Free ER Insider Sheet

ER Insider: Why Some Patients Are Seen First

You check in, sit down, and someone who came in after you goes straight back. It can feel unfair. Here is how ER triage works: sickest first, not first come.

• Sickest first. MedlinePlus says people arriving at an emergency room are evaluated right away, life or limb threatening conditions are cared for first, and people with other conditions may have to wait. [3]
• Five levels. Many U.S. emergency departments use the Emergency Severity Index (ESI), a five level triage scale from level 1 (most urgent) to level 5 (least urgent). [1]
• Danger comes first. Level 1 is a patient who needs an immediate life saving intervention. Level 2 is "a patient who shouldn't wait," such as active chest pain that could be a heart attack or signs of a stroke. [1]
• Then resources. For stable patients, ESI looks at how many types of resources the visit will likely need, like lab tests, an ECG, X rays, CT scans or IV fluids. Two or more is level 3, one is level 4, and none is level 5. [1]
• Many are seen quickly. CDC data show about 155.4 million ER visits in the U.S. in 2022. In 40.6% of visits, the patient was seen in fewer than 15 minutes, and 11.5% of visits ended in a hospital admission. [2]

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