Field P2 Sort arrival who deteriorates at the door — re-triage, secondary workup, and hospital flow under load

Expected management

• Re-triage on arrival, never honour the field label: door accuracy is 61% with 18% of life-threats missed and re-triage used in only 4% — her new hypotension and tachycardia make her P1 until proven otherwise.^[26]
• Run the secondary numbers: her Sort inputs (GCS 14, systolic 96, RR 26) sit in Sort territory, but the Sort finds 15.7% of LSI need with 84.3% undertriage — while her shock index is 1.33, far above the 0.75 cut that reached 70.0% sensitivity against the Sort at 58.6%.^[3][16]
• Upgrade and sequence: no triage algorithm is provably superior in all aspects, so clinical deterioration plus shock index upgrades her to the free theatre — first patients bleed from trunk and cavities, and the index operation stops bleeding and controls contamination only.^[10][12]
• Hold the door: convert receiving into a triage zone with streamed stations and 8-hourly rotations — the Mumbai model that triaged 163 and delivered 194 operations in 127 admitted.^[14]
• Name the evidence gap honestly: hospital triage rests on six MEDLINE studies with real-world application insufficiently studied — so the exercised local plan is the intervention, with in-house exercises and regular plan testing behind it.^[27][10]

Examiner traps

• Accepting the field P2 against new hypotension — the 84.3% Sort undertriage exists for exactly this patient.^[3]
• Ordering definitive surgery first while six inbound wait — TASC serves the situation, not the patient.^[12]
• Skipping re-triage of the walking wounded behind her — 61% door accuracy means the next arrival is mislabelled too.^[26]