Patient Assessment & Triage Concepts for EMTs

Patient Assessment and Triage

Purpose:

Effective patient assessment and triage form the core foundation of all emergency medical practice.Emergency Medical Technicians (EMTs) are often the first trained professionals to identify, stabilise, and prioritise patients in urgent, high-pressure environments. This unit connects clinical assessment skills with organisational emergency procedures, operational planning, and legal compliance.
The purpose of this Concept Explainer Sheet is to simplify complex theories behind assessment frameworks, triage models, and emergency response planning, while showing how EMTs must align their actions with UK legal, professional, and organisational requirements.
Visuals and examples are provided to improve comprehension and real-world application.

THE THEORY OF PATIENT ASSESSMENT — SIMPLIFIED

Patient assessment is a structured, systematic approach to collect essential information about a patient’s condition. The goal is to identify life-threats immediately and prioritise interventions.

A universally used rapid assessment tool.

┌──────────────┐
│ A – Airway │ → Is the airway clear?
└──────────────┘
↓
┌──────────────┐
│ B – Breathing │ → Is the patient breathing normally?
└──────────────┘
↓
┌──────────────┐
│ C – Circulation│ → Pulse? Bleeding? Skin colour?
└──────────────┘
↓
┌──────────────┐
│ D – Disability │ → AVPU / GCS?
└──────────────┘
↓
┌──────────────┐

│ E – Exposure │ → Hidden injuries? Environment risks?
└──────────────┘

Example (Simplified):

A 30-year-old male is found after a collision.

  • A: Speaking → airway clear
  • B: RR 28, laboured → oxygen needed
  • C: Heavy bleeding from leg → tourniquet required
  • D: Confused (V on AVPU)
  • E: Remove clothing → secondary bleeding visible

Why ABCDE?

It ensures life-threats are corrected in order of urgency—airway always comes before disability.

TRIAGE MODELS — COMPLEX THEORY MADE SIMPLE

Triage is prioritising patients based on clinical need, not arrival order.
For EMT level in the UK, two main systems are most relevant:

START Triage (Simple Triage and Rapid Treatment)

Used for major incidents.

START TRIAGE FLOW
┌──────────────────────────────────────────┐
│ WALKING? → Yes → GREEN (Minor) │
└──────────────────────────────────────────┘
↓ No
┌──────────────────────────────┐
│ BREATHING? → No → Open Airway│
└──────────────────────────────┘
↓
If still NOT breathing → BLACK (Deceased)
↓
Breathing rate > 30/min → RED (Immediate)
↓
Perfusion: Cap refill >2sec or no radial pulse → RED
↓
Mental state: Cannot follow commands → RED
↓
Otherwise → YELLOW (Delayed)

Colour Codes

  • Red: Immediate – life-saving intervention needed
  • Yellow: Delayed – serious but not immediately life-threatening
  • Green: Minor injuries
  • Black: Deceased or expectant

NHS / UK Practice: Triage in Ambulance Services

Ambulance crews often use:

  • NHS Clinical Decision Support Tools
  • NHS Pathways
  • JRCALC Guidelines

These ensure decisions are standardised, defensible, and compliant with UK law and clinical governance.

Visual Summary (Simple ASCII Chart)

┌────────────┐
│ RED │ Immediate threat
└────────────┘
▲
│
┌────────────┐
│ YELLOW │ Serious but stable
└────────────┘
▲
│
┌────────────┐
│ GREEN │ Minor injury
└────────────┘
▲
│
┌────────────┐
│ BLACK │ No signs of life
└────────────┘

EMERGENCY RESPONSE PLANNING — LINKED TO PATIENT ASSESSMENT

This section connects the clinical models to emergency systems an EMT must work within.

Designing Emergency Response Plans (Learning Outcome 1)

An organisation’s plan must include:

  1. Risk identification:
    o Fire, explosion, chemical spills, multi-casualty accidents
    o Local hazards: industrial sites, highways, schools, high-rise buildings
  2. Defined EMT assessment roles:
    o First responder begins ABCDE
    o Team leader assigns triage officers
    o Transport officer coordinates evacuation
  3. Communication pathways:
    o Radio channels
    o Handover (ATMIST / SBAR)
    o Emergency operations centre (EOC)
  4. Triage integration:
    o Red zone treatment
    o Yellow zone holding area
    o Green self-help area

Mini Visual: Incident Layout

[Incident Scene]
│
┌─────────────┬─────────────┬─────────────┐
│ RED Zone │ YELLOW Zone │ GREEN Zone │
│ Immediate │ Delayed │ Minor
│
└─────────────┴─────────────┴─────────────┘

EMTs must operate within UK law and clinical governance when performing assessment and triage.

Legislation / RegulationRelevance to EMT Assessment & Triage
Health and Safety at Work Act 1974Requires safe systems of emergency response; EMTs must avoid creating new risks while treating patients.
Civil Contingencies Act 2004Forms the legal basis for multi-agency emergency response and major incident planning in the UK.
Data Protection Act 2018 / UK GDPRProtects patient information during assessment, documentation, and handover.
Health and Social Care Act 2008 (Regulated Activities)Ensures care is safe, effective, and person centred; overseen by the CQC.
NHS Constitution & Clinical Governance FrameworkRequires consistency, accountability, and evidence-based practice.
JRCALC Guidelines (Professional standard, not law)Defines acceptable EMT clinical practice in assessments and triage.

DRILLS, REVIEWS & QUALITY ASSURANCE

Emergency systems must be tested and refined regularly.

Types of Drills

  • Tabletop Exercises: Planning discussion
  • Functional Drills: Testing communication, triage roles
  • Full-Scale Simulations: Multi-agency major incident exercises

What EMTs Learn from Drills

  • Speed and accuracy of triage under pressure
  • Proper flow through red / yellow / green zones
  • Real-time documentation and communication
  • Identifying bottlenecks (delayed handover, insufficient equipment)

Review Process

  • What worked?
  • What failed?
  • What needs more training or new equipment?
  • Are legal requirements still being met?

CASE EXAMPLE — Bringing All Concepts Together

Scenario:

A bus collision results in multiple casualties. An EMT arrives first.

Actions Taken:

  • Conducts rapid scene assessment (fire risk, fuel leak, hazards).
  • Applies ABCDE to first critical patient.
  • Begins START triage assigning red, yellow, green tags.
  • Communicates findings via ATMIST to control room.
  • Assists in setting up triage zones with responding teams.
  • Records patient priorities to support clinical governance.
  • After incident, participates in after-action review to identify learning.

LEARNER TASK

Using all content above, complete the following tasks.

TASK 1: Concept Explanation in Your Own Words

Explain the following in 250–350 words each:

  1. The purpose of the ABCDE model in emergency assessment
  2. How START triage helps manage multi-casualty incidents
  3. The role of EMTs in organisational emergency response planning

TASK 2: Applied Example (Use Extra Data Below)

Using the additional data provided, produce:

  • A scene assessment summary
  • A triage decision table
  • A brief emergency plan outline

Extra Data:

  • 1 × unconscious patient, not breathing after airway opening
  • 1 × adult with RR 34/min, capillary refill 3 sec
  • 1 × teenager with wrist fracture, walking injured
  • 1 × elderly female, confused, RR 20/min, cap refill <2 sec
  • Hazard: leaking diesel, light smoke visible

List three UK laws from the sheet and describe how each affects:

  • Your assessment
  • Your triage
  • Your documentation/handover

TASK 4: Drill Improvement Exercise

Design a 10-minute micro-drill your team can perform weekly to improve triage accuracy.