Simple triage and rapid treatment (START) is a

triage In medicine, triage (, ; ) is a process by which care providers such as Health professional, medical professionals and those with first aid knowledge determine the order of priority for providing treatment to injured individuals and/or inform th ...

method used by

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s to quickly classify victims during a

mass casualty incident A mass casualty incident (often shortened to MCI) describes an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of Casualty (person), casualties. For example, an ...

(MCI) based on the severity of their injury. The method was developed in 1983 by the staff members of Hoag Hospital and Newport Beach Fire Department located in

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, and is currently widely used in the

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.START Adult Triage Algorithm. Radiation Emergency Medical Management: REMM (US Department of Health and Human Services). https://remm.hhs.gov/startadult.htm

Classification

First responders using START evaluate victims and assign them to one of the following four categories: * Deceased/expectant (black) * Immediate (red) * Delayed (yellow) * Walking wounded/minor (green) The colors correspond to triage tags, which are used by some agencies to indicate each victim's status, although physical tags are not necessary if patients can be physically sorted into different areas. Responders arriving to the scene of a mass casualty incident may first ask that any victim who is able to walk relocate to a certain area, thereby identifying the ambulatory, or walking wounded, patients. Non-ambulatory patients are then assessed. The only medical intervention used prior to declaring a patient deceased is an attempt to open the airway. Any patient who is not breathing after this attempt is classified as deceased and given a black tag. No further interventions or therapies are attempted on deceased patients until all other patients have been treated. Patients who are breathing and have any of the following conditions are classified as immediate: * Respiratory rate greater than 30 per minute; * Radial pulse is absent, or

capillary refill Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. It can be measured by holding a hand higher than heart-level and pressing the soft pad of a ...

is over 2 seconds; * Unable to follow simple commands All other patients are classified as delayed.

Treatment and evacuation

After all patients have been evaluated, responders use the START classifications to determine priorities for treatment or evacuation to a hospital. The most basic way to use the START classifications is to transport victims in a fixed priority manner: immediate victims, followed by delayed victims, followed by the walking wounded. More detailed secondary

systems such as SAVE may also be used: in this case, the START classifications are used to determine the order in which victims should undergo secondary triage. START is not a system for determining resource allocation. The classification algorithm used in START does not depend on the number of victims or on the number of resources available to treat them, nor does using START alone provide any prioritization of patients within any of the four triage classes. Therefore, significant differences in implementation of treatment and evacuation may exist across different agencies using START.

Modifications to START and similar triage systems

Numerous agencies have developed modifications to START or new triage systems similar to START. One early proposed modification substituted the presence of a radial

pulse In medicine, the pulse refers to the rhythmic pulsations (expansion and contraction) of an artery in response to the cardiac cycle (heartbeat). The pulse may be felt ( palpated) in any place that allows an artery to be compressed near the surfac ...

for capillary refill in classifying patients as immediate. The

Fire Department of New York The New York City Fire Department, officially the Fire Department of the City of New York (FDNY) is the full-service fire department of New York City, serving all Boroughs of New York City, five boroughs. The FDNY is responsible for providing Fi ...

uses a modified version of START with an orange or "urgent" classification intermediate in severity between immediate and delayed.

Modification for pediatric patients

START has also been modified to provide better treatment for children. One such modification is known as JumpSTART. There are several simple modifications to the adult version. The primary modification for use with pediatric patients is to change the "normal" respiratory rate: since children breathe faster than adults, JumpSTART assigns the immediate classification on the basis of respiratory rate only if the child's respiration is under 15 or over 45 per minute. Another change is in the apneic pediatric patient with a pulse the patient is given 5 breaths. If they resume breathing on their own, they are tagged as "immediate". If they do not resume breathing on their own, they are tagged as "deceased". Another needed bit of information is to decide who qualifies as a pediatric patient and who qualifies as an adult. This can quickly be decided by a rapid check for underarm hair development on boys, and breast bud or breast development on girls. If the age is known, the age cut off for child versus adult is 8 years old.

Similar triage systems

Other triage systems that are variations of or similar to START include Triage Sieve, Pediatric Triage Tape, and CareFlite Triage. Each of these systems uses four or five triage classes with the red, yellow, green, and black colors.

Limitations

There is no accepted measure to judge the appropriateness of any given system in mass casualty triage. Like many other triage systems, START suffers from implementation problems such as substantial amounts of overtriage. One of the major strengths of START, its simplicity, is also a major limitation. Since START was developed, consensus has emerged that triage should be more sophisticated, by incorporating resource limitations and capacity in determining how to prioritize patients.

Notes

External links

* (Newport Beach Fire Department) * * * (PDF - 197 KB) (Adult, SC-EMS.com) * * Maryland Institute for Emergency Medical Service Systems {{cite web, url=http://www.miemss.org/home/TriageTagTraining/tabid/152/Default.aspx, title=Simple Triage and Rapid Treatment training, archive-url=https://web.archive.org/web/20130903224414/http://www.miemss.org/home/TriageTagTraining/tabid/152/Default.aspx, archive-date=2013-09-03 Triage