Simple Triage and Rapid Treatment
START triage is a scene management system. Its very effective for mass casualty incidents. Like many aspects of emergency prehospital management, you don’t get much advance warning. You may go your whole career and never have an MCI. Then, one day, after breakfast, you are the first on scene of a 25 car pileup. So, we need a SIMPLE system that we can stuff into our brains that doesn’t take up a lot of room. START triage is that system.
Learn it once, review it every year, and take it seriously. WHEN you end up being that guy whose action or inaction changes the lives of a whole slew of people forever, “I wasn’t ready… I didn’t think it would happen to me… I forgot what to do” will not help you sleep. This is required knowledge for heroes. Learn it.
If you’re first on scene – Your goal is to find and triage all victims in a timely manner. Estimate the treatment and transportation resources that will be needed. Communicate with dispatch on the number and type of victims so proper resources are called.
START TRIAGE – QUICK AND DIRTY
Yell “Anyone who can walk, move over to that grassy area.” WALKING WOUNDED GREEN TAG
RPM – stands for Respirations, Perfusion, Mental Status
Respirations : Are they breathing? If so, are they breathing over or under 30/min?
Perfusion : Do they have a Radial pulse or capillary refill time under 2 seconds?
Mental Status: Can they stick out their tongue when asked.
Each patient should take less than 30 seconds…
Patient 1: Didn’t walk away when asked to do so
Is patient breathing? Not breathing. I adjust his airway. Still no respirations. I have no reason to move on in RPM. My assessment is done. He is deceased and given a black tag 0 and move on.
Patient 2: Didn’t walk away when asked to do so
Is patient breathing? Patient is breathing!
Assess: Respiratory rate greater or less than 30? Over 30/min.
My assessment is done: This patient requires IMMEDIATE tag Priority 1
To print out pre-formatted business card versions of the above image, citmt.org has made them available free http://www.citmt.org/start/download/flowchart00.doc
Very dramatic high quality video of MCI Start triage in action.
Now lets look at part 2 of the MCI Start triage video, and break down the RPM steps.
Funny video if you’re one of those people who remember things better in musical form:
Aside from our tests, I found this great 30 car pileup START triage assessment exercise online. Test your skills.