Colombia Builds First National Prehospital Triage Framework With 91 Syndromic Conditions

Colombia has no nationally standardized prehospital triage system, despite legal frameworks governing its emergency medical services. A team led by the Colombian Association of Trauma, Prehospital Care, and Emergency Medical Systems (ACTAEM) and the Meditech Foundation research group has now proposed a structured framework designed to fill that gap. The proposal, published in the Journal of Emergency and Disaster Medicine, describes a four-level, colour-coded classification covering 91 syndromic conditions, three distinct operational triage modalities, and a vehicle-assignment protocol that adapts to Colombia’s sharply uneven geography. The authors are explicit that this is a development and design study, not a clinical validation: no patient-level data were collected, and the framework is intended as a structured basis for future evaluation rather than a proven instrument.

The epidemiological case for the work is stark. Between 2007 and 2017, 214,258 deaths in Colombia were attributable to trauma, with a mean annual mortality rate of 40.9 per 100,000 inhabitants. In 2022 alone, the Instituto Nacional de Medicina Legal y Ciencias Forenses registered 8,470 road traffic deaths. Gunshot wounds are the leading cause of trauma mortality in men, while road traffic injuries rank first in women. A local trauma registry study found that the median prehospital time was three hours, and 51.2 percent of trauma patients arrived at the emergency department by their own means, without any formal prehospital care. The authors argue that this figure reveals both the inadequacy of organized prehospital response and the absence of standardized triage criteria to guide timely dispatch.

Colombia has built a regulatory architecture for emergency medicine over two decades. The Single Emergency Number (NUSE), Urgent Emergency and Disaster Regulation Centers (CRUE), and Medical Emergency Systems (SEM) have been legally established, and Resolution 3100 of 2019 created prehospital care as an essential service category with defined standards. Yet no national regulation has established a standardized prehospital triage protocol, even though in-hospital triage has been regulated since 2010. The practical consequences are concrete: dispatch decisions by NUSE and CRUE operators vary with institutional training, vehicle-assignment criteria differ across departments, and severity information generated in the prehospital phase is not systematically communicated to receiving hospitals. The 60th World Health Assembly, through Resolution WHA60.22 in 2007, urged member states to strengthen prehospital and emergency trauma-care systems.

The framework was developed through a three-phase process. First, the team reviewed all current Colombian regulatory instruments relevant to prehospital care, including Resolutions 3100 (2019), 1441 (2016), 926 (2017), 1220 (2010), and 6408 (2016), alongside the conceptual framework of Resolution 5596 of 2015 for in-hospital triage. International references included the PAHO triage manual, the Emergency Severity Index, and evidence-based emergency-medicine references for each syndromic criterion. Second, a structured expert consensus process using the Nominal Group Technique was conducted over ten virtual sessions with the ACTAEM technical committee, comprising 14 members including prehospital-medicine specialists, emergency physicians, trauma surgeons, and regulatory experts. Each priority category and modality was deliberated and voted on separately, with disagreements resolved through successive rounds until at least 90 percent of the panel agreed. Conditions failing that threshold were excluded. Third, the team adapted the design to Colombia’s response infrastructure, defining three geographic scenarios: urban areas with comprehensive ground EMS, rural zones without air infrastructure, and rural zones with air access.

The resulting classification assigns patients to one of four priority levels designated by colour and defined by clinical urgency. The 91 syndromic and diagnostic conditions are distributed as Critical (27), High (24), Medium (20), and Low (20), each accompanied by objective signs and symptoms and a defined response-time standard. A single escalation rule governs the entire system: any patient who develops airway compromise, systolic blood pressure below 90 mmHg, a fall of at least two Glasgow Coma Scale points, or peripheral oxygen saturation below 90 percent is reclassified to the next-higher acuity level, or directly to Critical when these thresholds are met, regardless of the initial category. Selected boundary decisions reflect clinical reasoning: hemodynamically stable acute coronary syndrome sits at High, escalating to Critical for cardiogenic shock or malignant arrhythmia, while acute stroke is placed at Critical when the deficit is active with onset under 24 hours or unknown, to capture thrombolysis and thrombectomy candidates.

Where directly applicable guidelines exist, each priority assignment was anchored to current international references. Acute coronary syndrome links to the 2025 ACC/AHA guideline, sepsis to the Surviving Sepsis Campaign, traumatic brain injury to BOOTStraP, acute aortic syndrome to the 2022 ACC/AHA aortic-disease guideline, and cardiorespiratory arrest to American Heart Association resuscitation guidelines. Ophidian envenomation draws on WHO snakebite-management guidelines and the Colombian national ophidian-accident protocol, reflecting the country’s epidemiological profile. The four levels are also mapped to the Manchester Triage System, the Emergency Severity Index, and mass-casualty categories to situate the framework within existing practice. The authors caution that this anchoring represents expert mapping that has not been empirically tested.

