Chart — Emergency Nursing
ESI Triage Chart
Emergency Severity Index quick-reference chart — ESI levels 1 through 5 with patient severity, anticipated resource needs, example presentations, time-to-provider, and reassessment intervals.
Educational use only. This content is intended for nursing students and exam preparation. Always follow your institution's triage protocols. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
| ESI Level | Patient Severity | Resource Needs | Example Presentation | Reassessment |
|---|---|---|---|---|
| ESI 1 Immediate Now — nurse acts before provider if needed | Life-threatening — requires immediate life-saving intervention | Unlimited — resuscitative measures deployed at once | Cardiac arrest; respiratory arrest; unresponsive trauma patient; active status epilepticus; apneic anaphylaxis | Continuous |
| ESI 2 Emergent <10 minutes | High-risk situation — may deteriorate rapidly without prompt evaluation; severe pain/distress | Any number — complex workup anticipated | Chest pain + diaphoresis (STEMI); FAST+ stroke symptoms; worst headache of life (SAH); fever + petechiae (child); suicidal patient with plan; septic shock | Every 15 min |
| ESI 3 Urgent Varies by volume | Stable — not in immediate danger but needs multiple resources to evaluate and treat | ≥2 resources (e.g., labs + IV fluid + imaging) | Abdominal pain (labs + CT + IV pain meds); UTI with fever (UA + IV antibiotics); chest pain needing ECG + troponin + CXR | Every 30–60 min |
| ESI 4 Less Urgent Non-urgent queue | Stable — likely requires only one resource; not expected to deteriorate | 1 resource only (X-ray only; UA only; wound closure only) | Simple laceration (wound closure only); sprained ankle (X-ray only); ear pain + strep swab; UTI (no fever) + UA only | Every 1–2 hrs |
| ESI 5 Non-Urgent Longest wait | Stable — no resources anticipated beyond physician examination | 0 resources (exam only) | Mild URI (wants documentation); prescription refill only; minor rash without systemic symptoms; bug bite without infection signs | Every 2 hrs |
What Counts as a Resource
- ✦Laboratory tests (blood, urine, wound culture)
- ✦IV or IM medications
- ✦IV fluid bolus (rehydration)
- ✦CT, X-ray, or ultrasound (each = 1 resource)
- ✦12-lead ECG
- ✦Specialist consultation
- ✦Simple procedure (I&D, laceration repair)
Physician examination does NOT count as a resource.
Never Undertriage These Presentations
- !STEMI — chest pain + diaphoresis + radiation → ESI 1 or 2
- !Acute stroke (FAST+) — time is brain → ESI 2
- !Thunderclap headache → ESI 2 (subarachnoid hemorrhage)
- !Anaphylaxis with bronchospasm → ESI 1 or 2
- !Septic shock (hypotension + infection) → ESI 1 or 2
- !Pediatric fever + petechiae → ESI 2
- !Active seizure → ESI 1
- !Suicidal patient with plan and means → ESI 2
Retriage Rule
Any patient whose condition visibly worsens while waiting MUST be retried immediately — regardless of original ESI level. ESI 3 can deteriorate to ESI 1. The triage nurse is responsible for monitoring the waiting room at regular intervals.
Source: ESI Implementation Handbook, AHRQ/ACEP; Emergency Nurses Association (ENA)
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with ESI Implementation Handbook, AHRQ/ACEP; Emergency Nurses Association (ENA). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →