S.T.A.R.T.

Triage 

S.T.A.R.T. Logo and Algorithm

reprinted with permission of Hoag
Memorial Hospital Presbyterian and
Newport Beach Fire Department.
 Course Objectives
• Define MCI
• Describe Levels of On-scene Triage for
MCI
• Describe the Use and Purpose of START
Triage as an Initial Triage System
• Describe the Accepted Use of START
Triage Tags
 MCI

Multi Casualty Incident

• An accident or emergency that overwhelms

local response capability
 ICS
• Creates and provides for compatibility and
integration of all responding agencies
 ICS

Incident Command System

• Structural approach to emergency response

– Personal Roles
– Lines of Authority
– Effective Communication
 MCI?
• Multi Casualty Incident
• Mass Casualty Incident
• MVI Multi or Mass Victim Incident
 Field Triage

Accomplish the greatest medical good

for the greatest number of people
 Effective Field Triage
• Medically responsible
• Rapid
• Simple
• Smooth Transitions
Field Triage Consortium
Medical
Command

Triage Treatment Transport

Primary Secondary Tertiary

Triage Triage Triage
Speed

Accuracy

Organization
3 Assessments
Ventilation
Perfusion
Cognition

2 Treatments
Airway Maintenance
Hemorrhage Control
 RESPIRATION

NONE YES

REPOSITION AIRWAY
ASSESS RESPIRATIONS/VENTILATION

NONE YES < 30/MINUTE > 30/MINUTE

ASSESS IMMEDIATE
DECEASED IMMEDIATE PERFUSION

PERFUSION

< 2 SECONDS > 2 SECONDS

ASSESS CONTROL BLEEDING
MENTAL STATUS IMMEDIATEED

MENTAL STATUS

FOLLOWS SIMPLE FAILS TO FOLLOW

COMMANDS SIMPLE COMMANDS
DELAYED IMMEDIATE
 RESPIRATIONS/VENTILATION

NONE YES

REPOSITION AIRWAY
ASSESS RESPIRATIONS/VENTILIATION

< 30/MINUTE > 30/MINUTE

NONE YES ASSESS
IMMEDIATE
DECEASED IMMEDIATE PERFUSION
 PERFUSION

< 2 SECONDS
ASSESS > 2 SECINDS
MENTAL STATUS CONTROL
BLEEDING
IMMEDIATE
 MENTAL STATUS

FOLLOWS FAILS TO FOLLOW

SIMPLE SIMPLE
COMMANDS COMMANDS
DELAYED IMMEDIATE
 START
WHERE YOU
STAND
Walking Wounded
 Primary Triage
• Rapid patient assessment and tagging
• Immediate live sustaining care, as necessary
 Secondary Triage
• Document, reassess and sort patients by
treatment needs
• Provide medical treatment as appropriate
and available
 Tertiary Triage
• Reassess condition of patients relevant to
resources, transportation and medical
facilities
• Determine priority for disposition of
patients from incident site
 Normal Pediatric Vital Signs

Age Heart Rate Systolic BP Respiration

Newborn 100-160 50-70 30-60
1-6 weeks 100-160 70-95 30-60
6 months 90-120 80-100 25-40
1 year 90-120 80-100 25-40
3 years 80-120 80-110 20-30
6 years 70-120 80-110 18-25
10 years 60-90 90-120 15-20
 Exercise Objectives
• Rapid and accurate application of START
Triage during an MCI