Safety and triage rules

What this is, and what it is not

This is a content routing layer. It decides which guidance to show first. It is not a validated clinical triage system, it is not a decision-support tool, and it has not been through clinical validation.

It has two jobs. The first is to make emergency information impossible to miss. The second, more important, is to make sure that not matching a rule is never mistaken for an all-clear.

The four levels

1. Emergency A clinician-reviewed warning pattern matched. The notice appears immediately, and the article list is removed entirely rather than moved below it. A page that shows fifteen articles under a chest-pain warning teaches people to scroll past warnings.
2. Prompt assessment Concerning, persistent, new, worsening or recurring symptoms. Reviewed guidance about being seen soon, above any general content, with the practical thresholds spelled out.
3. General education No approved warning pattern matched. Relevant articles, plus a standing reminder of what this website cannot do. Matching no rule means only that no rule matched.
4. Unclear or ambiguous Too short or too vague to judge. We say exactly that, show general safety information, and never offer a guess. No rule firing is never treated as reassurance.

What the system will never do

• Give a diagnosis, name a condition as your condition, or suggest one.
• Estimate how likely a disease is, or score severity.
• Tell a reader that a symptom is harmless, or tell them to wait.
• Ask follow-up questions before showing an emergency notice.
• Rank an article above an emergency. There is no scoring function an emergency can lose.

Emergency rules currently in the system

4 rules. Every one is flagged as requiring clinician sign-off, and every notice rendered to a reader says so.

• Emergency Chest pain with difficulty breathing The 'unless' list here deliberately lets anatomical questions ('why does my chest hurt when I laugh') reach the symptom guide while still catching acute cardiac descriptions. Needs sign-off from a clinician, and a decision about whether a reader under 18 with chest pain and breathing difficulty should be routed anywhere other than emergency care.
• Emergency Severe or rapidly worsening abdominal or pelvic pain Deliberately suppresses on period-pain phrasing so the very common 'bad period pain' query reaches the period-pain guidance instead of this rule. That suppression is the highest-risk decision in the whole rule set and must be confirmed by a clinician: it is entirely possible a reader describing ovarian torsion as 'period pain' would be wrongly routed. A clinician may want severity terms checked first and the suppression narrowed.
• Emergency Sudden severe testicular pain This is the highest-priority rule on the site because missed testicular torsion is the clearest case where delay causes irreversible harm. Needs sign-off from a urologist or emergency clinician, including confirmation of which pain descriptions must fire the rule and whether the 'unless' phrases are too broad. The 'balls' and 'nuts' triggers are included because they are how a large share of readers will actually describe this, and must be confirmed as safe rather than assumed.
• Emergency Fainting alongside severe pain or heavy bleeding Fainting itself is treated as the escalation trigger rather than being combined with a pain term, because 'I fainted' is how a reader in difficulty most often describes what happened, and combining them would let 'I fainted during blood tests' through as unflagged. Needs sign-off and a decision on whether syncope in a gym or during blood donation should be excluded.

Prompt-assessment rules

4 rules.

• Prompt A new painful lump or swelling Deliberately catches any lump or swelling, because it cannot be narrowed to a body site without losing cases, and over-triage here is a low harm while under-triage is not. Needs a clinician to confirm, and to confirm whether any specific combination (lump plus hard plus fixed plus lasting) should escalate straight to emergency.
• Prompt Pain when passing urine Prompt rather than emergency. The action text names the escalation features (fever, flank pain, pregnancy) but a clinician must confirm those are the right ones and confirm the same-day threshold. Readers may be under 18 and may be embarrassed; the wording should be checked with someone experienced in young people's sexual health.
• Prompt Heavy bleeding Prompt rather than emergency because heavy bleeding on its own is usually urgent-but-not-critical; it becomes an emergency with the symptoms in the fainting rule. Needs a clinician to set the exact practical thresholds stated in the action text, and to confirm those thresholds match local guidance.
• Prompt Fever alongside pelvic or genital symptoms Fever on its own is common and usually self-limiting, so this is prompt rather than emergency. It is listed because fever *plus* a pelvic or urinary symptom is the combination that matters for pelvic inflammatory disease, and the pairing is currently only implicit. Needs a clinician to confirm this is the right pairing and the right urgency.

Outstanding clinical review

In priority order, this is the work that has not been done. It is not a disclaimer; it is a task list.

1. Testicular torsion rule — urologist or emergency clinician. Highest-harm miss on the site. Confirm the colloquial triggers ("balls", "nuts") are safe, and that the suppression phrases cannot hide a real presentation.
2. Severe abdominal/pelvic pain rule — emergency clinician. This rule deliberately suppresses itself on period-pain phrasing so that "bad period pain" reaches period-pain guidance. That suppression could route a reader describing ovarian torsion the wrong way. It must be reviewed, not assumed.
3. Chest pain with breathing — emergency clinician. Confirm the suppression list is not too broad, and decide whether under-18s should ever be routed anywhere other than emergency care.
4. Fainting with pain or bleeding — emergency clinician. Firing on fainting alone is intentionally broad. Confirm the benign exclusions.
5. Heavy bleeding — gynaecologist or GP lead. The practical thresholds in the action text are drafts and must match local guidance.
6. New lump or swelling — GP clinical lead. Intentionally over-broad. Confirm over-triage is acceptable and set any emergency-escalation feature combination.
7. Painful urination — sexual health clinician. Confirm the same-day features and the wording with someone experienced in young people's sexual health.
8. Fever with genital symptoms — sexual health clinician. The pairing is currently implicit and needs confirming.
9. Language and dialect coverage. Triggers were written in one variety of English. A clinician working across regions should review the vocabulary.
10. Local emergency numbers. Notices currently say "contact your local emergency number" rather than naming one, which is correct for a globally reachable site but must be replaced with verified local guidance in a regional deployment.

Completeness

These rules were never intended to be exhaustive. There are conditions this list does not cover, and a rule that exists but does not fire is not the same as a rule that does not exist. Absence of a warning here is not reassurance, and the interface is written to say so.

How the routing is tested

The routing engine is covered by an automated suite that runs every example from the specification — sudden testicular pain, severe abdominal pain, chest pain with breathing difficulty, fainting with bleeding, new lumps, painful urination, vague questions, misspelled questions, multi-symptom questions, and no-match queries — and asserts that an emergency always wins over a more relevant routine article.

Those tests verify the implementation against the rules as written. They do not establish that the rules are medically complete, and they are not a substitute for the review listed above.