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In Germany, an increased volume of patient cases in the emergency department has been observed for several years, many of which do not represent hospital emergencies. To improve the triage and management of patient flows, the Structured Initial Medical Assessment (Strukturierte medizinische Ersteinschätzung in Deutschland, SmED) triage system was developed. This certified medical product is intended to assess both the urgency of everyday complaints and their adequate medical care in a targeted, faster, and safer manner. It supports medical professionals in triage by suggesting courses of action, whereby the ultimate responsibility remains with the professionals themselves. For otorhinolaryngology, a content review was carried out with regard to plausibility and patient safety in the head and neck region on the basis of nine specific emergencies. The cases were simulated by nine otorhinolaryngologists and triaged on the basis of the SmED by medical staff and medical students by assigning a care level and timepoint (urgency). The majority of cases were correctly assigned. The SmED initial assessment system is a good tool for assessing urgent clinical pictures in ear, nose, and throat (ENT) medicine. The long-term goal of the initial assessment is to relieve the capacities of outpatient departments. In order to achieve this and to shorten patient waiting times, it would be necessary to refer patients quickly to otorhinolaryngology. It is therefore necessary to ensure that patients are referred to an ENT on-call service via the online tool., (© 2024. The Author(s).)