Ten Second Triage

Podcast – Ten Second Triage with Sean Brayford Harris at Tactical Trauma 24

In the unpredictable world of emergency medicine, rapid and effective triage can save lives. Enter the 10-Second Triage Tool – a groundbreaking system designed to simplify and enhance multi-agency responses to mass casualty incidents (MCIs). Developed collaboratively by paramedics, police, fire services, and key stakeholders, this innovative approach is already transforming how first responders manage crises.

In this blog and podcast, we delve into the origins of the 10-Second Triage Tool, its methodology, and its real-world impact with Sean Brayford-Harris. Sean is a paramedic with London Ambulance Service who has worked extensively on the tool and presented at Tactical Trauma (where this interview was recorded)

Whether you’re a paramedic, police officer, or part of the wider healthcare community, understanding this tool is essential.


Listening time: 19.46

The Problem with Legacy Systems

Traditional triage systems, such as “Sieve and Sort,” have been foundational for decades. However, their reliance on detailed physiological assessments—like Glasgow Coma Scale (GCS) scoring or blood pressure readings—has proven challenging in high-stress scenarios. These methods often demand complex calculations at a time when responders are already overwhelmed. As Sean says:

“On your worst day ever, the last thing you need is extensive mathematics.”

For non-clinical responders like police officers or firefighters, the gap in practical, actionable triage training compounds these challenges. Addressing these gaps was a critical motivation behind creating the 10-Second Triage Tool.


The Birth of the 10-Second Triage Tool

The tool’s development began within the Metropolitan Police Service, where Harris worked to improve medical responses in high-threat scenarios. The aim? Equip police officers with a simple, effective system for early-phase casualty management.

Recognizing its broader potential, the project expanded to include NHS England, the National Ambulance Resilience Unit (NARU), and other stakeholders. The result was a collaborative approach tailored for cross-agency use. As Harris aptly put it:

“We built a triage system around what responders already do well on bad days.”


Key Features of the Tool

The 10-Second Triage Tool replaces complex physiological criteria with a straightforward flowchart. Its primary objectives are to:

  1. Eliminate reliance on physiology – no GCS, AVPU, or blood pressure measurements required.
  2. Empower non-clinicians – designed for police, firefighters, and other first responders with minimal medical training.
  3. Prioritize actionable steps – focus on interventions like bleeding control and airway management.

The tool categorizes patients into four groups:

  • P1 (Immediate): Requires urgent intervention.
  • P2 (Urgent): Non-ambulatory but stable.
  • P3 (Minor): Walking wounded.
  • Not Breathing: Resources-dependent potential resuscitation.

How It Works

At its core, the tool involves five assessments and two interventions, summarized as follows:

"Flowchart titled 'Ten Second Triage (TST)' with the NHS logo in the top right corner. The flowchart outlines a triage process using yes/no decision pathways:

1. **Walking**: If 'Yes,' the patient is categorized as P3 (green tag). If 'No,' proceed to the next step.
2. **Severe Bleeding**: If 'Yes,' apply pressure, tourniquet, or packing, and categorize the patient as P1 (red tag). If 'No,' proceed to the next step.
3. **Talking**: If 'Yes,' assess for a penetrating injury to the front or back. If present, categorize as P1 (red tag). If absent, categorize as P2 (yellow tag). If 'No,' proceed to the next step.
4. **Breathing**: If 'Yes,' place the patient in the recovery position and categorize as P1 (red tag). If 'No,' the patient is categorized as 'Not Breathing' with the note 'CPR if Resources Allow.'

Each pathway is color-coded based on priority: green for P3, yellow for P2, red for P1, and gray for 'Not Breathing.'"
  1. Walking Patients: Ask all who can walk to move to a designated area. Tag these individuals as P3, recognizing that bystanders may provide valuable assistance.
  2. Severe Bleeding: Identify and address severe (not catastrophic) bleeding using pressure, wound packing, or tourniquets. Patients with severe bleeding are tagged P1.
  3. Talking Patients: Determine whether non-walking patients can talk. Those who can are assessed for central penetrating injuries, which also result in a P1 classification.
  4. Breathing Status: For non-talking patients, check breathing. Airway management may be initiated, and breathing patients are prioritized as P1 or P2.
  5. Non-Breathing: A nuanced “Not Breathing” tag replaces the traditional “Dead” classification, with resuscitation attempted if resources allow.

This system emphasizes simplicity and adaptability, ensuring responders can implement it effectively under duress.


Implementation and Training

The 10-Second Triage Tool is now part of the operational kit for the Metropolitan Police, London Ambulance Service, and London Fire Brigade. Training involves:

  • Laminated Flowcharts: Carried by responders for quick reference.
  • Scenario-Based Drills: Realistic practice sessions that simulate MCIs.
  • Peer-Led Training: Videos featuring police officers describing real-life applications of the tool, fostering buy-in and relatability.

Real-World Impact

Though mass deployment of the tool remains rare, early reports highlight its effectiveness. A notable example involves Territorial Support Group officers in London who successfully managed a multi-casualty road traffic collision using the tool. Reflecting on the incident, one officer remarked:

“We were terrified, but we had a system to guide us. It made all the difference.”

This feedback underscores the tool’s value in reducing responder stress and improving patient outcomes.


Cultural Shifts in Collaboration

The tool has also driven cultural changes in emergency response. Historically, inter-agency responses often suffered from “siloed” operations. By integrating triage responsibilities across police, fire, and ambulance services, the 10-Second Triage Tool fosters teamwork and mutual respect.

Sean notes:

“Instead of arriving and starting from scratch, we’re building on the actions of those already on scene. It’s a force multiplier.”


Looking Ahead

As the tool gains traction nationally, its potential for global adoption grows. Simplified, universally applicable systems like the 10-Second Triage Tool could become the new standard for MCI response worldwide.


Conclusion

The 10-Second Triage Tool is more than a practical solution; it’s a paradigm shift in emergency response. By prioritizing simplicity, inclusivity, and collaboration, it empowers responders to save lives under the most challenging conditions. Whether you’re a seasoned paramedic or new to triage, embracing this tool is a step toward better patient care and professional synergy.


Podcast Transcription


Where to listen

You can listen to our podcast in numerous ways, ensuring you never miss an episode no matter where you are or what device you’re using. For the traditionalists, Apple Podcasts and Google Podcasts offer easy access with seamless integration across all your Apple or Android devices. Spotify and Amazon Music are perfect for those who like to mix their tunes with their talks, providing a rich listening experience. If you prefer a more curated approach, platforms like Podchaser and TuneIn specialize in personalising content to your tastes. For those on the go, Overcast and Pocket Casts offer mobile-friendly features that enhance audio quality and manage playlists effortlessly. Lastly, don’t overlook YouTube for those who appreciate a visual element with their audio content. Choose any of these platforms and enjoy our podcast in a way that suits you best!


Tactical Trauma

Huge thanks to Fredrik Granholm and all at Tactical Trauma 24 for their very warm welcome and for letting us record this series of podcasts. This is a fantastic conference, and we would highly recommend you check it out when they advertise their next event.


Cite this article as: Iain Beardsell, "Podcast – Ten Second Triage with Sean Brayford Harris at Tactical Trauma 24," in St.Emlyn's, January 22, 2025, https://www.stemlynsblog.org/podcast-ten-second-triage/.

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