a simple fracture of the ankle from playing footy will wish to be seen quickly, the fact is that he is not going to die from his injury and it does not have great potential to deteriorate. The laughing 60 year old with chest pain and a cardiac history will be see before the groaning ankle injury. Which is not to say that treating pain is not important, but it is less important than treating a patient suffering a life threatening injury or illness.

Basically, triage is a system which sorts patients in order from those who are actually sickest, those have the potential to become the sickest and those who need to be seen but are not time critical. (And then there are those who should have seen the local GP!) If the triage nurse is on the ball, and usually a triage nurse is highly experienced, it is a really good system. It is frustrating to have to wait if you present with a low acuity injury or illness but if you were seriously ill I'm sure you would be relieved to 'jump ahead' of all the less sick or injured patients.

Cat 1 = those reqiring cpr (active life support) must be seen instantly. Some major trauma too like loss of limbs etc
Cat 2 = those that could potientally become 1s eg chestpain (heart attack) asthma attack, major trauma. These must be seen in 10mins.
Cat 3 = things like abdo pains ..need to be seen in half an hr.
Cat 4 and 5 = arent really seen as emergency. I think cat 5 are within an hr?

When im at work next i can get you the exact deffinitions if you want

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I found this quite interesting. When I was 30 weeks pg with DD I experienced leg pain/tingling for several hours, and since I have a blood clotting disorder, went to ER - thought it may have been a blood clot or dvt etc. Waited over 2 hrs to be seen, and one of the many people who went in before me had "something in his eye" that had "been there for a day or two".
At the time I was pretty unimpressed!!
My issue ended up being nerve tingling from DD's position (even though she had moved around it didn't go away for a while) so all ended well for me, luckily

Oh and to add- there are the smarties who know the system well and claim to have attempted suicide just so the are seen to mire quickly.


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I had a complete emotional breakdown a few years back, taken to hospy in an ambulance etc. I waited in the ER for 5 hours. Then they sent me home. It was the night of a music festival, I watched countless teen girls coming in and out being treated for drinking too much, dehydration, freaking out because they were having a bad trip. I needed help and I got sent home with a cabcharge.

yeah its weird
I waited 7 hours with a shattered elbow and broken collar bone before packing a fit and getting seen- then spent 3 weeks in hospital 2 on a morph drip- so think it really depends on who is on and what time you go. The more moaning you do I bet helps, fake a faint if you need to? Not a place I would want to work in, the ED is an insane place- hats off to those that work there

I have a lot of respect for those who work in ED - really can't be an easy place to work. I was impressed when I had to take DH to hospital as he'd been sick for over a week, diagnosed with pnuemonia by a GP and was having trouble breathing - we had his x-rays with us and were seen straight away, they brought a wheelchair with oxygen bottle. Mind you it was 7am on a Tuesday morning, so not exactly the busiest time.

Apparently my local hospital is one of the worst in Victoria with waiting times. The longest wait I've had there was about 12 hours with severe abdominal pain that turned out to be a UTI. I thought I was dying! The quickest I was dealt with was the day Ianto died, and I seriously didn't suspect anything was really wrong :-/ Even then, I waited quite a while up in Maternity before I was seen... I had to wait about four hours when I thought I was miscarrying Amelia, even knowing my history they didn't have anyone check on me.

In contrast, when I went to the Emergency department at the hospital Amelia was born in, I was treated quite quickly and thoroughly. Though I hated being strapped down in actual labour, I was happy to have a one-hour CTG when the machine in Emergency was a little screwy and said she hagan irregular heartbeat (I think it was the combination of her being in an awkward position and me being rather tubby right where the sensor needed to be)

...what were we talking about? I got a bit off track

I had a complete emotional breakdown a few years back, taken to hospy in an ambulance etc. I waited in the ER for 5 hours. Then they sent me home. It was the night of a music festival, I watched countless teen girls coming in and out being treated for drinking too much, dehydration, freaking out because they were having a bad trip. I needed help and I got sent home with a cabcharge.

