Triage in veterinary practice: the vital role and responsibility of VNs

In the high-pressure environment of veterinary emergency medicine, every second counts. Triage, the rapid assessment and prioritisation of patients, forms the basis of effective emergency care.

For veterinary nurses, triage is not just a technical task, but a crucial responsibility that directly influences patient outcomes, client confidence and the efficiency of the entire clinical team. Having worked in the emergency setting for many years while in clinical practice, I have seen first hand on so many occasions how vital an RVN’s input can be during these cases. I am enthusiastic about sharing my experience and equipping others with the skills and tools to be able to contribute to those cases that arrive unannounced or crash unexpectedly.

Triage is a vital skill for veterinary nurses, ensuring that critically ill or injured patients receive immediate care while managing workflow efficiently. Whether working in a first opinion practice, emergency hospital, charity or referral setting, veterinary nurses play a crucial role in assessing, prioritising and escalating urgent cases.

This article explores the principles of triage, common emergency presentations, preparation for critical cases, the importance of practice drills, and the value of reflection after emergency situations.

The principles of triage

Triage is the process of determining the urgency of a patient’s condition based on a rapid clinical assessment. The goal is to:

• Identify patients requiring immediate life-saving interventions.
• Prioritise serious cases over stable, non-urgent ones.
• Streamline workflow to prevent hold-ups in patient care.

Triage is an evolving process. A patient’s condition can change rapidly, so regular reassessments are crucial.

Primary assessment (initial contact and brief history)

• Gather a concise history from the owner, focusing on presenting signs, duration and any deterioration.
• Observe the patient’s demeanour, respiratory effort and obvious signs of distress.
• Apply the “ABC” approach (airway, breathing, circulation) for emergency cases.

Clinical assessment

Check vital signs:

• Respiratory rate and effort (for example, increased effort may indicate dyspnoea or trauma).
• Heart rate and pulse quality (for example, tachycardia or weak pulses may indicate shock).
• Mucous membrane colour and capillary refill time (pale or cyanotic membranes require immediate attention).
• Temperature (hypothermia or hyperthermia can indicate shock or heatstroke).

Triage categorisation

Categorisation is something that can be useful in particularly high caseload settings.

Based on the assessment, you could classify patients into the following categories:

• Immediate (red): life-threatening conditions requiring urgent stabilisation (for example, severe trauma, respiratory distress, active seizures, cardiac arrest).
• Urgent (orange): serious conditions needing prompt intervention but not immediately life threatening (for example, blocked cat, pyometra, moderate dehydration).
• Stable (yellow): non-critical cases that require veterinary attention but can wait safely (for example, mild vomiting, minor wounds, routine monitoring).
• Non-urgent (green): cases suitable for routine appointments or home care (for example, minor skin irritations).

Common emergency presentations and nursing priorities

• Respiratory distress: ensure airway patency, provide oxygen supplementation and minimise stress.
• Shock: establish IV access, provide fluid therapy as directed and monitor for changes in perfusion parameters.
• Seizures: maintain patient safety, administer medications as prescribed and monitor for post-ictal recovery.
• Blocked cats: recognise signs of urinary obstruction, manage pain and prepare for emergency catheterisation.
• Toxicities: gather information on potential toxins, initiate decontamination if appropriate and monitor vitals.
• Road traffic accidents (RTAs): assess for visible injuries, internal trauma, and shock. Provide analgesia, stabilise and prepare for imaging or surgery as needed.
• Severe bleeding: apply pressure to wounds, assess for internal haemorrhage, monitor perfusion parameters and prepare for potential transfusions.
• Bloat (gastric dilatation and volvulus; GDV): recognise signs such as distended abdomen, unproductive retching, and restlessness. Immediate stabilisation, pain relief and surgical intervention are critical.
• Cardiac arrest (CPR required): immediate recognition and response following the RECOVER CPR guidelines are crucial to survival.

Please ensure that any procedures or actions are fully discussed with the veterinary surgeon and owner, and anything conducted is under direction and consent.

Preparation: setting up for emergency cases

A well-prepared emergency team is essential for effective triage. Veterinary nurses play a key role in ensuring that critical equipment and supplies are ready before an emergency arises.

Check oxygen supply at the start of every shift. Ensure oxygen tanks are full and functional, and that flow meters and delivery systems (such as masks, nasal prongs and circuits) are in place and in working order.

Prepare an emergency tray or crash box. This should contain essential supplies such as:

• A range of IV catheters (various sizes).
• Syringes and needles.
• Tape and bandaging materials.
• Emergency drugs (labelled and easily accessible; be mindful of drug regulations and policies for storage).
• Endotracheal tubes and laryngoscope.
• Blood collection tubes and IV fluids (ensure that any colloids or additional fluids are heavily labelled or covered in red vet wrap to ensure they are not selected as crystalloids).
• Adrenaline, atropine and other resuscitation medications.

Keep resuscitation and monitoring equipment accessible. ECG, pulse oximeter and Doppler should be tested and within reach.

