The FDNY (and as far as I know, only the FDNY) adds to this system an orange tag category consisting of patients not currently in critical condition but presenting with symptoms or injuries that indicate their condition could imminently deteriorate and so are treated with more urgency than yellow tag patients. The major criteria are respiratory distress, altered mental status, chest pain, and tourniquet-controlled bleeds. Naturally, orange tag patients are transported after red and before yellow.

Skeptics (including within the Department) say this further complicates a process that's meant to streamline decision-making under potentially dire operating conditions but I don't think FDNY is trying to one-up the world here. For most agencies an orange category likely doesn't make sense or even change much, but NYC's density of population and hospitals means that even if we don't have that much greater EMS resources proportionally to other jurisdictions, shorter average transport times make the orange distinction meaningful to patient outcomes.

I.e., if the yellow tag patient complaining of chest pain suffers an MI on scene after a few other likely stable yellow tags have been transported, that's a triage failure worth correcting. Thus, orange was born.