Simple triage and rapid treatment

Simple Triage and Rapid Treatment (START) is a triage method used by first responders to quickly classify victims during a mass casualty incident (MCI) based on the severity of their injuries. It was developed in the 1980s by the Newport Beach Fire and Marine Department and Hoag Hospital in California, United States. The primary goal of START is to maximize the number of survivors in disaster situations where the number of victims overwhelms available medical resources.

Overview

The START method enables first responders to evaluate victims in less than a minute, based on their ability to walk, respiratory status, perfusion, and mental status. Victims are categorized into four groups: Immediate (red), Delayed (yellow), Minor (green), and Deceased (black). This system is designed to be simple and efficient, allowing for rapid assessment without the use of medical equipment.

Triage Categories

• Immediate (Red): Victims with life-threatening injuries who require immediate medical attention to survive.
• Delayed (Yellow): Victims with serious, but not life-threatening injuries, who need medical care but can wait.
• Minor (Green): Victims with minor injuries who can wait for medical attention and may assist in their own care.
• Deceased (Black): Victims who are found dead or whose injuries are so severe that they cannot survive given the current circumstances.

Procedure

The START triage process begins with first responders calling for all victims who can walk to move to a specific area, immediately classifying them as "Minor" (Green). The responders then assess non-ambulatory victims by checking their respiration, perfusion, and mental status in that order. If a victim is not breathing, the responder checks for airway obstruction. If the victim starts breathing after the airway is cleared, they are tagged as "Immediate" (Red). If not, they are tagged as "Deceased" (Black). Perfusion is checked by assessing the capillary refill; a refill time of more than 2 seconds indicates "Immediate" (Red). Mental status is assessed by the victim's ability to follow simple commands; inability to do so also leads to an "Immediate" (Red) classification.

Implementation

START is widely used in emergency medical services, fire departments, and by disaster response teams worldwide. It has been integrated into the Incident Command System (ICS) and is a cornerstone of disaster management training. The simplicity of the START method makes it adaptable to various types of MCIs, including natural disasters, terrorist attacks, and large-scale accidents.

Challenges and Limitations

While START is effective in quickly sorting a large number of victims, it is not without its challenges. The method assumes that the most severely injured victims cannot walk, which might not always be the case. Additionally, the rapid assessment may not identify all life-threatening conditions, especially those requiring diagnostic tools for detection. The psychological impact on both victims and responders is also a concern, as making quick decisions about life and death can be distressing.

See Also

• Triage
• Mass casualty incident
• Incident Command System
• Emergency medical services