As a PP pointed out- sometimes it the potential for a condition to be serious that makes a difference.
Dehydration and drug use has the potential to be very serious if not fatal. Compares to an emotional breakdown there would be very little the ED department can do for you short term other than refer u to another service (in which there are waiting lists etc) and prescribe you drugs meanwhile IYGWIM.
Working in ED, we are confronted with these questions everyday. "I'm sicker than him, I was here longer" etc and the fact it- it's the emergency department it's for emergencies. So the stable fracture your sitting there with isn't an emergency (although there are complications). You may be in pain and boy I would live to help u with that but unfortunately it doesn't always work that way. The man complaining of abdo pain and the lady with the cut finger would be seen to first because of the potential for him to develop an obstruction and her potential to develop an infection.

I'm not saying I agree with it all and I don't make the rules so please no one get upset at me... I'm just saying how it is. I have been on the receiving end too where I sat in an ED and miscarried in the waiting room during my 6 hour wait while all the druggies got seen to before me. It's just the way it is and predominately that is because GPs are to expensive or not available to manage the community so people come to us instead because we are free and available IYGWIM.
Oops. I have ranted... Lol..



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I found this quite interesting. When I was 30 weeks pg with DD I experienced leg pain/tingling for several hours, and since I have a blood clotting disorder, went to ER - thought it may have been a blood clot or dvt etc. Waited over 2 hrs to be seen, and one of the many people who went in before me had "something in his eye" that had "been there for a day or two".
At the time I was pretty unimpressed!!
My issue ended up being nerve tingling from DD's position (even though she had moved around it didn't go away for a while) so all ended well for me, luckily

I have worked in ED at the Gold Coast of all places! and I as a nurse there was even upset about these situations, I am not justifying it but behind the scenes there are certain beds for certain categories of illness/injury, these areas are equipped with staff who can handle more needy scenarios and better machinery, closer to resus bay, theatre, etc, it may have been that the next bed free was in a basic area where there is just a bed and one nurse looking after 5 patients as opposed to where you should/would/could have been with dr's near by, more highly trained staff, etc. There is a system that works behind the scenes. one area in my old ED we called "cubes" was a few private type rooms where only women with miscarriages, sexual assault victims etc would go as opposed to being stared at by 6 other patients. And one nurse would have this to her self, another area was bay 1-5 where it was closest to ambulance bay and resus and would hold the sickest/worse off patients stroke/giving birth/physical assault etc, I could go on forever! the point being there is a lot that is unseen and if it didnt work this way there would be so much chaos for staff and patient's and life saving machinery would be all over the department and hard to get a hold of when needed. I have been on the other side waiting for hours with pregnancy bleeding and gall stones and few other things and boy it sucks waiting! the problem is if there was more staff and a few more beds then waiting times would be less.

I was suicidal and needed help. These silly girls only came in because they got scared when they threw up or had a bad trip. In and out. But I do get your point delph. I despise people using the ED as a free clinic. When I was admitted (different hospy) 5 days after having DD with a bleed (I was seen straight away) as I was leaving, a mum, dad and boy were standing there while the mum explained she thought he had a cold and could they do anything for the congestion I don't envy anyone working in emergency...not enough resources, hands or time.

Cat 1 = those reqiring cpr (active life support) must be seen instantly. Some major trauma too like loss of limbs etc
Cat 2 = those that could potientally become 1s eg chestpain (heart attack) asthma attack, major trauma. These must be seen in 10mins.
Cat 3 = things like abdo pains ..need to be seen in half an hr.
Cat 4 and 5 = arent really seen as emergency. I think cat 5 are within an hr?

When im at work next i can get you the exact deffinitions if you want

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Wow thanks for that hun, i wonder if the hospital i went to with my gallstones attack is Teni's local?
I arrived by ambulance with chest pain, hard to breath etc they put me in a wheelchair and sat me in the ED with a baby (a friend bought DD1 in a car following us) and i waited there for over 3hrs.