Triage is a sorting method used to determine the priority of treatment for injured people. This system is crucial during a Mass Casualty Incident (MCI), where the number of injured persons overwhelms available medical resources. The most widely adopted method for initial sorting in the United States is the START Triage System, which stands for Simple Triage and Rapid Treatment. This standardized approach allows first responders to quickly categorize victims, ensuring limited resources are directed toward those who will benefit most.
The Purpose of START Triage
The goal of the START system is to maximize the number of survivors in a chaotic environment. This is achieved by rapidly identifying and providing minimal, life-saving interventions to victims with a high potential for survival. The system prioritizes doing the greatest good for the greatest number of people when emergency medical services are strained.
This triage model is utilized when a situation creates more casualties than can be immediately managed with normal resources. The process is designed to be completed in 30 to 60 seconds per victim, demanding speed and simplicity. Sorting patients into treatment and transport priorities brings organization to the initial, chaotic stages of an MCI. Rapid classification ensures those with life-threatening injuries receive attention before their chances of survival diminish.
The Assessment Sequence
The START assessment begins by asking all victims who can walk to move to a designated safe area. Those who relocate are immediately classified as “Minor,” as their injuries are not immediately life-threatening. Responders then focus on all remaining non-ambulatory patients, starting with those closest to them.
The evaluation of these remaining patients is based on the mnemonic RPM: Respiration, Perfusion, and Mental Status. The first check is for Respiration, focusing on its presence and rate. If a patient is not breathing, the rescuer must open the airway; if breathing does not resume, the victim is tagged as Deceased.
If the patient is breathing, the rate is assessed. A respiratory rate greater than 30 breaths per minute results in an Immediate classification. If the rate is 30 or fewer, the rescuer moves to Perfusion, evaluated by checking the radial pulse or capillary refill. An absent radial pulse or a capillary refill time longer than two seconds suggests poor circulation and leads to an Immediate classification.
Finally, if the patient has adequate breathing and circulation, the rescuer assesses Mental Status by asking the victim to follow a simple command. A patient unable to follow simple commands is classified as Immediate. Only patients who can follow commands, breathe at a rate of 30 or less, and have a strong radial pulse are classified as Delayed.
Understanding the Triage Categories
The assessment sequence assigns one of four color-coded categories, which determines the victim’s priority for treatment and transport. The Immediate category (Red tag) is reserved for victims with life-threatening injuries who have a high potential for survival if treated right away. These patients require minimal intervention to stabilize them and must be the first transported from the scene.
The Delayed category (Yellow tag) includes patients with serious injuries that are not immediately life-threatening. These individuals can wait for treatment for a period of time, such as up to an hour, and are transported after the Red-tagged patients. Minor victims (Green tag) are the “walking wounded” whose injuries are minimal. They are directed to a separate area and may wait for treatment for several hours.
The final category is Deceased (Black tag). This designation is given to victims who are already dead or those with injuries so severe that survival is unlikely, even with medical attention. In a mass casualty setting, these individuals are not prioritized for immediate care, allowing rescuers to focus on saving the greatest number of salvageable lives.