I never intended to derive a triage tool with such a global impact. I just wanted to stop finding folks dead before they were seen. Emergency Medicine was only recognised as a specialty the year before, in 2003. Not many folks know that the GF Jooste Triage Scale was the precursor to the current South African Triage Scale (GF Jooste was the hospital I worked at when I came up with the idea). I was invited to participate in deriving a triage tool for local use back in 2004, whilst I headed the emergency centre at GF Jooste, one of the busiest hospitals in South Africa. The rest is history; the Cape Triage Group was formed and the GF Jooste Triage Scale was chosen as the basis for the Cape Triage Scale which later became the South African Triage Scale. The masters thesis I wrote on the tool was awarded a distinction and I also first-authored the initial internal validation papers. It sort of got a life of its own after that. The tool has been thoroughly researched since with most of the work done by my good friend, Michele Twomey.
The South African Triage Scale is currently in use all over Africa with academic publications from South Africa, Ghana, Botswana, Malawi, Tanzania, Somalia, Sierra Leone and Uganda. It was also rolled out at an MSF site in Pakistan and has since been adopted as the preferred triage scale for their operational use. All credit goes to another good friend, Mohammed Dalwai who saw the tool's potential in Pakistan.
The SATS was rolled out in Fiji in 2016, adapted to a three-tier scale for use in the Solomon Islands in 2017, and in Europe an adapted version of SATS is being championed in Norway and Sweden. The tool has been translated in French, Arabic, Pashtu, Dari, Afrikaans, Serbian, Norwegian and Swedish. It is also available as a smartphone app from the Open Medicine Project. The Open Medicine Project is also willing to share the code for the app for free. And perhaps best of all, the World Health Organization's forthcoming triage tool, currently being externally validated at various sites, are largely based on the SATS as well.
The South African Triage Scale is currently in use all over Africa with academic publications from South Africa, Ghana, Botswana, Malawi, Tanzania, Somalia, Sierra Leone and Uganda. It was also rolled out at an MSF site in Pakistan and has since been adopted as the preferred triage scale for their operational use. All credit goes to another good friend, Mohammed Dalwai who saw the tool's potential in Pakistan.
The SATS was rolled out in Fiji in 2016, adapted to a three-tier scale for use in the Solomon Islands in 2017, and in Europe an adapted version of SATS is being championed in Norway and Sweden. The tool has been translated in French, Arabic, Pashtu, Dari, Afrikaans, Serbian, Norwegian and Swedish. It is also available as a smartphone app from the Open Medicine Project. The Open Medicine Project is also willing to share the code for the app for free. And perhaps best of all, the World Health Organization's forthcoming triage tool, currently being externally validated at various sites, are largely based on the SATS as well.
side by side
The GF Jooste Triage Scale, the first version and the current version of the South African Triage Scale for adults (Michele Twomey derived and validated the paediatric version which was also validated by Mohammed Dalwai). Initially the early warning score was placed first followed by the list of discriminators. The reason for including the latter was because it was felt that these symptoms might not affect the early warning score sufficiently to trigger the correct priority. My initial research showed that a fourth category (orange) was needed, more discriminators needed including, as well as early warning score compensation for trauma (a trauma score was added to the early warning score). Work by Sean Gottschalk led to the inclusion of the mobility factor. It was subsequently found that the tool could be made more efficient as well as safer by starting with the discriminators and adding additional investigations. All credit goes to Michele Twomey for leading this work.
The SATS concept = discriminator list + physiology
The SATS concept = discriminator list + physiology