What Is START Triage?

What Is START Triage?

Simple triage and rapid treatment (START) refers to the triage method developed in 1983 by the Newport Beach Fire Department and Hoag Hospital in California. START is a triage method used by first responders during a mass casualty incident (MCI) to quickly and efficiently classify victims based on the severity of their injuries.

Classifications

The goal of triage is to do the “greatest good for the greatest number” of victims. To achieve this goal, START uses four color-coded categories that victims are assigned after a quick evaluation:

• Deceased or expected to die (Black)
• Immediate (Red)
• Delayed (Yellow)
• Walking wounded/minor injuries (Green)

The colors correspond to triage tags, tape, or designated areas, although triage tags are the most commonly used in the field.

Sorting Victims

1. Upon arrival at the scene, the first step is to call out to victims and ask anyone who can hear your voice and walk to go to a designated location. These are the walking wounded and are considered green or third-priority patients.

2. The second step is focused on nonambulatory victims. Go to the nearest victim and assess respiratory status. If the patient is not breathing, open the airway. If they start breathing, they are given a red tag and are considered a priority patient. If they do not start breathing, they are given a black tag.

3. Any victim who is spontaneously breathing faster than 30 breaths/minute or fewer than 10 breaths/minute is given a red tag.

4. If a patient is breathing normally, check for bilateral radial pulses. If a pulse is absent, tag them as red. If both pulses are present, ask them to follow a simple command, such as holding up two fingers. If they can follow your command, they are tagged as yellow and in the delayed category. Move on to the next victim and repeat.

Transport Priority

Once your victims/patients are triaged and tagged, the red tags will be the first to be transported to the hospital or treatment facility. Next will be yellow, then green. If time permits, the black tagged victims can be reassessed to see if they require a red tag.

Reducing Chaos

While the START triage system was developed to do the greatest good for the greatest number, it is also an extremely useful tool for first responders to reduce chaos at a stressful and taxing mass casualty incident. To test your knowledge of the START triage system and trauma care, check out our practice tests, lessons, and flashcards.