You might be the first person waiting in line for an examination, discount but you might not be the first patient
seen, cialis whether it be your local Emergency Room, or your pet’s local Emergency Room.
Not fair, right? Wrong.
The sickest patients, and most critically ill patients are going to be seen first, and are going to get all the
attention that they need until they are stabilized.
This is called TRIAGE, and comes from the French word trier, which means to separate, sift or sort. In
practice, it means that the medical staff all cooperate in the process of prioritizing patient severity and
allocating medical care resources to those in greatest need first, and those with lesser need afterwards.
For example, if the doctor is in the exam room with a patient with Kennel cough, and a Labrador
Retriever comes in with a ball stuck in his throat, that patient in the exam room is going to have to
wait, because the doctor and staff have about 4 minutes to re-establish an open airway in that Lab. 4
minutes. That is about how much residual oxygen the red cells have stored to deliver to the body’s cells.
So, minus the amount of time it took for the dog to get to the ER…… Medical ethics just do not allow us
to let a patient die, just because it arrived later in the queue, no matter how UNFAIR it might seem to
someone who has to wait.
The original triage concept was devised on the battlefield in the Napoleonic wars, and the triage
concepts developed then would more likely apply to a disaster scenario today, such as one might
encounter after an earthquake. In that case, the triage decision tree narrows it down to 3 very basic
categories:
Those likely to live, no matter what healthcare is provided;
Those likely to die, no matter what healthcare is provided;
And those likely to live if you give them immediate care.
So clearly, the last category is the first to receive care until they are stabilized.
Most articles on triage focus on battlefield medicine, small disasters such as train wrecks, and huge
disasters, such as tsunami, earthquakes, and the like. They all focus on the situation faced when there
is a limited number of caregivers and a large number of patients, much like the first responders after
Hurricane Katrina. How do you begin to take care of thousands of people? How do you “start” your
decision making process? (That’s a little pun, because one of the triage decision making trees is called
Simple Triage And Rapid Treatment – S.T.A.R.T.)
One can read a lot about triage, much more than I need to go into here, but at its heart, even a little
emergency room for animal patients needs to make decisions based on the severity of the patient’s
illnesses that enter its doors.
As mentioned above, triage IS a team approach. Oftentimes, the first person to see a gravely ill pet will
be the front receptionist. This person will be the first person handed a Chihuahua attacked by a coyote,
or a cat with asthma that is unable to breathe, and this person will be the one to recognize that this
animal is in immediate distress and needs immediate care. He or she will carry the patient to the back
treatment where emergency work can begin.
The difference in triage medicine at the emergency room level is that we don’t assume that any patient
group is going to die without care. Again, veterinary medical ethics (in the absence of a disaster, in
which case the situation is a lot different) prevent us from leaving a patient to die without care. And,
from the business perspective, we have developed a set of procedures to allow for triage and immediate
emergency care to proceed so that a patient should never have to die without medical care, unless the
owner refuses the care for whatever personal reason they may have. (For example, perhaps the client is thinking that it may be time to euthanize the pet, but they are afraid to tell the front desk, or they want to discuss the idea with the veterinarian first. That category of patient might well declined a “consent for emergency care.”) The doctors and staff operate
under the assumption that anyone who loves their pet enough to take them to an emergency room,
wants to at least know enough about the pet’s health condition, such that they can then make the
decision that is best for them and the pet.
So, while it may, on occasion, seem unfair, triage saves lives. It may be inconvenient for some, but it
means the world to others.
