DÄ internationalArchive16/2011Easily Done Without Triage Models
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The conclusions of the review article are not acceptable for emergency patients. Patients want to have the severity of their illness assessed primarily not by caregiving doctors but by competent doctors. This applies even when patient volumes in emergency departments are high.

The situation may be different in times of war and in disaster situations, when many people are severely injured simultaneously. Even then the term used is not that of triage (which comes from military medicine) but pre-triage, or, rather, primary survey on scene, with guiding times for examinations per patient of 20–60 seconds (vision, hearing, thinking). These short surveys do not allow for extensive documentation nor assessment according to the established triage models, which no population would accept in times of peace. This particularly applies to the triage argument used by the authors—namely, of shorter waiting times in the emergency admission setting. Clinically experienced doctors are required in this setting, who can assess patients in the minimum amount of time, with regard to their need for treatment (sending patients away on the basis of their triage scores without them seeing a doctor at all would pose legal and forensic problems).

Regarding the evidence for triage (6 of 7 studies included only 15–30 subjects), no absolute numbers were reported, such as reduced mortality and unnecessary transfer to intensive care.

The triages performed by non-doctors in Canada and Australia (where long distances need to be covered in order to see a doctor) do not apply to Germany.

The author has 35 years of experience at university gynecology hospitals, with 2400 births every year managed excellently without triage models, in spite of unplanned high volumes of patients simultaneously in the delivery suite and outpatient clinics. How that worked can be found is Germany's Science Book of the Year (Wissenschaftsbuch des Jahres) 2007. The neurological insights sketched out there also apply to doctors’ thoughts and actions (on the basis of high competence) in situations with many emergency patients simultaneously.

DOI: 10.3238/arztebl.2011.0281b

Prof. Dr. med. Dipl.-Psych. J. M. Wenderlein

Eythstr. 14

89075 Ulm, Germany

wenderlein@gmx.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Gigerenzer G: Bauchentscheidungen – Die Intelligenz des Unbewussten und die Macht der Intuition. Goldmann-Verlag 2008
2.
Christ M, Grossmann F, Winter D, Bingisser R, Platz E: Modern
triage in the emergency department. Dtsch Arztebl Int 2010; 107(50): 892–8. VOLLTEXT
1.Gigerenzer G: Bauchentscheidungen – Die Intelligenz des Unbewussten und die Macht der Intuition. Goldmann-Verlag 2008
2.Christ M, Grossmann F, Winter D, Bingisser R, Platz E: Modern
triage in the emergency department. Dtsch Arztebl Int 2010; 107(50): 892–8. VOLLTEXT