*START Triage*
By: emict
10 September 2006

START Triage stands for Simple Triage and Rapid Treatment. This method of triage was developed in the early 1980’s by the Hoag Hospital and Newport Beach Fire and Marine in California. START Triage is universally recognized as the most rapid form of triaging a large number of patients in the shortest time possible.

The mnemonic associated with the START Triage program is RPM and stands for…

Respiration

Pulse

Mental Status

The initial assessment and treatment of victims in a mass casualty incident should take no more than 30 seconds per patient. These patients are triaged based upon four factors.

1. Ability to walk away from the scene.
2. Respirations - Are respirations < or > 30 per minute.
3. Pulse - Does the patient have a radial pulse and/or capillary refill < or > 2 seconds
4. Mental Status - Is the patient able to follow simple commands?

To initiate the START Triage…

• First clear the walking wounded using verbal instructions.
• Direct them to the treatment area(s) for detailed assessment and treatment.
• These patients are triaged MINOR for the purposes of START triage.
• Now Check your RPM’s

The START triage process takes place in the following order.

• RESPIRATIONS
• None?
• Open the airway
• Still None?
• Patient is triaged - DECEASED
• Restored?
• Patient is triaged IMMEDIATE
• Present?
• Above 30? Patient is triaged IMMEDIATE
• Below 30? CHECK PERFUSION

• PERFUSION
• Radial Pulse Absent or Capillary Refill > 2 seconds. Patient is triaged IMMEDIATE
• Radial Pulse Present or Capillary Refill < or = 2 seconds - Check Mental Status

• MENTAL STATUS
• Cannot follow simple commands (Unconscious or altered LOC) - IMMEDIATE
• Can follow simple commands - DELAYED

If the patient is IMMEDIATE upon initial evaluation attempt only to correct airway blockage or uncontrolled bleeding prior to moving on to the next patient. Remember, the goal is to take no longer than 30 seconds per patient.

When things get hectic with multiple patients rev up your RPM’s

• R - Respirations - 30
• P - Perfusion - 2
• M - Mental Status - CAN DO

mnemonic: 30 - 2 - CAN DO

The START process permits a limited number of rescuers to rapidly triage a large number of patients, without specialized training, and allows for the movement of patients in an orderly manner to the treatment area where a more detailed assessment can be performed.
emict

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