Today, triage helps millions of people receive the proper treatment in emergency departments. The history of triage, however, is not a straightforward study. Health care assessments have probably existed as long as people have been treating illness and wounds, but documentation is not so consistent, so when and how was our modern triage system developed? Let’s take a look.
The origin of the word triage has its roots in the French trier, which means to sort. Exactly when the more general term began to be associated with its medical application is unclear, though the earliest execution of the practice may have been by Baron Dominique-Jean Larrey, Surgeon-in-Chief to Napoleon’s Imperial Guard, in the early 1790s. Medical use of the word triage isn’t documented until around World War One.
When Baron Dominique-Jean Larrey saw the destruction on the battlefields of revolutionary France, what struck him most was that too many of the casualties were men dying from treatable wounds. There was simply no designated system for removing injured men from the battlefield until after the battle had ended. Larrey’s determination was that if such men could receive the medical care they needed more quickly, many could be spared.
In the early 1800s when he was made Surgeon-in-Chief over Napoleon’s Imperial Guard, Larrey devised a system of transportation from the battlefield to mobile hospitals using wagons and trained medical assistants. These personnel would brave the battlefield to treat injured soldiers and perform necessary surgical procedures on the spot. The entire system, the wagons as well as the assistants, nurses, and surgeons, Larrey called ambulance volante—“flying ambulances.”
In addition to making sure treatment was administered directly on the battlefield, Larrey utilized what might be the first form of triage by sorting casualties according to severity of wounds, making sure that first priority was given to the most severely wounded. His efforts saved the life of many who would have died had they not been treated immediately. He is key in the history of triage as he is said by many to have invented triage.
Other early examples of triage procedures followed Larrey’s. In 1846, John Wilson, British Naval Surgeon, contributed to the history of triage by focusing his attention on the injured for whom treatment was expected to succeed, starting with those whose need was immediate. Such cases took priority over those for whom treatment was likely ineffectual and soldiers with less severe wounds.
In the mid-1850s, Nikolai Pirogov, the celebrated Russian surgeon, utilized his own system of sorting battle casualties in the Crimean War. In addition to being the first to use anesthesia in a field operation, Pirogov sorted the wounded into four categories: 1. Those who were beyond medical help, 2. Those requiring immediate surgery, 3. Those for whom surgery was needed but could wait a few days and could be transferred to a hospital, and 4. Those whose injuries were minor enough to allow them to walk. These last were sent to hospitals for treatment and returned to their units after medical care was administered.
In summer of 1861, in Prince William County, Virginia, the First Battle of Bull Run saw triage-like procedures implemented as brother fought brother in the American Civil War. Surgeons on the scene describe recognizing those who seemed possible to save and removing them for treatment while under fire. Those whose wounds were less severe were pulled to the back of the column.
As the world moved toward its first world war, triage began to be used off of the battlefield. At this step in the history of triage, emergency departments in the United States and Europe started implementing short clinical evaluations to sort patients into practical treatment sequences. In warzones, priority was also assigned for the immediacy of transportation to and choice of hospital for medical care.
Today, triage is a nuanced process defined by three phases. Prehospital triage occurs before an ambulance or prehospital resources are dispatched. Triage on site is performed by the first clinician, and the third phase happens when a patient arrives at the emergency department or hospital. Proper triage ensures that a patient receives care respective to their condition.
CareXM has its own place in the history of triage as a pioneer in the field of telehealth triage. Catering to our ever-more-online society, our telehealth diagnostics can reach people that, in the past, would never have been able to receive help. Though the history of triage is long and not always straightforward, at CareXM, we offer the most modern and efficient means of getting you the care you need.