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:
- Eliminate reliance on physiology – no GCS, AVPU, or blood pressure measurements required.
- Empower non-clinicians – designed for police, firefighters, and other first responders with minimal medical training.
- 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:

- 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.
- Severe Bleeding: Identify and address severe (not catastrophic) bleeding using pressure, wound packing, or tourniquets. Patients with severe bleeding are tagged P1.
- 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.
- Breathing Status: For non-talking patients, check breathing. Airway management may be initiated, and breathing patients are prioritized as P1 or P2.
- 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
Welcome to the St Emlyn’s podcast. I’m Iain Beardsell.
I’m Liz Crowe.
And it’s a delight to be here with Sean Brayford Harris, who is going to talk to us a bit about his part in the team that was designing the 10 second triage tool. But Sean, before we start, why don’t you just introduce yourself to our listeners.
Yeah. Hi. so my name’s Sean. I am a paramedic by trade with the London Ambulance Service. I have a incredibly made up job title of the interoperability development officer, between us and the Metropolitan Police. I’ve spent the last six years, on secondment to the Met, so the largest police force in the UK, to help develop anything that we do clinical that crosses green and blue and everything in between.
So perhaps we could just go back to a little background, because I was obviously brought up in the world of sieve and sort when it came to major incident triage. What was it about the sieve and sort that really meant that people felt it needed a change?
Oh, good question. so two real parts, mainly. So firstly was accuracy, which is the most important thing. heavily reliant on physiology. Or at least the sort part. and some slight concerns regarding the human factors of on your worst day ever, the worst day of your career, asking you to do some extensive mathematics regarding, GCS and blood pressure,meant that it wasn’t quite fit for purpose.
So there’s this idea we need to change. You’ve obviously been then part of a huge team sorting this all out. Where do you go if you’re going to start designing a new tool that has to be working for everybody? And I guess you’re working when you say interoperability, that’s fire, police, paramedics, all those people working in the pre hospital environment.
Yeah, absolutely. So where did we went? Literally, we went to Wales of all places, physically. So by the work that myself, Dr. Claire Park do with the Metropolitan Police. originally we were trying to solve this problem, for a police officer. Wasn’t necessarily thinking the bigger picture at the time.
We were concerned about police officers finding themselves in the early phases of high threat incidences where help was maybe a little bit further away than we’d like and trying to give them something to help decision making and aid casualty evacuation. We got a little bit down the road with that, realized that sort of the, the big guns at NHS England and NARU were doing some of the same sort of thing. which brought us all together. We brought the ideas together and dare I say it, made a beautiful baby together.
How hard is it, we are doing what Amy Edmondson calls teaming all the time. So we’re a team, so you could be an ED and then you’ve got a team with the renal department or team with radiography. How hard is it to do that between Services and different levels of governance.
Or I think you’ve hit the nail on the head. That’s probably the hardest thing that I’ve experienced within my career thus far, especially in liaison with the police. I remember my first couple of days at the Metropolitan Police, my little green uniform and my feet were held to the fire by my police officer colleagues who immediately wanted to know, who are you?
Who are you that arrived here to tell us to do something different? So time spent listening to the end users, working with them, trying to understand truly what they do, the collaborative team effort of, the broader clinical governance structures within the Met, when they realized we’re there to help, not judge like everything else in policing at the moment, gave a little bit of buy in, realized it critical friends rather than critique,allowed some collaborative work together rather than us saying, Hey, do this because we’re better than you, which was definitely not the case.
When you spoke to frontline police officers, what did they have to say about their levels of stress or distress or a combination of both about trying to triage a situation that is predominantly, has become medical?
Oh, really good question. So whenever you speak or whenever one of the overarching themes of speaking clinical within policing, it’s always important to recognize that this is job number two or number three. There’s always a policing priority. And We think of these types of examples, these types of incidents, something bad has happened, it might be terrorism, it might be violence, the policing priority will always be confronting the threat, confronting the problem, trying to make it safe, and the worry is that medicine was always an afterthought, early on. Police medical training didn’t necessarily get the time it was, it potentially deserved. So everyone just felt really unprepared, felt it was always an afterthought. and yeah, we didn’t necessarily provide them a much of a structure. So before this, there was no police triage really, other than maybe in a couple of forces in the UK. It was just a big empty space of what do we do? And at the time, no one really had the answers.
