Secondary Triage

When time and resources allow, a secondary, more detailed triage assessment is made. It may be performed at the scene if evacuation times are prolonged, or more commonly occurs at the casualty clearing station or on a patients arrival to hospital (7). Perhaps a key difference in secondary triage is that, where appropriate personnel are available, clinician judgement is allowed. This would capture patients such as the airway burns case considered above.

The triage sort

A number of different methods exist to perform the secondary triage process.  Most commonly known is the Triage Sort, as taught by MIMMS. This is derived from the Triage Revised Trauma Score (T-RTS) which was originally designed in the 1980s in the US to identify those patients who needed to be transferred to a major trauma centre.  To use the Triage Sort, three physiological variables are assessed and given a score; the sum of these three scores is then used to derive the triage category.

Fig 4: Triage Sort Tool (8)

It is obvious that the triage sort aims to consider the casualty’s condition in more detail. It may therefore lead to their reassignment to a different triage category, either higher or lower than that initially allocated. This should be noted and triage card updated as required.

Controversies in secondary triage

Recent evidence demonstrates that within a UK civilian trauma population, the primary triage tools (MPTT-24 and NARU sieve) have a greater sensitivity than that of the Triage Sort and are quicker to perform.  Alternative secondary triage tools are currently being researched and are likely to replace the triage sort tool above in the near future (9). However, the tool described here is currently still in common use and is taught on the UK Major Incident Medical Management and Support (MIMMS) course, so is included for completeness.