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Emergency Severity Index (ESI) Implementation Handbook, 2012 Edition

Appendix B. ESI Triage Algorithm, v.4

This figure illustrates the ESI Triage Algorithm and its four decision points, top to bottom: A. 'Requires immediate life-saving intervention?' If yes, an arrow points to the number 1 (for triage level 1). If no, the arrow points down to the next box, B. 'High risk situation?' Or 'confused/lethargic/disoriented?' Or 'Severe pain /distress.' If yes, the arrow points to the number 2 (for triage level 2). If no, the arrow points to the next box, C. 'How many different resources are needed?' If the reader chooses 'none,' the arrow points to the number 5 (for triage level 5). If the reader chooses 'one,' an arrow points to the number 4 (for triage level 4). If the reader chooses 'many,' the arrow points to the next box, D. 'Danger zone vitals?' If the reader chooses no, an arrow points to the number 3(for triage level 3). If the reader chooses yes, the arrow (labeled 'consider') points to the number 2 (for triage level 2).

© ESI Triage Research Team, 2004

ResourcesNot Resources
  • Labs (blood, urine).
  • ECG, X-rays.
  • CT-MRI-ultrasound-angiography.
  • History & physical (including pelvic).
  • Point-of-care testing.
  • IV fluids (hydration).
  • Saline or heplock.
  • IV or IM or nebulized medications.
  • PO medications.
  • Tetanus immunization.
  • Prescription refills.
  • Specialty consultation.
  • Phone call to PCP.
  • Simple procedure =1
       (lac repair, foley cath).
  • Complex procedure =2
       (conscious sedation).
  • Simple wound care (dressings, recheck).
  • Crutches, splints, slings.

D. Danger Zone Vital Signs. Consider uptriage to ESI 2 if any vital sign criterion is exceeded.

Pediatric Fever Considerations:

  1. 1 to 28 days of age: assign at least ESI 2 if temp >38.0 C (100.4F).
  2. 1-3 months of age: consider assigning ESI 2 if temp >38.0 C (100.4F).
  3. 3 months to 3 yrs of age: consider assigning ESI 3 if: temp >39.0 C (102.2 F), or incomplete immunizations, or no obvious source of fever.

©ESI Triage Research Team, 2004—(Refer to teaching materials for further clarification)

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Page last reviewed November 2011
Internet Citation: Emergency Severity Index (ESI) Implementation Handbook, 2012 Edition. November 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/esi/esiappb.html