Pan American Health Organization · Version 2.3
PAHO guidance for establishing dedicated triage facilities to screen patients with respiratory symptoms during COVID-19 and similar outbreaks.
- Issuer
- Pan American Health Organization
- Edition
- Version 2.3
- Audience
- Emergency medical teams, health facility administrators, public health authorities
- Evidence
- Expert consensus based on WHO/PAHO infection prevention and control guidance
- Reviewed
- 20 Oct 2026 · GMJ
What this guideline says
GMJ summary
This PAHO technical document provides detailed specifications for establishing triage areas dedicated to screening patients with respiratory symptoms during COVID-19 and similar respiratory disease outbreaks. The triage area serves three critical functions: early identification of patients with severe acute respiratory disease, isolation of possible infectious sources with infection prevention and control measures, and reduction of hospital transmission risk.
The guidance covers structural requirements (estimated 300 m² space in tents, containers, or reorganised health facility areas), patient and staff flow patterns (maintaining 2-metre physical distancing throughout), environmental controls (60 litres/second air circulation per patient, natural or mechanical ventilation with HEPA filtration where possible), and staffing (minimum one nurse/physician for triage, plus support staff). The triage area should operate 24 hours daily with capacity for expansion.
Key operational recommendations include separate routes for patients with and without respiratory symptoms, mandatory hand hygiene and surgical mask use upon entry, vital sign screening with infrared thermometry and pulse oximetry, and clear protocols for hospital admission versus home isolation. Disinfection of surfaces between patients and use of 1,000 ppm chlorine solutions for floors are specified for infection control.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Maintain 2-metre physical distancing between patients throughout all triage areas, marked clearly on floors
- All patients with respiratory symptoms must perform hand hygiene and wear surgical masks (if tolerated) upon entry
- Check vital signs using infrared thermometers for temperature and pulse oximetry for oxygen saturation
- Ensure air circulation rate of 60 litres/second per patient, with natural ventilation or mechanical extraction with HEPA filters
- Disinfect patient-contact surfaces with disinfectant wipes between patients; use 1,000 ppm chlorine solutions for floor cleaning
- Establish separate entry and exit routes for patients, physically separated by at least 2 metres or by screens/structures
- Staff the triage area with minimum one nurse/physician for triage assessment, one nurse for vital signs, two nursing auxiliaries, and one administrative staff member per shift
- Maintain a secure perimeter of at least 2 metres around air exhaust outlets to prevent exposure to expelled droplets
Recommendations for triage area for patients with respiratory symptoms
Table extracted from the guideline
| Area | Recommendations |
|---|---|
| Reception and waiting room | Patients not exhibiting respiratory symptoms directed to routine triage; those with respiratory symptoms directed to designated area with hand hygiene and surgical mask. Floor markers placed 2 metres apart in waiting area. Wheelchairs available. |
| Vital sign check | Check temperature (infrared thermometer) and oxygen saturation. Sanitize equipment after each patient. Collect general information and risk factors. Patients not meeting criteria given home isolation recommendations and directed to exit. |
| Data entry | Patients meeting criteria have information recorded. Patient file kept by triage personnel at all times, no direct patient contact with file. |
| Waiting room | Chairs placed 2 metres apart. Patients wait for classification. |
| Triage | Evaluate patient condition, identify hospitalization needs. Patients meeting hospitalization criteria directed to appropriate area via internal route. Others given instructions and directed to exit route separated by at least 2 metres from entry. |
Source: Pan American Health Organization, Technical recommendations for configuration of a triage area for patients with respiratory symptoms. Reproduced in summary form.
