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Tuesday, 17 March 2009

Triage is the hardest word

When the level of available medical resources is below the aggregate demand placed on them, medical types employ a form of rationing termed Triage. It's based on the principle of the greatest good for the greatest number. Those who need treatment but can wait. Those with a good chance of survival who need treatment immediately. And those who need immediate treatment but whose prospects of survival are low or the medical resources required disproportionate. Being a Triage nurse or doc must be the hardest job in the world. In war, the stretchers bearing those too badly injured to be treated effectively are directed away, with a large shot of morphine and the attention of the Catholic padre.

In A&E departments, the Triage process still applies. The lonely and attention seekers with minor ailments; over-protective parents with embarrassed kids, the drunken lout waiting loudly to be stitched, the reticent middle-class stroke victim making an anti-drama of their crisis, the addict angling for a prescription. No, I'm not a medical man - but in my half-century with three or four visits to casualty, either as patient or accompanying one, I've seen them all. Or I think I have. I couldn't really tell who needed treatment and who was malingering, what was serious and what wasn't, but I have always believed in the ability of the Triage staff to do so. As a layman, spend ten minutes in an A&E department and you find yourself making medical judgements about who is a priority for care and who isn't. And you'll probably get it completely wrong.

OK, get to the point, I hear you saying. It's this. Every reasonably bright person, every manager who manages something, every intelligent layman knows the above. We all know the importance of Triage. We, completely medically unqualified, realise how important these decisions are. We're not NHS managers, just ordinary people. So NHS managers must know it better than we do, yes? No. Not if they're managing Stafford Hospital.

At Stafford, they thought receptionists were the proper people to carry out Triage. Yes, receptionists like that ignorant and boorish woman who staffs your GP's surgery. Clerical grade jobsworths who can just about stab at the computer keys with their lacquered nails but can't spell prostate. And as a result, some 400 people have died.

The Chief Executive is suspended on full pay, the Chairman has resigned and Alan Johnson has apologised. And they all imagine this is action enough. It's not. If you and I know the importance of Traige, an NHS manager who deliberately neglects to staff this function with appropriately qualified persons deserves not censure and early retirement on a generous pension but a long term of imprisonment.


it's either banned or compulsory said...

As usual a very well written and thoughtful article Raedwald but I do feel that you are being a little harsh on the receptionist. I don't suppose that she asked to , or was paid for, take on such responsibility.
The national NHS body that 'discovered' something was wrong at North Staffs was nauseatingingly preening itself on how clever it had been to spot the problem. It only took an extra 400 dead people before they did so.

Anonymous said...

Of course you may not see a doctor anyway as ' nurse practitioners' with protocols are appearing all over the medical scene.

Anonymous said...

Just thank your lucky stars that we don't have a National Food Service.

Anonymous said...

As a former military medic, there is only one rul of thumb for Triage:

If you are bleeding, you'll get seen to, otherwise wait your turn.