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JumpSTART Triage Method: How to accurately distinguish between acute and serious patients at a disaster scene?
In the event of a major disaster, an effective triage system can mean the difference between life and death. JumpSTART triage is a triage tool designed specifically for children that is intended to quickly and accurately identify patients who need immediate medical attention. The tool was developed in 1995 by Dr. Lou Romig, an emergency physician at Miami Children's Hospital, inspired by observations of children affected by Hurricane Andrew in 1992.
What is JumpSTART?
JumpSTART triage is a variation on the Simple Triage and Rapid Action (START) system, but focuses on children, particularly those under eight years old. This was done by categorizing patients into four categories: immediate, delayed, minor injury, and deceased or expected. At a disaster site, every second is precious, so accurate triage can effectively optimize the allocation of medical resources.
In skip triage, a patient's criticality and medical needs are assessed quickly, which can save lives.
Triage categories
The JumpSTART system divides patients into four categories based on their condition:
- Immediate: Life-threatening injury; medical attention required within one hour
- Delayed: Injury that is not life-threatening; although medical attention is required, it can be delayed for several hours
- Minor injuries: minor injuries; may require medical attention in the next few days (so-called "walking wounded")
- Dead or expecting: Deceased or too ill to receive life-saving treatment with available resources
JumpSTART algorithm flow
Step 1: Identify ambulatory patients
Same as START, at the beginning, the triage doctor instructs all patients who can walk to move to the designated area and marks these patients as green (minor injuries). These patients were then secondary triaged by clinicians assigned to the green zone.
Step 2: Is the patient breathing?
In this step, the doctor first confirms whether the patient is breathing. If the patient is breathing, they proceed to step three; if not, an airway maneuver is performed. If the patient resumes spontaneous breathing after airway manipulation, they will be marked as red (immediate).
Step 3: Assess respiratory rate, perfusion, and psychological status
In this step, the patient's respiratory rate, pulse, and psychological state are further assessed and classified according to the assessment results:
If the patient's respiratory rate is below 15 or above 45, or if they have no peripheral pulse, or if their mental state is not appropriate for their age, they will be marked red; if their respiratory rate is between 15-45 and their mental state is normal, will be marked in yellow.
Literature Review
Although JumpSTART has been repeatedly evaluated for use in simulated disaster environments, there is still a lack of effectiveness and reliability research in real-life major casualty cases. Studies have shown that after learning the JumpSTART algorithm, medical personnel can improve their ability to triage pediatric patients and maintain relative accuracy.
A 2013 study found that medical residents at all career stages easily mastered the JumpSTART algorithm, demonstrating high assessment reliability. However, for ambulatory patients, the reliability is relatively low. In comparison, in a simulated pediatric mass casualty event, JumpSTART performed on par with the SALＴ triage system, but JumpSTART was superior in triage time per patient, saving an average of eight seconds.
Although JumpSTART performs well in most simulated scenarios, its sensitivity and specificity in real scenarios still need to be improved.
As attention to disaster medical needs has increased, triage systems have evolved. For healthcare providers, the ability to effectively identify and quickly treat critically ill patients is not only the key to improving medical outcomes, but can also make the difference between life and death. In the future, should we seek more comprehensive research to verify and improve the feasibility of these triage systems?
