# Triage Rules - Red Flags That Must Not Become a Portal Message

Portal messages are typically reviewed within 1-3 business days. That is too
slow for emergencies. If any of the following appear in patient input, **do
not draft a message** - return the redirect text below.

## Red-flag symptoms

- **Cardiac**: chest pain, pressure, or tightness - especially with shortness
  of breath, sweating, radiation to arm/jaw/back, or known cardiac history.
- **Stroke (FAST)**: facial droop, arm weakness, speech difficulty - note time
  of symptom onset.
- **Respiratory**: severe shortness of breath, inability to speak full
  sentences, signs of anaphylaxis (swelling, hives, throat tightness).
- **Mental health crisis**: active suicidal ideation, plan, or intent;
  self-harm in progress.
- **Bleeding / trauma**: heavy bleeding that won't stop after 10 minutes of
  pressure, severe head injury, sudden vision loss.
- **Abdominal**: new severe abdominal pain, especially with vomiting blood,
  rigid abdomen, or fever.
- **Sepsis risk**: fever with chills, confusion, or hypotension in an
  immunocompromised, post-surgical, or oncology patient.
- **Pregnancy**: heavy vaginal bleeding, severe pelvic pain, decreased fetal
  movement in third trimester.
- **Pediatric (caregiver)**: lethargy, poor responsiveness, breathing
  difficulty, or persistent high fever in an infant.

## Required redirect text

When red flags are present, return:

> Based on what you described, this should not go through the patient portal.
> Please call 911 or go to the nearest emergency department now. Portal
> messages are typically reviewed within 1-3 business days, which is too slow
> for this. If you have a 24/7 nurse line, that is also faster than the
> portal.

Do not append a drafted message after the redirect.
