START

START

START (Simple Triage and Rapid Treatment) 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. The goal of START is to do the greatest good for the greatest number of people.

History

The START triage system was developed in 1983 by the staff at Hoag Hospital and the Newport Beach Fire Department in California. It was designed to be a simple and efficient method for first responders to use in the field.

Triage Categories

START categorizes patients into four groups based on the severity of their condition:

• Immediate (Red): These patients have life-threatening injuries that require immediate attention to survive.
• Delayed (Yellow): These patients have serious injuries that are not immediately life-threatening.
• Minor (Green): These patients have minor injuries and can wait for medical treatment.
• Deceased (Black): These patients are either deceased or have injuries that are not survivable given the resources available.

Triage Process

The START triage process involves a quick assessment of each victim using the following criteria:

• Respiration: Check if the patient is breathing. If not, open the airway. If they start breathing, tag them as Immediate. If they do not start breathing, tag them as Deceased.
• Perfusion: Check the patient's circulation by feeling for a radial pulse or checking capillary refill. If the pulse is absent or capillary refill is greater than 2 seconds, tag them as Immediate.
• Mental Status: Check if the patient can follow simple commands. If they cannot, tag them as Immediate. If they can, tag them as Delayed or Minor based on other criteria.

Advantages and Limitations

The START system is advantageous because it is simple, quick, and can be used by responders with minimal training. However, it has limitations, such as the potential for over-triage or under-triage, and it may not be as effective in certain types of incidents, such as those involving chemical, biological, radiological, or nuclear (CBRN) hazards.

Related Pages

• Triage
• Mass casualty incident
• Emergency medical services
• Disaster medicine
• Hoag Hospital
• Newport Beach Fire Department

See Also

• JumpSTART - A pediatric version of the START triage system.
• SALT triage - Another triage system used in mass casualty incidents.

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