Clinical Triage — Severity Assessment

Triage is the process of determining the priority of patients' treatments based on the severity of their condition.

The RED / YELLOW / GREEN System

🟥 RED — Immediate (Emergency)

Life-threatening conditions requiring immediate medical attention:

• Cardiac arrest or respiratory arrest
• Severe respiratory distress (RR <10 or >30, SpO2 <90%)
• Shock (hypotension, tachycardia, poor perfusion)
• Unconscious patient (GCS <9)
• Ongoing seizures
• Severe haemorrhage
• Anaphylaxis
• Acute stroke with symptoms <4.5 hours

🟨 YELLOW — Urgent

Serious conditions requiring prompt attention (within 10-30 minutes):

• High fever (>39°C) in at-risk patients
• Moderate respiratory distress
• Chest pain — suspected ACS
• Acute abdomen
• Head injury with brief loss of consciousness
• Severe headache
• Uncontrolled hypertension (BP >180/110)
• Active vomiting or diarrhoea with dehydration
• Altered mental status

🟢 GREEN — Non-Urgent (Routine)

Stable conditions that can wait:

• Mild fever (<38.5°C)
• Minor injuries and lacerations
• Routine follow-ups
• Mild diarrhoea without dehydration
• Minor skin rashes
• Prescription refills
• Common cold symptoms

General Triage Principles

• Reassess waiting patients regularly — conditions can deteriorate
• Use a triage tool consistently (Manchester Triage System, CTAS, etc.)
• Document triage assessment and time
• Activate emergency response for RED patients immediately
• Move patients to appropriate treatment areas based on triage category