Triage Color Codes at Rome's A&E: What They Mean and How Long You'll Wait
Red, orange, blue, green, white: Italy's five-level triage system tells you how urgent your case is and whether you'll pay a fee. A practical guide for Rome.
In a nutshell
When you walk into a Pronto Soccorso (Italian A&E / emergency room), a specialist nurse takes your vital signs and assigns you a color code that reflects how serious your condition is — and therefore how long you wait. Since 2019 Italy has used five codes (it used to be four). The A&E is free for everyone except patients who leave with a white code, which costs €25 in Lazio.
At a glance
| Cost | Free for red, orange, blue, green codes. White (exit) code: €25 in Lazio. |
| Wait times | Red: 0 min · Orange: 15 min · Blue: 60 min · Green: 120 min · White: 240 min |
| Where in Rome | Full A&E departments (DEA II level): Policlinico Umberto I, Gemelli, Tor Vergata, S. Camillo, S. Giovanni, S. Andrea |
| Documents | Photo ID, Tessera Sanitaria (Italian health-insurance card) or TEAM (EU health card) or STP card. Without documents you still get treated. |
How triage works
The word "triage" comes from French for "to sort". You don't get seen in order of arrival — you get seen in order of clinical urgency: life-threatening cases go first. This is what lets a busy A&E handle dozens of different situations fairly.
When you arrive, you first go through administrative check-in (this can happen later if you're seriously ill), then you see the triage nurse — a specially trained nurse who spends 5–10 minutes measuring your blood pressure, heart rate, blood-oxygen level, temperature, and pain on a scale of 0–10. Based on those readings you're assigned a color code, shown on a wristband or on the waiting-room screen.
Your code can change while you wait: if you get worse, the triage nurse reassesses you and bumps your priority up. Always tell staff if your condition deteriorates.
The five codes explained
| Code | Color | Max wait | When it applies | Examples |
|---|---|---|---|---|
| 1 | RED | 0 minutes | Immediate risk of death, vital functions compromised | Cardiac arrest, active stroke, shock, major trauma, massive haemorrhage |
| 2 | ORANGE | 15 minutes | Risk of rapid deterioration, critical but currently stable | Chest pain, moderate breathing difficulty, suspected stable stroke, open fracture |
| 3 | BLUE | 60 minutes | Stable, but needs complex assessment | Significant abdominal or back pain, persistent vertigo, high fever in an adult |
| 4 | GREEN | 120 minutes | Acutely stable, mild symptoms | Wounds needing stitches, bruising, ear infection, mild headache, non-severe back pain |
| 5 | WHITE | 240 minutes | Non-urgent, could be handled by a GP | Common cold, sore throat, stable chronic symptoms, prescription renewals |
The 2019 reform (State-Regions Agreement 1/8/2019) abolished the old yellow code and introduced the blue code for stable-but-complex cases. The wait times shown are the maximum for your first medical assessment, not your total time in the department — green and white patients waiting for test results may spend 4–6 hours in the A&E.
Entry code vs exit code — they are not the same thing
The code assigned at triage is your entry code. After your examination and any tests, the doctor gives you an exit code. It's this second code that determines whether you pay.
You only pay if your exit code is white. If you come in as green but tests reveal something serious, you leave with an orange code and pay nothing. If you come in as white but your condition worsens while you wait, your code goes up and you still pay nothing.
If you leave with a white exit code, you receive a PagoPA receipt for €25 (DGR Lazio 1086/2017), payable within 30 days via the SaluteLazio app, pharmacies, tobacconists (tabaccherie), or ASL (Azienda Sanitaria Locale — your local public-health authority) counters. You pay nothing at the A&E itself at the time of the visit.
Who is exempt from the white-code fee
You don't pay the €25 even with a white exit code if you are:
- Under 14 years old
- Pregnant
- Exempt for income or medical condition
- Brought in by ambulance (118)
- Sent by your GP with an urgent referral
- Admitted to hospital following your A&E visit
- Returning within 5 days for the same condition
- Holding an STP or ENI card (non-EU nationals not registered with the SSN — Servizio Sanitario Nazionale, Italy's national health service)
- A victim of violence (including domestic violence)
Who has the right to use the A&E
The A&E takes everyone, regardless of nationality, documentation status, or financial situation. Italians, EU citizens, documented non-EU residents, undocumented foreigners, tourists, unaccompanied minors, asylum seekers — no A&E can refuse urgent care (DLgs 286/1998 art. 35; Constitution art. 32).
If you have no documents, you're identified by the personal details you provide. If needed, the A&E issues a temporary STP card on the spot to handle the administrative paperwork.
Mistakes to avoid
- Going to the A&E for non-urgent problems. A white code costs you €25 and slows down people who genuinely need emergency care. For a sore throat, a cold, or a repeat prescription, see your GP or call the out-of-hours service (Guardia Medica) on evenings, weekends, and public holidays.
- Leaving before you're formally discharged. If you walk out without a discharge note, the A&E records it as a "voluntary departure" — and you may still receive a bill. If you've been waiting a long time and your condition changes, tell the triage nurse. Don't just leave.
- Paying cash at the A&E before your visit. The public A&E is free at the point of entry. The white-code fee is always paid afterwards, via PagoPA with a printed receipt. If anyone asks you for cash upfront, it is a scam.
Special cases
You're an EU tourist: Your TEAM card (Tessera Europea Assicurazione Malattia — European Health Insurance Card) entitles you to the same terms as residents: free A&E except for a possible €25 white-code fee.
You're a non-EU tourist without travel insurance: Urgent care is never refused, but you'll receive a full invoice instead of the flat fee. Travel health insurance is always a good idea.
You're a woman who has experienced violence: Rome's main A&E departments — S. Camillo, S. Giovanni, Policlinico Umberto I, Gemelli — have dedicated "pink pathways" with trained staff and guaranteed confidentiality. The service is free. National anti-violence helpline: 1522 (free, 24/7).
You suspect you have Covid or another infectious disease: Tell staff immediately on arrival. You'll be isolated and managed through a separate pathway.
The A&E is packed: A long wait is not a reason to leave. If your condition changes, tell the triage nurse. Reassessment is your right.
Official sources
- Ministry of Health — Emergency and Urgent Care
- Ministry of Health — Triage guidelines 2019
- Lazio Region — Health
- SaluteLazio — Official portal
- ARES 118 Lazio
- 118 Roma
- IRCCS Bambino Gesù (children's hospital)
- Anti-violence helpline 1522
Legal references: State-Regions Agreement 1/8/2019 (five-code triage reform), National intra-hospital triage guidelines, Ministry of Health 2019, DM 70/2015 (hospital standards), DPCM 12/01/2017 (LEA essential health services), DGR Lazio 1086/2017 (A&E white-code fee €25), DLgs 286/1998 art. 35, Constitution art. 32.