START Triage
During a Mass Casualty
Gina Smith RN
Gina Smith RN
Director of Emergency Management
Presenter
Gina Smith RN CHEP
Team Commander MA-2 DMAT
UMass Memorial Medical Center
Program Director
EMS
Emergency Management
Injury Prevention
Disclosure Statement:
I have no actual or potential conflict
of interest in relation to this
program/presentation.
Gina Smith
Objectives
Describe the key elements of
disaster triage
 Recognize the basic principles of
“START” Mass Casualty Triage
 Demonstrate options for Start Triage
tagging

MCI
Mass Casualty Incident
An incident which generates more
patients than available resources
can manage using routine
procedures
Determining Factors
 number of patients
 number of ambulances.
number of available, qualified personnel.
personnel efficiency.
number of appropriate hospital beds.
minus the number of beds occupied by patients.
communications system capacity.
Medical concerns
Search and rescue
 Triage and initial stabilization
 Evacuation
 Definitive medical care

Search and Rescue




Local population is usually your first
search and rescue team
Communities are now developing
specially trained Search and rescue teams
Technical specialists knowledgeable in
HAZMAT, structural engineering, and
technical search and rescue equipment
such as listening devices, remote
cameras etc.
May include trained canines
START
Simple
Triage
And
Rapid
Treatment
START

Developed in the early 1980’s

Rapid approach to triaging large
numbers of casualties

Easy to remember
START MCI Triage

Initial assessment and treatment
should take less than 30 seconds for
each patient
Triage Categories
Red (Priority 1)
 Yellow (Priority 2)
 Green (Priority 3)
 Black (Dead or death is imminent)

TRIAGE RED

Red
Priority 1
Immediate

Life threatening
but treatable
injuries requiring
rapid medical care
TRIAGE YELLOW

Yellow
Priority 2
Delayed

Potentially serious
injury but stable
enough to wait a
short time for
treatment
TRIAGE GREEN

Green
Priority 3
Minor

Minor injury that
can wait longer for
treatment
Triage Black

Black


Deceased
(holding)
Deceased,
Patients with
irreversible injuries
for which death is
imminent
Triage Begins

Clear the walking wounded from site
using verbal instruction
Direct them to treatment areas for
detailed assessment and treatment
Tag as GREEN or Priority 3
RPM

Respirations

Perfusion

Mental Status
Assessment guide
R
30
P
2
M
Can DO
What’s your call?
An adult, shaking his head, non
ambulatory. He says he’s too dizzy
to walk.
 RR 20
 CR 2 sec
 Obeys commands

What’s your call?
Adult female, had been trapped by
her lower legs under caved-in
wreckage.
 RR 24
 Cap refill 4 sec
 Moans with verbal stimulus

What’s your call?
A woman is carrying a crying infant.
She is able to walk.
 RR 20
 CR 2 sec
 Obeys commands

What’s your call?
An adult male lies on the ground
 RR 20
 Good distal pulse
 Obeys commands but cries that he
can’t move his legs

OR
What’s your call?
Adult Female apparent Compound
fracture, left femur
 Respirations over 36/minute
 Radial pulse weak
 Awake

Triage Tag Sample
Hospital Triage
Secondary Triage
 Quickly reassess
 Triage should take place outside of
ER dept.
 Initial hospital triage can be
changed from initial field triage.

Triage

Triage is a dynamic process and is
often done more than once for each
patient.
Triage Tagging
Commercial product
 Ribbons
 Skin Markers
 Colored tape

Questions
Thank you for all that you do!