Journal of Dr. NTR University of Health Sciences

: 2022  |  Volume : 11  |  Issue : 1  |  Page : 101--102

COVID-19 pandemic: A three-step protocol for ED triage

Suhrith Bhattaram, Varsha S Shinde 
 Department of Emergency Medicine, Dr DY Patil Medical College, Pimpri, Pune, Maharashtra, India

Correspondence Address:
Dr. Suhrith Bhattaram
Department of Emergency Medicine, Dr DY Patil Medical College, Pimpri, Pune, Maharashtra - 411 018

How to cite this article:
Bhattaram S, Shinde VS. COVID-19 pandemic: A three-step protocol for ED triage.J NTR Univ Health Sci 2022;11:101-102

How to cite this URL:
Bhattaram S, Shinde VS. COVID-19 pandemic: A three-step protocol for ED triage. J NTR Univ Health Sci [serial online] 2022 [cited 2022 Nov 30 ];11:101-102
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Full Text

Dear Editor,

Hospitals around the globe are faltering under the pressure of the novel coronavirus disease 19 (COVID-19) virus, which is claiming millions of lives and over-burdening health systems.[1],[2]

With the tremendous spike in cases, it has become extremely hard to separate COVID from the non-COVID cases in the Emergency Department (ED). Although having exclusive COVID hospitals is ideal, a more practical approach would be to utilize and streamline the pre-existing resources and develop a system where suspects can be rapidly assessed and segregated from the general ED population.[1]

We present a three-tier triage system that focuses on patient safety, provider safety, and decreased waiting times, while effectively segregating COVID-19 suspects and minimizing non-personal protective equipment clad health care workers' (HCWs) exposure to suspects.

The three tiers of triage are as follows:

Tier 1 - Pre-triage - Based on patient stability.

Tier 2 - Pre-triage - Based on COVID suspicion.

Tier 3 - Triage - Confirmation of classifications of Tier 1 and 2 [Figure 1].{Figure 1}

This protocol started with the creation of a makeshift suspect ED, opposite to the pre-existing ED. If a pre-informed arrival of a suspected/confirmed case occurs, they are immediately directed to the isolation intensive care unit or ward based on the stability of the patient. However, when an uncategorized patient arrives, they are 'Pre-triaged' based on broad physiological parameters and segregated on COVID-19 suspicion.

The triage doctor/nurse will be provided a desk at the ED entrance and will focus on rapidly assessing the physiological parameters of the patient while simultaneously eliciting history and symptomatology suspicious for COVID-19.

A pre-made checklist available with the triage nurse ensures that the screening occurs only according to institutional protocols.

Once a suspect case is identified, they are rapidly shifted to the COVID-ED, where emergency/life-saving care and procedures are carried out. Following initial stabilization, repeat segregation of the patients would be carried out by the ED residents, and the patients would be transferred accordingly.

This dual layer of safety ensures appropriate and timely care to those in need while preventing cross infection to the non-COVID populace.

This system has worked very effectively in our hospital setting; however, each ED must develop a specific system of triage compatible with the hospital milieu to facilitate smooth integration into the pre-existing system.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1World Health Organization. Regional Office for the Western Pacific. Algorithm for COVID-19 triage and referral: patient triage and referral for resource-limited settings during community transmission. WHO Regional Office for the Western Pacific. 2020.
2Bhattaram S, Bhattaram MP. Humbled: Life in the emergency department under the shadow of a pandemic. Eur J Emerg Med J 2021;28:178-9.