Assign roles within the team. Knowing who is responsible for patient monitoring, drug administration and documentation improves efficiency in an emergency.

Practice drills: training for emergency scenarios

Regular emergency drills are essential for maintaining a well-prepared and confident veterinary team.

These allow team members to refine their skills, improve communication and reduce response times in real-life emergencies.

We used to do these often in practice and it supported the whole team for those situations. Tagging CPR drills on to the end of a staff meeting is a good idea when a good number of the team are present.

CPR drills

Follow the RECOVER CPR guidelines:

• Recognise arrest: confirm lack of heartbeat and breathing.
• Initiate chest compressions: 100 to 120 compressions per minute for medium/large dogs; 120 to 150 for small dogs and cats.
• Airway and breathing: intubate and ventilate at 10 breaths per minute.
• Drugs and defibrillation: administer adrenaline or atropine as needed.

Assign team roles (compressions, airway management, drug administration, documentation).

Use a CPR mannequin if available for direct practice, and time the drill to improve response speed.

Shock and trauma drills

Simulate a patient in hypovolaemic shock (for example, severe bleeding or RTA). Practise rapid IV catheter placement and fluid resuscitation. Review blood transfusion procedures.

GDV drill

Recognise the signs of GDV and practise rapid assessment. Prepare for immediate decompression. Have discussions around what this entails and what equipment is required. Organise surgical preparation for gastropexy.

Toxicity drill

Role-play a poisoning case (for example, chocolate, rodenticide, lilies in cats). Review appropriate decontamination steps (emesis, activated charcoal or IV fluids). Simulate calculating antidote doses and monitoring parameters.

You could make an emergency drugs/dosage chart to hang on the emergency trolley, although you need to ensure this is kept relevant and up to date.

The importance of reflection and case discussion

Emergency situations can be intense and fast paced, making post-case reflection and discussion a crucial part of learning and improving future responses.

• Case debriefs: holding structured debriefs after emergencies or challenging cases allows the team to review what went well, what could be improved and any challenges faced.
• Open communication: encouraging all team members to share their perspectives helps build confidence and strengthen teamwork.
• Learning from experience: discussing challenging cases provides an opportunity to refine triage decision-making and response times.
• Mental well-being: emergency cases can be stressful, and taking time to reflect as a team helps support emotional resilience.

The veterinary nurse at the frontline

In many practices, the veterinary nurse is the first clinical professional to encounter an emergency patient; whether on the phone, at reception or in the consulting room. This places nurses in a pivotal position. Their ability to gather information, remain calm under pressure and make swift, informed decisions can make a significant difference in cases.

Tips and examples

Being prepared saves time

In triage, preparation is everything. Many nurses keep triage trays stocked with essentials (IV catheters, fluids, analgesics, tape, and syringes), so that the team can act immediately when a critical patient arrives; for example, when a collapsed Labrador retriever with suspected GDV presented at one practice, having the tray ready meant IV access and fluid resuscitation could begin within minutes of arrival, buying valuable time for surgical intervention. This tray is small, movable and separate from the emergency trolley.

Think about the patient’s potential route to the prep/treatment room – do you need a stretcher? Is the oxygen nearby and easily accessible?

Subtle emergencies

Not all triage cases are dramatic. A cat presented as “quiet and off food”, but was found at triage to be open-mouth breathing with pale mucous membranes. The nurse’s rapid recognition of dyspnoea and immediate transfer to oxygen stabilised the patient long enough for diagnostics to confirm congestive heart failure. This illustrates how triage can turn a “routine” presentation into an emergency response.

Clear communication under pressure

Owners arriving with emergencies are often distressed. In one case, a spaniel presented after an RTA. While the veterinary surgeon prepared for radiographs, the nurse calmly reassured the owner, explained what was happening and obtained a concise but vital history.

This balance of patient care and client support is effective triage nursing.

Teamwork and handover

Documentation and communication are as vital as hands-on care.

In one practice, a triaged patient with haemorrhage secondary to rat bait toxicity was stabilised with fluids and pressure dressings by the nursing team before handover to the vet (under the vets’ direction). A clear, structured triage note ensured no detail was missed during the initial stages of treatment.

The emotional component of triage

Triage is not only about clinical skill; it requires resilience, empathy and the ability to balance patient care with client support. Nurses are often the reassuring presence for anxious owners while managing their own stress in high-stakes situations.

Reflecting on cases, both positive and challenging, helps nurses process experiences and continuously improve. Something that can be done as part of your case handling is reflection on these cases each time; it helps to talk about all the things that went well and anything that could be improved upon.

Developing confidence in triage

To excel in triage, veterinary nurses benefit from:

• Ongoing CPD: simulation training, emergency CPD courses, and case-based discussions.
• Team protocols: clear triage guidelines shared across the practice to support consistent decision making.
• Mentorship: learning from experienced colleagues and debriefing after challenging cases.

