Difficulties in triage are more common with the well-looking patient whose toxidrome has yet to develop or does not manifest in altered sensorium, gastrointestinal upset or dyspnoea. Experienced triage officers are able to appropriately triage poisoned patients with symptoms and signs, particularly those involving agents that cause reduced level of consciousness or coma. ED triage officers may also choose to contact a PIC during or at the completion of triage in order to modify risk stratification. PICs also play a key role in ambulance triage at the scene as well as in ambulance control systems that decide on transportation of potentially poisoned patients. 5 The ability to filter the majority of trivial and minor exposures with out-of-hospital management selects higher acuity patients for ED presentation. The existence of poisons information centres (PIC) within a healthcare system has significant implications on emergency triage presentations. Additionally, in deliberate self-poisoning presentations, the psychiatric background, social stressors, affect and suicidality of the patient all have a significant bearing on the assigned triage category. This key function has a major impact on time to medical treatment and risk of adverse outcome. In the case of poisoned patients, emergency triage aims to perform a risk assessment of the overdose or envenoming within 5 minutes. Over-triaging has little consequence for the specific patient, however, affects the ED as a whole by creating stress, increasing workload and delaying treatment for the true high acuity patient. Under-triage of patients leads to increased risk of potential complications, morbidity and mortality. 4 Overall, triage officers aim to correctly triage ED presentations to match the level of urgency. 3 The essential goals of triage are to identify life-threatening conditions, prioritise patients with higher acuity presenting complaints, and instituting early treatment strategies. The more objective nature of the MTS has increased its acceptance in many parts of the world, though alterations to the flowcharts may be required in specific or geographically unique circumstances, such as envenomation.
2 MTS has an algorithmic approach to ED triage and, by using an array of flowcharts, the triage officer chooses a five-scale triage category for a particular presenting complaint. The MTS was introduced in the UK in 1996 and its use is now widespread, particularly in Europe. The Canadian Triage & Acuity Scale (CTAS) is similar to the ATS and came into use throughout Canada by 1997. The subjective nature of ATS category assignment allows for variability in triaging between triage officers. 1 The basis for assigning ATS categories rely on Airway, Breathing, Circulation and Disability parameters, involving appropriate matching of clinical descriptors to ATS categories. The ATS comprises five categories of clinical acuity associated with timeframes for medical attention. Discussion: Since its development in the early 1990s, the ATS has had multiple revisions and improved on earlier issues with inter-rater reliability. Applying this to the poisoned patient, triage aims to risk stratify a given overdose or envenomation to predict clinical deterioration and potential for complications. Common systems used around the world in triaging emergency patients are the Australasian Triage Scale (ATS) and the Manchester Triage System (MTS). Since its inception, triage systems have continued to develop and be modified into ever more useful tools in early recognition of the acutely ill. Introduction: Triage of the patient presenting to the Emergency Department (ED) has evolved considerably over the last two decades. Emergency Triage of the Poisoned Patient: A Toxicology Risk Assessment in 5 MinutesīEmergency Department, Westmead Hospital, Sydney, Australia
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