My brother is ex police and the things that I think really have continued to haunt him since leaving there is often around decisions made medically or having to be first on the chest or for hands on and thinking this is so far outside my scope but help is, minutes to half an hour to an hour away and they’re just there, aren’t they?
Yeah, absolutely. often left describes holding the baby. If something goes horribly wrong, if there’s a medical emergency, you phone the ambulance service. If something’s on fire, you phone the fire brigade or fire and rescue service. but for everything else, it seems to be that policing, find themselves in and amongst it.
So completely utterly empathize with it. It’s a, a position where they’re left on their own, perhaps without some support, lots of public criticism. I don’t envy it at all. I think it’s a really tough job.
So let’s come to the 10 second triage tool itself. All too often sadly, watching the news, we have these incidents where there are clearly multiple casulaties involved. What does the tool now involve and how would you go about using the tool? And then let’s maybe just talk a bit about how you’ve gone about teaching the tool to people who may have no medical training at all.
What it involves, it’s probably easier to describe what it doesn’t involve in comparison to some of the systems that were before. The main systems that existed within the UK beforehand were the, so sieve and salt, perfect example. relied on physiology as one of the biggest, differentiators, that’s a word I’m sure. Knowing that our target audience were going to be non clinicians who frequently tell us that, obtaining physiology is hard, especially when it’s raining and it’s three o’clock in the morning and you’re wearing tactical gear. So, we removed all physiology. one of the big things for me, we tried to make sure it was designed around, what they would do on a bad day anyway.
So really important to recognize that if we put some armed police officers with someone sick or injured on the streets of London. It is entirely likely that they’re going to do a fantastic job anyway, because their training is designed to focus on the things that are killing people quickly, stopping them bleeding to death, finding holes in their chest, opening their airways or doing CPR if they require. And so lo and behold, we try to build a triage system that’s built around what they would do anyway. So it provides them a structure. It emphasizes a clinical response that we already know to be good. It’s what we drill them in day in and day out. so yeah, what it includes,five assessments, two interventions and, some color coded triage outcomes as you’d grow to expect P1, P2, P3, and a not breathing tag.
Talk me through how the 10 second triage would work. You’ve got patients in front of you or potential patients in front of you.
Yeah. So scrolling from the top, we would ask that people manage your walking patients first. And though it sounds really simple and it’s existed in other triage sieves before, we’ve tried to make sure that’s covered with the appropriate nuance. It’s a low threat incident where I was to step out of a little yellow car, me managing walking patients might be relatively simple. if you’re stepping out of an armed response vehicle at a explosion or an active, shooter, the management of those walking patients might be a little bit more robust. so though on the flow chart, it’s a simple yes or no, where we want, any walking injured patients, tagged as a P3, there’s a subtle nuance to, to make sure that, if policing priorities come first, that’s okay. Or if critically injured walking patients come up to you, then, you pragmatically recognizing that they’re actually quite poorly means, you’re empowered to do some intervention. So yeah, so that’s step one,moving those who are walking, clearing the scenes, trying to leave,the scene clearer for perhaps your sicker patients. Another subtle nuance , to, mention, is that we also recognize the role of the bystander. So quintessentially we would often describe, you arrive at the scene, say everyone who could walk, come to me, and everyone would get up and leave, making it completely sterile and fantastic. But we know for a fact people won’t leave their loved ones, off duty doctors, police officers, firefighters, nurses, you name it. will be there. They’ll want to help. And actually, we are far better using them as force multipliers rather than trying to get them out of the way. Because if I’m there by myself, I want all the help I can get really. So next on the list, we want anyone who’s following this triage system to address severe bleeding. Severe is an intentional term. Often we would describe catastrophic or massive. and we purposely use the terminology severe to lower that threshold ever so slightly. This is trying to undo some training scars. If you ask a police officer, what does catastrophic bleeding look like? Often terms you’ll hear back, spurting up the wall, and actually, if your patient has been bleeding for a while before you got there, or if they’ve been moved, or if they’re wearing lots of layers of dark clothing, they may not necessarily see that. And what we don’t want is a lack of intervention, due to a lack of realism or accurate descriptions.
So severe lowers that threshold, encourages some intervention, because we know that any of those interventions in the short time scale that, initial responders will be with them, are far better than doing nothing. Anyone who’s obviously severe bleeding, we would prioritize as a P1. if they’re not severe bleeding, we’ve gone for a, simplified summarized response check. So no GCS, no AVPU bearing in mind that we want this to be done by, the police officers, firefighters, non clinicians, and it’s a simple, are they talking yes or no, within some of the training material. We nuance that talking bit a little bit more.
