Emergency Triage Assessment and Treatment (ETAT): Manual for Participants

What this guideline says

GMJ summary

The Emergency Triage Assessment and Treatment (ETAT) manual provides a systematic approach to rapidly identifying and treating children with life-threatening conditions in hospital settings. The course teaches health workers to triage all sick children within 15–20 seconds using the ABCD framework: Airway, Breathing, Circulation, Coma/Convulsion, and Dehydration. Children are sorted into emergency (requiring immediate treatment), priority (requiring prompt assessment), or non-urgent categories.

The manual emphasizes that many hospital deaths occur within 24 hours of admission and could be prevented through early recognition and immediate treatment of emergency signs. Treatment protocols include specific, weight-based doses for oxygen delivery, fluid resuscitation, glucose administration, and anticonvulsant therapy. The approach requires both clinical skills training and system-level changes including reorganization of patient flow, placement of triage before administrative procedures, and availability of essential emergency equipment and medications.

ETAT was developed in Malawi and field-tested in Angola, Brazil, Cambodia, Indonesia, Kenya and Niger. Implementation requires institutional commitment to advocacy, staff training across all cadres (including non-clinical staff who have early patient contact), ensuring material resources, and ongoing quality improvement. The course includes seven modules covering triage principles, airway/breathing management, circulation assessment, coma/convulsion treatment, dehydration management, case scenarios, and implementation planning.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. Triage all children on arrival using ABCD: check for obstructed breathing, central cyanosis, severe respiratory distress; cold hands with capillary refill >3 seconds and weak fast pulse (shock); coma (AVPU scale: responds only to Pain or Unresponsive) or active convulsion; severe dehydration (lethargic + sunken eyes + skin pinch >2 seconds in child with diarrhoea)
2. Give oxygen at 0.5–1 litre/min in infants <12 months, 1–2 litres/min in older children via nasal prongs or catheter for any airway/breathing problem, shock, coma, or convulsion
3. Treat shock in well-nourished children with 20 ml/kg Ringer's lactate or normal saline IV as rapidly as possible; reassess and repeat up to 3 times; if no improvement give blood 20 ml/kg over 30 minutes
4. Treat shock in severely malnourished children differently: give 15 ml/kg half-strength saline with 5% glucose over 1 hour IV, or preferably ReSoMal 5 ml/kg every 30 minutes orally/NG for 2 hours then 5–10 ml/kg/hour; monitor pulse and respiratory rate every 5–10 minutes and stop IV if pulse increases by 15 or respirations by 5/min
5. For convulsions give diazepam 0.5 mg/kg (0.1 ml/kg of 10 mg/2 ml solution) rectally; if continues after 10 minutes repeat; check blood glucose and give 5 ml/kg of 10% glucose IV if <2.5 mmol/L (45 mg/dL) or <3 mmol/L (55 mg/dL) in malnourished children
6. For severe dehydration without shock in well-nourished children: give 100 ml/kg Ringer's lactate IV: 30 ml/kg in first hour (infants) or 30 minutes (children >1 year), then 70 ml/kg over next 5 hours (infants) or 2.5 hours (children); add ORS 5 ml/kg/hour orally when able to drink
7. Position unconscious child in recovery position (on side, neck slightly extended, cheek on hand, one leg bent) unless trauma suspected; if neck trauma possible, stabilize neck and use jaw thrust without head tilt
8. Severe malnutrition defined as visible severe wasting (marasmus: skin and bone appearance, ribs visible) or oedema of both feet (kwashiorkor); hypoglycaemia threshold is higher (3 mmol/L vs 2.5 mmol/L) and fluid management completely different in these children

IV fluid volumes for shock treatment in well-nourished children (20 ml/kg rapid bolus)

Table extracted from the guideline

Source: World Health Organization, Emergency Triage Assessment and Treatment (ETAT): Manual for Participants. Reproduced in summary form.

From the guideline

Verbatim

“Deaths in hospital often occur within 24 hours of admission. Many of these deaths could be prevented if very sick children are identified soon after their arrival in the health facility, and treatment is started immediately.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

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