Educational Materials

What’s available?

The developers of ESI have produced the following materials at either low (web-course) or no cost (handbook, DVD’s, wall poster and pocket cards). These materials were developed with cost in mind for one reason, the ESI Triage Research Team has a vision of widespread implementation of ESI, while retaining excellent reliability and validity.

The ESI Implementation Handbook and accompanying DVD’s

In 2005, the ESI Research Team collaborated with the Agency for Healthcare Research and Quality (AHRQ), and developed the "Emergency Severity Index, Version 4: Implementation Handbook". This handbook is the official handbook and we recommend using this source when implementing ESI. Other sources of training may be available, however, misrepresentations, and misinterpretations of the ESI algorithm may, and have been found in the past. These materials were developed to be the standardized ESI training materials, with the sole purpose of retaining the excellent inter-rater reliability and validity that has been found with ESI.

What other training materials are available? Again, the developers of ESI recognized the need for low cost materials. The implementation handbook and DVD are available at no cost. You will also find that most segments of the handbook, including some of the acted out triage case scenarios included on the DVD, have been imbedded as files within the webcourse.

The Handbook

The handbook is brief, but includes the following chapters:


  1. The Evolution of Triage
  2. Triage Acuity Systems
  3. Introduction to the Emergency Severity Index
  4. ESI Level 2
  5. Expected Resource Needs
  6. The Role of Vital Signs in ESI Triage
  7. Implementation of ESI Triage
  8. Evaluation and Quality Improvement
  9. Practice Cases (n=30)
  10. Competency Cases (n=30)

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The DVD’s

Two DVD’s are available at no charge to supplement your training. The DVD’s include several lectures on the Emergency Severity Index v.4 that can be used at your own facility. These lecture provide an overview of ESI, describe in detail the algorithm and definitions, and also presents an overview of the changes from v.3 to v.4. Powerpoint versions of these lectures are included on the DVD, however, they cannot be modified. The DVD’s also include several acted out triage scenarios which are followed by a brief discussion of the correct triage acuity rating using ESI v.4. Additional cases are presented as a teaching tool with a group of several emergency nurses participating in a discussion of more cases with Nicki Gilboy and Paula Tanabe.

Free posters and Pocket Cards You can obtain a free hard copy of the wall poster by ordering the handbook. A poster is included with the handbook. In the handbook, the last page is designed to allow the user to easily print and make your own pocket cards.

How do I obtain the handbook and DVD’s?

You may download a free copy of the training manual at the following website: A pdf version can be printed from your computer. If you would like to order a free copy, you may call AHRQ at 800-358-9295. You can order 3 copies with no cost. You may also call the same number to obtain the DVD’s.