The Emergency Medical Service attends to a wide variety of patients. Because the resources of all EDs are finite, there is a need to prioritise patients on arrival to receive emergency medical care. Acuity would naturally form the basis for such prioritisation. While different communities have varying triage practices (with triage categories of patients varying from 2 to 6), we recognise that, for practical purposes, most EDs tend to have four different acuity-type patient care areas, viz :-

a) Resuscitation Area

b) Non-Resuscitation Major Emergency (Critical) Area

c) Minor Emergency (Ambulant) Area

d) Non-Emergency Area

It is also well recognised that the greater the number of triage categories present, the more difficult it is for triage nurses to accurately reflect the correct triage value. Sometimes, a more accurate acuity categorisation is done at the end of the patient visit by the Emergency Department doctor who attended to the patient

In Emergency medicine, the work-up and intensity of initial investigations and management often depends on the presenting complaint, rather than on the final diagnosis. Waiting time, resource utilisation and process times would therefore tend to mirror more the presenting complaint than the final diagnosis. The Emergency Medicine Services, MOH has, therefore, agreed that patient acuity criteria be based on a combination of initial complaints and initial provisional diagnoses. There will be four patient acuity classes for all public Emergency Departments.

Annex A gives the 4-point Singapore Patient Acuity Category Scale (PACS)

Definitions

PAC Scale 1

These are patients who are either already in a state of cardiovascular collapse or in imminent danger of collapse and would therefore be required to be attended to without a moment’s delay. They would be likely to require the maximum allocation of staff and equipment resources for initial management.

PAC Scale 2

These patients are ill and non-ambulant and in various forms of severe distress. They would appear to be in a stable state on initial cardiovascular examination and are not in danger of imminent collapse. The severity of their symptoms requires very early attention, failing which early deterioration of their medical status is likely. . They would be trolley-based.

PAC Scale 3

These patients have acute symptoms, but are ambulant, have mild to moderate symptoms and require acute treatment which will result in resolution of symptoms over time.

PAC Scale 4

These are non-emergency patients. They should not be presenting to Emergency Departments in the first place and should more appropriately be managed in a primary health care setting such as in family practice or public polyclinics. They may have an old injury or condition that has been present for a long time. They do not require immediate treatment. There is no immediate threat to their life or limb.

SINGAPORE EMERGENCY MEDICINE SERVICESPATIENT ACUITY CATEGORY (PAC) SCALE
	The Emergency Medical Service attends to a wide variety of patients. Because the resources of all EDs are finite, there is a need to prioritise patients on arrival to receive emergency medical care. Acuity would naturally form the basis for such prioritisation. While different communities have varying triage practices (with triage categories of patients varying from 2 to 6), we recognise that, for practical purposes, most EDs tend to have four different acuity-type patient care areas, viz :- a) Resuscitation Area b) Non-Resuscitation Major Emergency (Critical) Area c) Minor Emergency (Ambulant) Area d) Non-Emergency Area It is also well recognised that the greater the number of triage categories present, the more difficult it is for triage nurses to accurately reflect the correct triage value. Sometimes, a more accurate acuity categorisation is done at the end of the patient visit by the Emergency Department doctor who attended to the patient In Emergency medicine, the work-up and intensity of initial investigations and management often depends on the presenting complaint, rather than on the final diagnosis. Waiting time, resource utilisation and process times would therefore tend to mirror more the presenting complaint than the final diagnosis. The Emergency Medicine Services, MOH has, therefore, agreed that patient acuity criteria be based on a combination of initial complaints and initial provisional diagnoses. There will be four patient acuity classes for all public Emergency Departments. Annex A gives the 4-point Singapore Patient Acuity Category Scale (PACS) Definitions PAC Scale 1 These are patients who are either already in a state of cardiovascular collapse or in imminent danger of collapse and would therefore be required to be attended to without a moment’s delay. They would be likely to require the maximum allocation of staff and equipment resources for initial management. PAC Scale 2 These patients are ill and non-ambulant and in various forms of severe distress. They would appear to be in a stable state on initial cardiovascular examination and are not in danger of imminent collapse. The severity of their symptoms requires very early attention, failing which early deterioration of their medical status is likely. . They would be trolley-based. PAC Scale 3 These patients have acute symptoms, but are ambulant, have mild to moderate symptoms and require acute treatment which will result in resolution of symptoms over time. PAC Scale 4 These are non-emergency patients. They should not be presenting to Emergency Departments in the first place and should more appropriately be managed in a primary health care setting such as in family practice or public polyclinics. They may have an old injury or condition that has been present for a long time. They do not require immediate treatment. There is no immediate threat to their life or limb. Annex A...