We use emergency room triage principles: life-threatening issues first, then quality of life, then cosmetic. Priority 1 - Production Blockers (fix first 1-2 weeks): app crashes or won't start, broken builds or deployments, critical security vulnerabilities (authentication bypass, SQL injection, exposed secrets), data loss or corruption, payment processing broken (if applicable), and complete feature failures (core functionality doesn't work at all). Priority 2 - High-Impact Issues (fix weeks 2-4): performance problems causing customer churn (10+ second load times, timeouts), serious UX problems making app unusable, flaky tests or broken CI/CD preventing deployments, architectural debt preventing any new development, scalability limits being hit currently, and moderate security issues (XSS, CSRF, weak authentication). Priority 3 - Quality of Life (fix weeks 4-8): technical debt slowing development but not blocking it, missing test coverage for non-critical paths, code quality issues (duplication, complexity, poor naming), performance optimizations beyond 'good enough', nice-to-have features partially complete, and documentation gaps. Priority 4 - Cosmetic/Deferred (future work): UI polish and visual improvements, minor refactoring opportunities, optimization beyond requirements, and aspirational architecture changes. Our decision framework: business impact (revenue loss, customer churn, reputational damage), risk level (security, data loss, legal/compliance), fix effort (quick wins first if equal impact), and dependencies (fix blockers before dependent work). We present priority list during triage and adjust based on your business priorities. Some clients prioritize customer-facing fixes over infrastructure; others prioritize security over features. Your business context drives final prioritization, but we provide the expert recommendations.