So if they’re not quite talking normally, we know that’s a, quite a sensible capture for people who are quite poorly. And we encourage that use if the user is appropriately trained. Following the talking question, if someone’s up and talking to you, like my point of what we’ve trained cops to do already is we want them to try and find central penetrating injury.
And this is the injury pattern that should make, all pre hospitalists,not sleep at night. It’s the thing that despite our best efforts, it’s not much we can do for pre hospitally. So, finding that sneaky axilla injury, finding that stab wound to the back, would trigger a, another P1, and, emphasis for evacuation. So going back a bit, so if your casualties were talking and they didn’t have a penetrating injury to their chest, that would give you a P2, so non ambulatory because we’ve gone through that walking bit at the start. If they’re not talking, we then go to the, are they breathing? Yes or no. Immediate intervention for that will be dependent on the scenario, on the tactics. Previous triage sieves at this point would have always been a dead tag, which was something we were quite keen to avoid. And that’s been replaced with a silver not breathing tag and with a little nuance of resuscitation if resources allow. So in the early phases of a mass casualty incident, I don’t want to make decisions about or split second decisions about death. As a paramedic, I definitely don’t want our police officers or firefighters to have to do the same thing. And it goes against everything we’ve been teaching and learning that traumatic cardiac arrest being futile is not actually true. And so yeah,the guaranteed dead tag has been replaced by a slightly more nuanced not breathing tag where if resources allow we can potentially do some resuscitation where we otherwise wouldn’t have done. Anyone who needs some airway management is obviously a P1, with some airway management, provided thereafter. So that’s it. Although I know for a fact it’s more complicated to talk about than to actually do, I’d definitely recommend having a look at it rather than just listening to me describe it because it makes it more complicated than it’s intended.
So let’s see if I can, I’ve never used the tool. So listening to you talk it, let’s see if I can talk it through and remember. So first of all, are you walking? Yes, you are P3, but keep some bystanders if you think they can help, because why not many hands make light work, then double check for serious, severe bleeding.
Severe was the word, not catastrophic. So severe. And if you’ve got severe bleeding, then press on it, try and stop it. And they’re P1.
Yeah, absolutely. So pressure, tourniquets, wound packing, whatever you need, whatever you have to be trained to do. P1. Yes.
Then we’ve got onto this slightly, as you’ve said a few times, the nuanced bit of P2. this is then the talking bit. Just for my learning, remind me of this bit next, because this is the one bit where I think, I understand walking and not walking, I understand bleeding, not bleeding. Do this next bit again for me, just one more time.
Yeah. So I’ll do it in its simplest term. So it’s, is the casualty or is the patient talking to you? Yes or no. And so if they are talking to you, fantastic, that’s what we want that to be and that’s when we start looking for penetrating injuries. If they’re not talking to you or not talking normally and another little sneaky one, if they’re too young to talk, we treat that as a no.
And then you go on to check, whether or not they’re breathing.
So I think I can get a handle of this, particularly after just talking to you. But I’m guessing our police officers, firefighters, they’re carrying this on laminated cards in their kit and they can just refer to it and just work down a pretty simple flowchart.
Yeah, absolutely. That’s the intention.
And who is using this now?
At this very moment in time, I can personally confirm that it’s in every operational first aid kit across the Metropolitan Police. It’s in use by, The London Ambulance Service, it’s in use by the London Fire Brigade. The setting, the stance,the instruction that brought it to us has gone national as well, so I can only hope that, nationally it’s being used too.
So they’ve got a flowchart. Do they have somewhere in their car that they’re issuing people as a P1, P2, P3 so that when the ambulance or HEMS or whoever arrives that they can visually see where that triaging is?
Yes, absolutely. So there are a number of tagging systems available. It all gets very commercial, but there’s a number of systems that are being used. the recommended one by NHS England was Slap bands or snap bands, so if you ever remember when you was younger, that you could slap on a wrist. Reflective, snap bands that go on to, to, to the wrists of casualties, so we can identify who’s been triaged,and they’ve got a little checkerboard edge to identify that they’re different than your established healthcare triage.
