If It Bleeds, It Leads...Maybe

Triage is the system by which nurses determine the order in which patients will be seen in the emergency room. It is a system that prioritizes care for those most likely to suffer debilitating outcomes from the injury or illness with which they present, the most serious of which is, of course, death. It is an imprecise system that makes caring for multiple patients easier for ER staff, while at the same time, frustrating for some patients.

In most service industries, first come, first served. This because the nature of the services rendered to various customers is usually nearly the same with no one customer's issues being more important or more serious than anyone else's. Think of taking a number and waiting until your number is called. "Now serving..."

Our triage system sorts the severity of health problems into three categories. "Emergent" problems (whether injury or illness) are the most serious, and it is these that lead, bleeding or not. If you come to my ER and you can't breath, or your heart has stopped, or you have severe chest pain, or you're bleeding uncontrollably, then you get served first. The potential negative outcomes of your condition are so extreme that you require immediate attention.

"Urgent" problems have less severe potential outcomes and require attention within about an hour. Asthma attacks, severe histamine reactions, open fractures or fractures with vascular compromise, burns and open wounds without systemic complications...you won't probably die from these, so you drop down the ladder a few rungs.

"Non-emergent" is the category of problems that requires that you be seen sometime today, but literally, you could sit most of the day in the waiting room without any severe or even mildly negative outcome. Yes, it is this patient who sits and watches the severed dangling limbs, the chest clutching heart attacks, and the blue anaphylatic reactions jump to the front of the line.

Of course, sometimes in life it's a good thing not to have to be first.

About 85% of ER nursing is caring for patients with non-emergent problems. These are usually minor injuries (e.g., finger lacerations, eye irritations, sprains and simple fractures) and uncomfortable or inconvenient illnesses (e.g., back pain, hives, nausea). Most of these patients could probably be treated elsewhere, like at their primary physician's office, but they come to us for a variety of reasons (which I'll discuss another time).

Another 10% of ER nursing is caring for the urgent problems of patients who are very uncomfortable and who require more immediate attention than they could probably get going anywhere else. Sometimes the severity of their injuries or illnesses requires specialized treatment, equipment, or procedures that are unusual or unlikely in other health care settings. These patients usually need IVs, x-rays, narcotics, electrocardiograms (EKGs), or oxygen; they may need frequent or constant monitoring of their vital signs, their blood sugar; they might require a surgical consult.

Emergent conditions comprise the final 5% of emergency nursing. These patients arrive by ambulance from traumatic falls, motor vehicle crashes, construction sites where they've severed their fingers or shot themselves with pneumatic nail guns. These patients walk in with the metaphoric elephant on their chest, the swollen and compromised airway due to a peanut allergy, the shard of glass in their back which punctured their lung when they were violently pushed through the plate glass window. These are the unconscious patients with head injuries, strokes, chemical overdoses (e.g., drugs, alcohol, carbon monoxide).

These patients command an ER nurse's immediate attention not because they're more fun to take care of, but because if not cared for immediately and properly, they risk the unforgiving dance with mister D. Nobody should want to be this patient just to be first, and no one should complain that this patient comes first. After all, we may all be this patient or our loved one might be this patient at some point.

Who wouldn't want to wait in the lobby with a sore throat while the ER nurse saves the life of someone else?