Algorithm for Triaging Mental Health Needs
Emergency department staff can use this triage tool to determine for significant positive response to “proximity/level of exposure”
who needs urgent or nonurgent psychological assessment and to will depend on the incident itself and will be determined by the
decide how to station mental health staff in the most efficient and nature and severity of the event and by the surge for mental health
effective manner. The tool is for use in “clean” (nonisolated) zones. care that your facility is experiencing. For instance, in the event
See note for further details. For more on this topic, please refer to of a “dirty” bomb, you will have to decide what the “X” is in the
the “Zebra book.” question, “Were you within X miles of ground zero” based on the
known properties of that bomb.
Step 1: Medical evaluation triages patients into one of two groups.
On the right side of the diagram are persons who have a high prob- Step 4: If a patient does not meet the criteria for urgent assess-
ability of exposure and/or are seriously ill. On the left side of the ment, continue to screen for nonurgent assessment: young children,
diagram are persons who are mildly ill or not at all ill and need little anyone who suffered a secondary loss (loss of job or home, forced
or no treatment, except perhaps observation or outpatient treatment. relocation/evacuation, etc.), persons without social supports, and
individuals who have suffered from an injury or illness due to the
incident (e.g., a mild incident-related injury). An individual who
Step 2: Individuals who are so ill that they need emergency and/or meets any of these criteria should be sent for nonurgent assessment.
inpatient medical treatment are probably too ill for mental health
care to be a priority. However, family members are potential candi-
dates for mental health or spiritual care. Individuals who are mildly Step 5: Remaining patients should receive psychological first aid
ill or not at all ill and need little or no treatment, except perhaps (PFA) and relevant written materials from PFA-trained staff.
outpatient follow-up or observation, form a second group of people
who will need further psychological triage. These individuals may
have event-related concerns, but they are not ill and may never have Step 6: Discharge to outpatient follow-up as indicated.
been exposed to the harmful agent.
NOTE: Factors used to differentiate level of urgency come from
Step 3: Assess these individuals for the following: traumatic loss of trauma and disaster studies. However, there is no “one-size-fits-all”
a loved one, proximity/level of exposure to the incident (see below), strategy since exact traumas will differ among incidents and the
extreme psychological responses that are not improving with balance between patient need and health care resources will differ
attention, and intent to harm themselves or others. An individual among facilities. This triage tool is meant to be a flexible, generic
with any of these characteristics should be sent to a mental health strategy that can be adapted for different events or as knowledge
specialist for urgent assessment and intervention. The threshold changes.
Patients with Exposure-Related Concern or Illness
STEP 1: Medical evaluation
• Low or intermediate probability of exposure • Definite or high
• Minimal or no treatment required probability of exposure
• Other medical/surgical disorders ruled out • Seriously ill or deceased
STEP 2. Psychological evaluation Offer family assistance
• Referral to mental health
services and/or chaplain
Urgent psychological • Bereavement/grief
STEP 3: Assess for urgent need counsel
• Traumatic loss assessment and
YES appropriate mental • Supportive services
• Geographic proximity/dose exposure
• Extreme reactions that worsen/do not improve health intervention
• Desire to harm self or others (by mental health specialist)
NO
Nonurgent
STEP 4: Assess for nonurgent need psychological
• Secondary loss • Incident-related injury YES assessment and
• Socially isolated or illness appropriate mental
• Children, elderly • Past psychiatric history health intervention
(by mental health specialist)
NO
STEP 5: Provide Psychological First Aid and brochure
(By a PFA-trained health professional)
STEP 6: Discharge to outpatient follow-up
Algorithm for Triaging
Mental Health Needs