By Dr. Shari Andrews
You’ve been sitting in the emergency room waiting room for 40 minutes.
You checked in. You answered the questions. They took your vital signs. You sat down.
And waited.
Then somebody walks through the door after you and somehow gets taken back before you.
Excuse me?!
“BUT I WAS HERE FIRST!”
Listen. I get it.
From the waiting room, it can look unfair, disorganized, or like somebody simply forgot about you.
But the emergency department doesn’t operate like the deli counter. Your place in line isn’t determined only by what time you walked through the door.
It’s determined largely by something called acuity.
And nobody really explains this shit.
First, what is triage?
When you arrive at an emergency department, one of the first clinical assessments you’ll typically receive is triage.
A triage nurse gathers information such as your symptoms, vital signs, medical history, and what brought you to the ER.
That information helps the team determine your acuity. Essentially, how urgently you may need medical attention.
And here’s the part that causes so much confusion:
The person who arrived after you may need medical attention before you do.
Imagine you’re waiting with abdominal pain.
Someone else walks in experiencing signs concerning for a stroke.
Another patient arrives by ambulance in severe respiratory distress.
Someone else has a major traumatic injury.
Those patients may need immediate resources even though you arrived first.
That’s not because your problem doesn’t matter.
It’s because certain medical conditions are time-sensitive, and delaying treatment could significantly change the outcome.
So the ER isn’t first come, first served?
Not necessarily.
Emergency departments have limited resources at any given moment: treatment spaces, monitored beds, nurses, physicians, advanced practice providers, respiratory therapists, CT scanners, and more.
When multiple people need those resources simultaneously, the clinical team has to continuously decide:
Who needs what and how urgently do they need it?
That’s why two patients arriving ten minutes apart may have very different experiences.
And there’s another piece patients often don’t see.
A lot may be happening before you ever get an ER room
Modern emergency departments use different systems to try to move care forward even when all of the traditional treatment rooms are occupied.
Depending on the hospital, you might see a physician or advanced practice provider (like a PA or NP) before you ever get a room.
Your blood work may be drawn.
An X-ray or CT scan may be ordered.
You may receive medication.
Some hospitals use rapid-evaluation areas, provider-in-triage models, or virtual providers to help start appropriate evaluations earlier.
So sometimes you’re technically still “waiting” while parts of your medical evaluation are already moving forward.
Is that ideal?
Not always.
Would we rather have unlimited beds, staff, and resources immediately available for every patient?
Absolutely.
But that’s not the reality of emergency medicine.
And I need to say something important: triage isn’t perfect.
Explaining how triage is supposed to work doesn’t mean pretending the system always gets it right.
It doesn’t.
Patients’ conditions can evolve. Symptoms can initially appear less serious than they actually are. Important information may not be apparent during the first assessment. Emergency departments can become overcrowded, understaffed, and overwhelmed.
There have been real situations in which patients deteriorated while waiting for emergency care.
So I never want “that’s just triage” to become a dismissive answer to legitimate concerns about ER wait times.
Waiting does not automatically mean you’re fine.
And waiting certainly doesn’t mean your symptoms don’t matter.
If something changes while you’re waiting, SAY SOMETHING.
This may be the most important thing you take away from this article.
Triage isn’t necessarily a one-time event.
Your condition at 8:07 PM may not be your condition at 8:47 PM.
If you’re sitting in the waiting room and something changes such as your pain becomes significantly worse, you develop new weakness or numbness, you become short of breath, you feel faint, you develop new confusion, you begin bleeding heavily, or you experience another concerning change then
tell the triage team.
Don’t sit there thinking:
“Well, they already checked me.”
New information matters.
Your condition can change.
And when your condition changes, your acuity can change too.
“So if I’m waiting, does that mean somebody else is sicker than me?”
Sometimes.
But I don’t love reducing triage to that sentence.
Because it can sound like we’re telling patients:
“You’re not sick enough, so sit down.”
That’s not the message.
The more accurate explanation is that emergency departments are continuously prioritizing patients based on the information available, the urgency of their medical needs, and the resources required to safely care for them.
Those decisions happen in real time.
And sometimes they’re complicated.
The Teeny Dose
So yes…you may have been there first.
But in the ER, we don’t treat the clock first.
We treat based on how urgently you need care.
That’s triage.
But triage isn’t perfect.
The ER isn’t perfect.
We’re making decisions in real time, with limited information, while patients’ conditions can change.
So if you’re waiting and something changes, tell us.
The goal isn’t to make you wait.
The goal is to get everybody the care they need as safely and as quickly as we can.
And if nobody ever explained that to you before…
Well…
Nobody explained this shit.
— Dr. Shari
Helping you get healthy, stay healthy, and bounce back when you’re not…one teeny dose at a time.
Watch: Nobody Explained This Shit with Dr. Shari — Episode 1: “But I Was Here First!” ER Triage Explained
Medical disclaimer: This article is for general educational purposes and is not a substitute for individualized medical advice, diagnosis, or treatment. If you believe you are experiencing a medical emergency, seek emergency medical care.
TeenyDose is your resource for navigating the healthcare world, providing general health and wellness information to help patients and providers make informed decisions. This content is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Every individual’s health is unique, and what you read here may not be specific to your situation. Always consult with your primary care provider or a qualified healthcare professional regarding any medical concerns. If you love what you read here, don’t be selfish—share it with your friends. We’d love to hear from you if you have suggestions or wish to be a contributor.
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