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One second determines fate! How to identify the injured who need treatment most in an instant?
In mass casualty incidents, the challenge facing rescue workers is often how to correctly identify the injured who need immediate medical attention in a very short period of time. In response to this need, the Simple Triage and Rapid Treatment (START) method was developed in 1983 by Hoag Hospital and the Newport Beach Fire Department in California, USA, and was quickly adopted throughout the United States.
START's classification system
When using the START method, first responders will classify the injured into one of four categories based on their condition:
1. Dead/Expecting (Black)
2. Immediately (red)
3. Delay (yellow)
4. Can walk with minor injuries (green)
These colors correspond to different triage labels, allowing rescue workers to quickly determine the condition of each injured person on the spot. If any injured person is able to move on their own, they will be directed first to a designated area to identify patients with walking injuries. For patients who are not ambulatory, further evaluation is performed. When a deceased patient is identified, rescuers will only try to open the airway. If breathing cannot be restored, the patient is considered deceased and marked with a black tag. After all patients have been evaluated, priority is given to those who require immediate attention.
Treatment and evacuation
After the casualty assessment is completed, rescuers will determine the priority of treating or evacuating the patients based on the START classification. Based on the START triage system, the order of patient transport is: patients with immediate marking are handled first, followed by patients with delayed marking, and finally patients with minor injuries.
Adjustments to the START method
Over time, different institutions have made various adjustments or improvements to the START approach. One of the early adaptations was to use the presence of a pulse instead of capillary refill time to determine the severity of the casualty. In addition, the FDNY uses a modified version of the START system that adds an orange "Emergency" label as an intermediate category between immediate and delayed.
START adjustments for children
The START method was further modified to more precisely address pediatric patients, and this version was called JumpSTART. The main difference from the criteria for adults is that JumpSTART adjusts for a child's "normal" respiratory rate, flagging them as a patient in immediate need if their respiratory rate is below 15 or above 45 breaths per minute.
Other related triage systems
Several triage systems similar to the START system have appeared on the market, such as Triage Sieve, Pediatric Triage Tape and CareFlite Triage, which are based on four or five colors.
Limitations of the START method
Although the START method is widely praised, there are some problems in its implementation, such as over-triaging patients. At the same time, because of the simplicity of START, experts have agreed that it needs to be more sophisticated to take into account resource limitations and treatment capacity.
In every emergency, the ability to make the right decisions quickly will save lives. This makes us think, in the face of emergencies, are you ready to make a decision in that one second?
