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The evolution of triage systems and upcoming developments for the NHS

When a high number of people are injured in a single incident, multiple casualty triage is vital because it allows first responders to prioritise patients and provide urgent care to those who most need it.

In a multiple casualty incident (MCI), there are often more patients than there are resources to treat them. Triage helps to ensure that the most critical patients are seen first, while those with less severe injuries are given appropriate emotional and physical support while awaiting medical care.


Now, the UK’s multiple casualty triage guidelines are changing, with two new triage systems that have come into effect from June 2024: the Ten Second Triage and the Major Incident Triage Tool.

The Ten Second Triage (TST)

The Ten Second Triage (TST) is designed to be a simple, rapid and effective way to prioritise casualties at the scene of a major incident where there is a high number of injured people. It focuses on the provision of immediate life-saving treatment, such as the control of severe bleeding or the preservation of a casualty’s airway.

The TST does not require any physiological measurements, such as breathing or pulse rate, so it can be used by responders with little or no clinical training.  Also, it does not classify casualties as ‘dead,’ but instead categorises them as ‘not breathing.’ The TST allows for appropriate interventions, such as casualties being moved into the recovery position or CPR being administered until formal triage is carried out by a healthcare professional.

NHS Major Incident Triage Tool (MITT)

The NHS Major Incident Triage Tool (MITT) is a new triage for prioritising patients at the scene of a major incident. A single tool for both adult and paediatric patients, MITT is designed to be rapid, reliable and reproducible. The MITT, which has been shown to be more sensitive than the current triage tools at identifying patients who need life-saving interventions, will replace the triage sieve tool, the triage sort tool and the paediatric triage tape.

The MITT is based on the Modified Physiological Triage Tool-24 (MPTT), which is featured in the NHS England Clinical Guidelines for Major Incidents and Mass Casualty Events. The MPTT is a well-established triage tool that has been shown to be more effective than other triage assessments in identifying patients who need urgent care.

Find out more about our triage and incident management solutions

At TSG Associates, we supply a range of triage and incident management solutions for first responders, medical professionals and scene commanders to eliminate the confusion at MCIs and improve the identification of critically ill patients. Our products are fully compliant and compatible with the TST and the MITT.

To find out more, please browse our products or get in touch for expert advice.


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