How to Use the ESI Triage Tool

This ESI Triage Tool follows the official Emergency Severity Index (ESI v4) algorithm used in U.S. emergency departments. It helps determine the patient’s urgency level by following the same four-step decision process used by experienced triage nurses.

Step 1 — Life-Saving Intervention

Choose “Yes” if the patient requires an immediate, critical intervention such as airway support, emergent cardioversion, intubation, severe respiratory distress treatment, or active resuscitation.
If “Yes,” the patient is ESI Level 1.

Step 2 — High Risk, Confusion, Severe Pain or Distress

Choose “Yes” if the patient is clinically high-risk (e.g., septic appearance, abnormal mental status, chest pain with concerning features), confused, disoriented, or in severe pain or distress.
If “Yes,” the patient is ESI Level 2.

Step 3 — Number of Resources Needed

Count the number of resources the patient will require, such as labs, imaging, IV meds, fluids, EKG, or procedures.
0 resources → ESI Level 5
1 resource → ESI Level 4
2 or more resources → ESI Level 3

Resources include: labs, X-rays, CT scans, ultrasounds, IV fluids or meds, IM/PO medications, wound care, splinting, and more.

Step 4 — Vital Sign Danger-Zone Check (ESI Level 3 Only)

If the patient is determined to be ESI Level 3 based on resources, assess their vital signs. Certain abnormal values may indicate the patient is less stable than they appear.

Danger-zone vital signs:
Heart rate > 100 or < 50
Respiratory rate > 20 or < 12
Systolic BP < 90
Temperature > 101°F
SpO₂ < 92%

If any of these values are present and the patient is an ESI 3, consider upgrading them to ESI Level 2.
If the patient is ESI 4 or 5, vital signs do not change the ESI level.

Understanding Your ESI Result

After completing all steps, the tool will display the patient’s ESI level:
ESI 1: Immediate resuscitation needed
ESI 2: High-risk, severe pain, or abnormal presentation
ESI 3: Stable but requires multiple resources
ESI 4: Stable and needs one resource
ESI 5: Stable and needs no resources

Graph Interpretation

For patients with ESI Levels 3–5, a color-coded graph will appear showing their entered vital signs:
Red bars represent abnormal values
Purple/Blue bars represent normal values

The graph provides a quick visual snapshot of patient stability.

Resetting the Tool

Click “Reset Tool” at the bottom of the results screen to clear all answers and begin a new triage assessment.

This tool is for educational and training purposes and does not replace clinical judgment, facility policy, or national triage guidelines.