START Triage

Aka: START Triage, Simple Triage and Rapid Treatment

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II. Indications

  1. Mass Casualty Incident (MCI) triage method

III. Background

  1. START Triage system is the most commonly used Mass Casualty Incident (MCI) triage system in the United States
  2. Pediatric patients are best triaged with the JumpSTART Triage protocol

IV. Categories: Triage

  1. Minor (Green)
    1. Delayed care (may be delayed up to 3 hours)
    2. Avoid letting these patients overwhelm resources before arrival of the more seriously injured patients
    3. Examples
      1. Lacerations or abrasions
      2. Minor Fractures or burns
  2. Delayed (Yellow)
    1. Urgent care (may be delayed up to 1 hour)
    2. Injuries requiring less immediate intervention
    3. May start Intravenous Fluids or Antibiotics while awaiting definitive management
  3. Immediate (Red)
    1. Immediate care for life threatening injuries
    2. Examples
      1. Airway obstruction
      2. Tension Pneumothorax
      3. Uncontrolled Hemorrhage
      4. Major injury to the head, neck, or torso
  4. Expectant (Black)
    1. Patient is either deceased or mortally wounded and is not expected to survive without significant resources
    2. Critical Vital Signs not responding to initial measures
    3. As resources change, Resuscitation or palliative measures may be considered
    4. May attempt early maneuvers that may change status (e.g. airway repositioning)
  5. Deceased (Black)
    1. Patient has died and no further Resuscitation needed

V. Evaluation

  1. Walking Wounded
    1. Triage to Minor
  2. Assess Respirations
    1. No respiratory effort
      1. Position airway
      2. Triage to Expectant, if no respiratory effort after positioning airway
      3. Triage to Immediate, if respiratory effort after positioning airway
    2. Respiratory effort
      1. Triage to Immediate, if Respiratory Rate >30/min
      2. Assess perfusion (see below) if Respiratory Rate <30/min
  3. Assess Perfusion
    1. Radial pulse absent and Capillary Refill >2 seconds
      1. Control bleeding
      2. Triage to Immediate
    2. Radial pulse present or Capillary Refill <2 seconds
      1. Assess mental status (see below)
  4. Assess Mental Status
    1. Cannot follow simple commands
      1. Triage to Immediate
    2. Can follow simple commands
      1. Triage to Delayed

VI. Resources

  1. DHS REMM START Triage Flowsheet
    1. http://www.remm.nlm.gov/startadult.htm

VII. References

  1. Seeyave and Bradin (2014) Crit Dec Emerg Med 28(12): 2-13

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