The framework defines three operational modalities. ICT-mediated dispatch triage makes the first triage decision remotely, via telephone or digital systems, before any healthcare worker reaches the scene. On-scene one-to-one triage applies when a single patient can be fully managed with available resources. Multiple-casualty-incident (MCI) triage activates when an event involving two or more casualties exceeds the immediately available response capacity of trained personnel and sufficient supplies, medications, and medical devices. The two-or-more-patient check in the operational algorithms functions as a screening prompt to assess whether capacity is exceeded, not as an automatic MCI declaration. For MCI response, the framework adopts a two-tier approach: initial physiological sorting using validated parameters of walking, severe bleeding, talking, and breathing, adapted from the NHS England Ten Second Triage Tool, which assigns priority categories in under 30 seconds per patient, followed by secondary syndromic refinement using the full ACTAEM criteria once resource capacity is re-established.

A novel element is the geographically adaptive vehicle-assignment protocol, built on Colombia’s regulatory vehicle taxonomy: rapid-response vehicles (VRR) with advanced life support, medium-complexity transport (TAM) that is critical-care capable and may be ground or aerial, rotary-wing and fixed-wing air medical transport, and low-complexity basic-life-support transport (TAB). In high-acuity Red and Orange scenarios, the first-priority vehicle and the definitive transport vehicle should be dispatched simultaneously whenever resources allow. For Medium priority in rural settings, ground vehicles are the preferred first-line option; aerial resources are reserved for Medium cases exclusively when estimated overland transport time to an appropriate facility exceeds 45 minutes. The authors note that this prioritization reflects hierarchical ordering based on clinical and logistical suitability, not mandatory sequential dispatch, and that preserving aerial resources for Critical and High priorities matters where time-to-definitive-care is directly outcome-determinant.

The geographic logic is grounded in documented resource distribution. Using data from the Registro Especial de Prestadores de Servicios de Salud of Colombia’s Ministry of Health, the article reports 6,008 basic ambulances, 1,614 medicalized ambulances, and 278 rapid-response vehicles of installed capacity nationwide. Ambulance capacity concentrates in the Occidental, Central, Noroccidental, and Bogotá functional health regions, while the Sur (Amazonía) and Insular regions have the fewest units. Fluvial and maritime ambulances cluster in the Caribe, Noroccidental, and Sur regions, and aerial units concentrate in the Oriental, Bogotá, and Occidental regions. The operational geographic definitions draw on Resolution 1789 of 2025, distinguishing urban areas with high population density and ground vehicles available within 15 minutes from rural zones with population density below 50 inhabitants per square kilometer, differentiated by the presence of a certified airport, airstrip, or helipad within 60 minutes of ground travel. In river-basin territories, fluvial or maritime transport is designated the primary response modality.

The authors position the proposal against the international evidence base. A systematic review found no studies meeting rigorous inclusion criteria for direct comparative evaluation of prehospital triage systems on patient outcomes, and a scoping review of 55 primary studies confirmed that prehospital triage tools remain overwhelmingly concentrated in high-income countries, with virtually no published validated tools from Latin America. The most widely used ICT-mediated system, the Medical Priority Dispatch System, operates through 33 chief-complaint-based protocol cards but, the authors argue, was designed for English-speaking, high-income, single-tiered EMS systems whose determinant codes do not map onto Colombia’s vehicle taxonomy and which do not natively capture ophidian envenomation, blast and penetrating trauma from armed conflict, or the combined urban-rural geographic spectrum. The framework is designed to be interoperable with Resolution 3100 of 2019 and Resolution 5596 of 2015, and to feed into the BOOTStraP TBI-management pathway. The limitations are stated plainly: the consensus panel comprised exclusively ACTAEM and Meditech Foundation members without independent external reviewers, the framework includes no pediatric-specific criteria, and no claim is made regarding diagnostic accuracy, safety, or reliability in operational use. A staged validation programme is planned, beginning with retrospective concordance testing against dispatch and trauma-registry records, followed by inter-rater reliability assessment among dispatchers, a prospective multi-site pilot, and a formal cross-walk to the in-hospital triage system.

Subject of Research: Development of a consensus-based national prehospital triage classification framework for Colombia

Article Title: Development and structure of a multiscenario prehospital triage classification system: a Colombian framework proposal

Article References: Rubiano, A. M., Carranza, J. P., Peña-González, M. R., Olaya, S. L., Acosta, S. R., Lozano-Alvarez, S. L., Yepes, S. M., Osorio, K. J. A., Loaiza-Cardona, L. M., Tobar, W. G., Sifuentes, D. B., Gracia, C. O. R., Torres, D. F. R., & Torres, A. B. (2026). Development and structure of a multiscenario prehospital triage classification system: a Colombian framework proposal. Journal of Emergency and Disaster Medicine, 2(1), Article 22. https://doi.org/10.1007/s44467-026-00025-w

Image Credits: AI Generated

DOI: 10.1007/s44467-026-00025-w

Keywords: prehospital triage, emergency medical services, Colombia, trauma, dispatch systems, mass-casualty incidents, vehicle assignment, expert consensus, geographic adaptation, emergency medicine, triage classification, health policy