From the guideline
Verbatim
“The triage area provides a rapid clinical assessment of patients with respiratory symptoms to detect cases that meet the criteria for hospitalization or referral to a higher-level health facility.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and WHO consultant, I find this PAHO guidance particularly relevant for Georgia's continued pandemic preparedness, especially given our experience implementing respiratory triage during COVID-19 across diverse healthcare settings from Tbilisi to rural Kakheti and mountainous Svaneti. The specification I would emphasise to Georgian clinicians is the 60 litres/second air circulation rate per patient—this is critical yet challenging in our older healthcare infrastructure, and natural ventilation using prevailing winds may be the most practical solution for many facilities. The realistic implementation caveat is that whilst the 300 m² space requirement and 24/7 operation are appropriate for regional centres like Batumi, Kutaisi, and Rustavi, our rural ambulatories and smaller rayon hospitals will need adapted, scaled-down models that maintain the core principles of physical distancing, separate patient flows, and adequate ventilation within their existing footprint and staffing constraints.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 20 Oct 2026
Applicability
Georgia and the South Caucasus
This guidance is directly applicable to Georgia and the South Caucasus region for COVID-19 response and preparedness for future respiratory disease outbreaks. Georgian health facilities implementing respiratory triage should consider that the estimated 300 m² space requirement and 24/7 operation may require adaptation for smaller rural facilities with limited infrastructure. The specification for 60 litres/second air circulation per patient may be challenging in existing Soviet-era healthcare buildings without modern ventilation systems; natural ventilation strategies using prevailing winds and cross-ventilation may be more feasible in the Georgian context. National programmes should assess current emergency department capacity, identify facilities where foldable structures (tents, containers) could be deployed, and ensure availability of infrared thermometers and pulse oximeters, which became widely available during COVID-19. The 2-metre distancing and separate flow patterns align with infection prevention standards already implemented in Georgian facilities during the pandemic and should be maintained in future outbreak preparedness plans.
Questions this guideline answers
Quick answers
What is the minimum space required for a respiratory triage area?
The estimated space requirement is approximately 300 m², which should include areas for vital sign checks, data entry, triage assessment, and a waiting room with chairs placed 2 metres apart.
What ventilation standards are needed in the triage area?
An air circulation rate of 60 litres/second per patient should be ensured where possible. This can be achieved through natural ventilation (opening windows to create cross-currents or using convection with ceiling outlets) or mechanical ventilation with electric extractors, preferably with HEPA filters.
How should surfaces be disinfected in the triage area?
All surfaces touched by patients (such as tables) should be disinfected with disinfectant wipes between patients. For large surfaces like floors, use chlorine solutions at a concentration of 1,000 ppm, following national and international recommendations.
What staffing is required per shift for respiratory triage?
Minimum staffing includes: 1 nurse and 2 nursing auxiliaries/health technicians for vital sign checks, 1 administrative staff for data entry, at least 1 nurse and/or physician for triage assessment, and 1 nursing auxiliary/health technician for the waiting room.
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Quality & accreditation
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Hospital — Standard 11 — Critical Care
- ASF Medical Transport — Standard 6 — Emergency Response During Transport
- ASF Medical Transport — Standard 5 — Infection Prevention & Control
- ASF Laboratory — Standard 7 — Examination: Process & Safety
Other guidelines on this topic
- Recommendations on Chemical Safety for Cleaning and Disinfection Supplies
- The Immunization Program in the Context of the COVID-19 Pandemic
- Recommendations for Heating, Ventilation, and Air Conditioning in Health Care Facilities
- Considerations on Social Distancing and Travel-Related Measures in the Context of the Response to COVID-19 Pandemic
- Care for health workers exposed to the new coronavirus (COVID-19) in health facilities
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- Version 2.3
- Status
- Current
- Published
- 2020-01-01
- Languages
- English, Spanish
- Scope
- Configuration and operation of triage areas for patients with respiratory symptoms during COVID-19 and similar outbreaks
- Audience
- Emergency medical teams, health facility administrators, public health authorities
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus based on WHO/PAHO infection prevention and control guidance
- Record history
- Created 20 Oct 2026 · updated 20 Oct 2026 · next check Apr 2027
Pan American Health Organization. Technical recommendations for configuration of a triage area for patients with respiratory symptoms. Draft document, Version 2.3. Washington, D.C.: PAHO; 2020. Available from: https://iris.paho.org/handle/10665.2/52135GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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