Triage tips

• Being prepared, as we have already discussed.
• Prioritise using the ABC approach:
  • Airway: check for obstruction or respiratory distress.
  • Breathing: assess respiratory rate, effort and oxygen saturation if available.
  • Circulation: look for pulse quality, heart rate, mucous membrane colour and signs of shock.
• Assess rapidly but thoroughly.
  • Gather key history quickly: presenting problem, duration, previous conditions, medications and vaccination status.
  • Observe the patient’s behaviour and posture while talking to the owner: sometimes, subtle signs indicate severity.
  •  Be cautious of handling if patient seems compromised: for example, cats with dyspnoea. You could monitor some vitals “hands off”.
• Communicate clearly and calmly.
  • Keep owners informed and reassured without giving false promises.
  • Provide concise instructions; for example, how to safely transport a seizing patient.
  • Collect critical information calmly, even in high-stress situations.
• Document everything.
  • Record vital signs, triage category, initial interventions and observations clearly.
  • Structured notes help the vet make quick decisions and ensure continuity of care.
  • Making triage sheets can be useful, but do not let filling them in take over the rapid triage of the patient. Telephone triage sheets can be useful to help prompt relevant questions when taking calls prior to patients’ arrival at the practice.
• Prepare for immediate interventions.
  • Know which patients may need urgent IV access, oxygen, analgesia or fluids. Have everything out and ready to set up if required. It is always better to have kit out and ready and then tidy it away, than not being prepared and scrambling for catheters during treatment or arrival.
  • Set up monitoring equipment in advance for unstable patients.
  • Set up the multiparameter.
  • Have suction, warming devices and any other vital equipment available.
• Recognise subtle signs of deterioration.
  • Pale or cyanotic mucous membranes, altered mentation, tachycardia or shallow breathing can indicate serious illness, even if the patient “looks stable”.
• Work as a team.
  • Triage is collaborative: communicate your findings to the vet and other team members efficiently.
  • Anticipate what the vet will need, and have equipment ready.
• Reflect and debrief.
  • Discuss challenging cases with colleagues to improve future triage decisions.
  • Identify everything that went well and anything that could be improved.
• Maintain emotional resilience.
  • High-stress situations are part of emergency care. Acknowledge your own stress and use coping strategies.
  • Supportive teamwork and regular CPD reduce burnout and improve confidence in triage.

Conclusion

Triage is one of the most important skills in veterinary emergency medicine, and veterinary nurses are at its core.

By combining clinical knowledge, rapid decision-making and compassionate communication, nurses not only save lives, but also strengthen the trust and cohesion of the veterinary team.

Real-life preparation and experience, such as having triage trays ready, recognising the subtle emergency and supporting both patient and owner, make the difference between chaos and calm, and life and death.

Working as an emergency and critical care nurse, triage is more than a task; it is a responsibility that can feel both exhilarating and intense.

When a patient arrives in crisis, you shift into “assessment mode”, scanning for life-threatening signs, gathering essential history and preparing equipment, all within moments.

The pace is fast, the decisions are high stakes and yet every second you spend is meaningful.

Conducting triage can feel like walking a tightrope: acting quickly while staying thorough, calm while under pressure and compassionate while focused on clinical details. There is a unique satisfaction in recognising a subtle emergency that others might miss and knowing your intervention could directly save a life.

At the same time, triage carries emotional weight. You witness fear and urgency from owners, and sometimes outcomes are not what you hope.

Being the calm, organised presence that guides both patient and owner through the crisis is part of the role, but it can be draining.

Over time, triage becomes instinctive. You develop an intuitive “clinical radar”, quickly spotting abnormalities, anticipating needs and preparing for the worst-case scenario. Every shift builds confidence, resilience and a deep appreciation for the impact of veterinary nursing in emergency medicine.

In short, triage as a nurse is demanding, fast-paced and emotionally charged, but it is also one of the most rewarding aspects of the profession. There is a unique pride in knowing that your knowledge, preparation and quick thinking directly contribute to saving lives.

If your practice is not utilising nurses in a formal triage role, consider how your skills could be better integrated to support patient outcomes and workflow efficiency.

Start the conversation with your practice management team, share your insights, highlight the benefits of structured triage protocols and advocate for training or procedural changes.

With the right support, nurses can play a pivotal role in improving emergency care and ensuring that every patient receives timely, prioritised attention.

• This article appeared in Vet Times (30 June 2026), Volume 56, Issue 26, Pages 10-12.

Sarah Benzie has been in the veterinary profession since 2002. Qualifying in 2007, she built her career across a wide range of settings – from small animal practice and charity work to seven years in a high-pressure emergency and critical care environment as a senior nurse in Edinburgh and Berkshire, where she led trauma cases and supported colleagues through complex clinical situations. She then transitioned into a dual clinical/operational role for a further seven years, supporting veterinary teams across the UK and Ireland while earning her Emergency and Critical Care certificate. In 2023, Sarah joined Vets4Pets as a business development partner, and her continued drive to support and develop people led her to the role of veterinary development manager in April 2025. She is passionate about mentoring, nurse utilisation, surgical nursing, wound management, and fostering a positive and inclusive practice culture.