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According to the Oxford English Dictionary, the word triage comes from the French word trier, meaning ‘to pick’ or ‘to cull’.
The Mosby medical dictionary defines it as: French. Trier, to sort out.
There are approximately 44 million people in South Africa today with an average life expectancy in years at birth estimated to be around 46.5 for males and 48.3 for females. The top ten causes of premature mortality includes HIV/AIDS, homicide/violence, tuberculosis, road traffic accidents, diarrhoeal disease, lower respiratory infections, low birth weight, stroke, ischemic heart disease and malnutrition. Furthermore, 38 million South Africans does not have access to private medical aid funds and have to rely on the public health care service. According to national health minister MantoTshabalala-Msimang, the majority of South Africans (84%) have access to a public medication budget of about R3 billion a year, whereas medical aid members (16%) spend about R13 billion a year on medication. These data become even more relevant when the number of doctors and nurses per 100,000 population in South Africa are compared to that of First World countries (Table 1). Not surprisingly this has lead to overcrowding at government hospitals becoming the norm. Thus, the burden of disease and dependence of the majority of South Africans on public health care services have resulted in excessive numbers of patients trying to access public sector Emergency Units. The need for triage in this context is apparent.
| Number per 1,000 population | |||
|---|---|---|---|
| Country | Doctors | Nurses | Doctor: Nurse ratio |
| South Africa | 0.77 | 4.08 | 1: 5 |
| Canada | 2.15 | 9.95 | 1: 5 |
| Australia | 2.47 | 9.71 | 1:4 |
| Israel | 3.82 | 6.26 | 1:1.6 |
| United Kingdom | 2.30 | 12.12 | 1:5 |
In the South African context, absence of a triage system lead to prolonged waiting times, poor management of clinical risk and increased morbidity and mortality. In order to maximise the efficient use of resources and to minimise risk to the patient, an effective triage system with high sensitivity and specificity was required. Without objective clinical parameters, variations in patient assessment are inevitable. The terms ‘stable’ and ‘unstable’ failed to reflect the patient’s clinical condition accurately. The Cape Triage Group (CTG) was convened in April 2004 by the Joint Emergency Medicine Division, Universities of Cape Town and Stellenbosch, in order to design a triage system suitable for local use. The South African Triage Group (SATG) was convened in June 2007 following the successful implementation of the Cape Triage Scale (CTS) in Western Cape public sector emergency departments. The EMSSA agreed to take over the reigns from the Universities of Cape Town and Stellenbosch in order to get national representation for the SATG. The SATG is multidisciplinary and comprises doctors, nurses and paramedics representing the state and private sectors. The SATG set goals that included defining vital sign parameters, while ensuring that the triage system remained user-friendly in order to enable rapid and accurate sorting of emergency patients.
The SATG has designed an effective triage tool intended for utilisation in both the pre-hospital and EU settings. Considering practical issues such as labels for patients, stickers for folders and colour zones in ED’s, it was decided that a colour-based system would be implemented. The colour categories are as follows:
The orange category reduces the number of patients in the potentially large yellow category while limiting the red category to resuscitation cases. For the sake of simplicity, the orange category will not be used in the pre-hospital setting.
The SATS validation process has been through both expert opinion and in-hospital prospective studies. Three versions have been developed, based on a prospective study of the SATS on 22,500 patients in a public hospital setting, and 2,000 patients in private hospitals. The adult version is intended for those over 12 years of age or 150 cm in height, the child version has been developed for those 95 - 150 cm or 3 - 12 years old, and the infant version for those under 95 cm or less than 3 years of age. The pre-hospital use of the SATS still requires validation.
A two-tiered approach to triaging is utilised, using both a physiological scoring system and a series of discriminators.
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