Out of curiosity, I guess a big question I’m having is, this whole issue, as I said, about cross teaming and coming together and seeing ourselves as a team. a team on the day rather than your police and I’m ambulance, this is hospital, etc. What have been the benefits apart from obviously triaging patients?
What did you observe? Because in hospitals at the moment, if we could team better, just in between teams, or if emergency departments could be more encouraging of our police and paramedic clinicians and see them as part of an extended team, I think we’d all be better off. What have been your lessons learned about this teaming thing and helping us be able, from a cultural perspective, be able to work together more effectively for the same goal.
Yeah, without focusing too much on the clinical, but it’ll all make sense. When we, before this triage was in the hands of everybody and you looked at incident response, As soon as an ambulance resource would arrive, the clock would restart. So everything that had been done beforehand didn’t really matter. Don’t worry, the ambulance service is here, we’ll start from scratch. And that kind of not undermines, but any action put in place by whoever was there first, whether it’s fire and rescue, whether it’s community first responder, whether it’s the police, that all had to stop and wait. Now, when we are approaching it far more collaboratively, we can end up being a false multiplier for our colleagues who were there beforehand.
I know that’s a buzzword I use a lot. I make no apologies.
Instead of the ambulance service arriving saying, everybody stop, we’re here, and starting from scratch, you can arrive to a casualty management plan that’s already in action. So if I arrive and the police are already evacuating some of my sickest patients, that’s only a good thing.
They’ve done, some of the more difficult parts of my role, and it allows healthcare to focus on the things that only we can do. So the provision of, pain relief, for example, and it is something that’s coming to policing or is in policing in some examples, but we can arrive and do our job a little bit better. It allows policing to, to get on with something in the early phases and all adds momentum, which is crucially important for some of these patient groups. And when you see or when I reflect back on some older training scenarios, it was all very cliquey. You’d have blue uniforms in one side of the room, green uniforms in the other side of the room, patients only been moved by, oh that’s an ambulance patient, oh that’s a fire patient. And now we see collaborative, like truly joint collaborative efforts in managing some of our sick patients. instead of it being, oh, no, that’s not my job. There is now a huge focus from all three services on, actually, we’re all here to reduce injury. We’re here to reduce harm. We’re here to reduce mortality in these sorts of incidents. and that’s fantastic to see. I feel that it’s giving me the warm, fuzzy feelings,
And has there been any reports, and I’m, like, this is probably outside your role description, but has there been any reports of a reduction of moral distress or a reduction of kind of what, that sense of what if, or if only I had of, when people actually now do have a specific role with patients and they know that they’ve been able to do it to the best of their ability, do we know if that helps the police?
I suppose it’s fortunately we haven’t had to see it used in great scale. When during some of the initial testing, we’re down at Winterbourne Gunner at NARU. we brought loads of people from all over the UK. one that stands out is we brought some police officers from London’s territorial support group and shortly after they were involved in the training. a couple of the officers were involved in a,a multi casualty RTC in South East London. They reported being appropriately terrified and worried about what they were going to. But having the phone calls afterwards saying, hey, we knew what to do though. We had a thing that we could refer to. we had an answer for that scary day, was fantastic and clearly, has struck an appropriate chord within policing. We convinced those police officers to come onto video and explain their feelings, their thoughts, their concerns and fears before the call, and then how the triage system helped them. And that’s now been incorporated, that training video has been incorporated in the training for all other police officers, hearing from their own colleagues saying, here’s how it helps me rather than here’s an NHS branded thing with someone in green telling you, Hey, you have to use this now, but actually selling it for what it was, what started as a project for police officers to try and make their job a little bit better, has actually ended up just being bigger than the sum of its parts.
Look, I think this is fascinating and I really congratulate you and the team on, you’re making it all sound very simple, but I’m sure the politics and the bureaucracy and the hurdles around this have been massive, but you have the potential to change how the rest of the world is now going to do this.
It has been a process, but we’ve been really lucky that there’s been incredible people involved from start to finish. And it’s fantastic to see it here and real.
Sean, thanks so much for spending some time chatting to us about the 10 second triage tool. Obviously, if you want to see the flowcharts, they’re available on the various websites that Sean’s mentioned, NARU and others, and we’ll have a copy of it on the St Emlyn’s blog as well. Sean, thank you for your time, and keep up the good work.
Yeah, thanks Sean. Wonderful.
Thank you very much.
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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.
