We align with:

  1. Institute of Medicine. 2013. Crisis Standards of Care: A Toolkit for Indicators and Triggers. Washington, DC: The National Academies Press. https://doi.org/10.17226/18338. [Link]
  2. European Centre for Disease Prevention and Control, Technical report: Pandemic influenza preparedness in the EU, 2007. [Link]
  3. Hick, J. L., D. Hanfling, M. K. Wynia, and A. T. Pavia. 2020. Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2. NAM Perspectives. Discussion paper. National Academy of Medicine. Washington, DC. https://doi.org/10.31478/202003b. [Link]
  4. Institute of Medicine. 2009. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. Washington, DC: The National Academies Press. https://doi.org/10.17226/12749. [Link]
  5. The Australian Health Sector Emergency Response Plan for Novel Coronavirus COVID-19. [Link]
  6. Emergency Response Plan for Communicable Disease Incidents of National Significance: National Arrangements. [Link]
  7. New Zealand Pandemic Action Plan. [Link]
  8. Communicable Diseases Network Australia (CDNA) National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Care Facilities in Australia. [Link]

Given the highly infectious nature of COVID-19 it is imperative to ensure transmission of the virus is reduced as much as possible. Emergency departments (EDs) are the first point of contact for many patients with suspected COVID-19 symptoms or disease.
During a pandemic, principles of triage include a triage system that:

  • Is simple and easy to use and facilitates rapid processing of patients presenting to the ED.
  • Will identify and isolate those at increased risk of disease, thus reducing potential for transmission to other patients and health staff.
  • Can be easily taught and reliably applied by credentialed staff. 

A pandemic is not a surge over a few days like a Mass Casualty Incident (e.g. plane crash) but an initial slow increase, then an exponential increase. Triage processes will thus need to be fluid and adaptable. There should be agreed trigger points when your ED will switch to disaster triage, and the Hospital Incident Management Team should have predetermined responses to a graded whole-of-hospital response when this occurs (also see recommendations in the Pandemic planning section).
Planning should include discussions regarding funding implications of changing from Australasian Triage Scale (usual) triage to disaster triage, and the development of hospital electronic information systems that are compatible with this change.
A ‘whole of health service’ approach, balancing capacity and safety, will be necessary to identify optimal ED configuration and direct streaming to inpatient areas. ED zoning will allow for the creation of high risk and lower risk areas within ED, according to risk factors and clinical features identified during patient screening (also see ED design layout section).

  • Triaging – practical considerations
  • The role of disaster triage
  • Stages in disaster/crisis care
  • How to do disaster triage
  • References
  • Section disclaimer
  • Resources