Development and structure of a multiscenario prehospital triage classification system: a Colombian framework proposal

Abstract Purpose Colombia has established legal frameworks for prehospital emergency medical services (EMS) but has no nationally standardized prehospital triage system. Given a high trauma burden and marked geographic heterogeneity, we aimed to develop a structured, nationally adapted prehospital triage classification framework and describe its design. This article reports a consensus-based development and design study; it describes the framework’s structure and does not constitute a clinical validation. Methods The framework was developed through a three-phase process: (1) review of Colombian regulatory instruments and international triage literature; (2) structured expert consensus using the Nominal Group Technique with a ≥ 90% agreement threshold across ten virtual consensus sessions, conducted with the technical committee of the Colombian Association of Trauma, Prehospital Care, and Emergency Medical Systems (ACTAEM) and the Meditech Foundation research group; and (3) geographic and operational adaptation to Colombia’s response infrastructure. No patient-level data were collected. Results The framework defines three operational modalities (information-and-communication-technology [ICT]-mediated dispatch triage; on-scene one-to-one triage; and multiple-casualty-incident triage), a four-level colour-coded priority classification comprising 91 syndromic conditions with objective criteria and defined response-time standards, and a geographically adaptive vehicle-assignment protocol aligned with Colombia’s regulatory vehicle taxonomy. It is designed to be interoperable with Resolution 3100 of 2019 and Resolution 5596 of 2015. Conclusions We propose the first structured, criteria-based prehospital triage framework adapted to Colombia’s regulatory, epidemiological, and geographic context. It is intended as a structured basis for evaluation and for potential future adoption; prospective validation of clinical outcomes, inter-rater reliability, and implementation fidelity remains the essential next step.