The START Triage Method

S.T.A.R.T. = Simple Triage and Rapid Treatment

• Developed by Hoag Memorial Hospital in Newport Beach, California.
• This type of triage has quickly become one of the most popular forms.

RPM = Respirations, Pulse and Mentation

This is the way EMS professionals are taught to rapidly assess patient’s airway, respiration, pulse and mental status while at the scene of a MCI, or multiple casualty incident. After the assessment has been completed, the patient is placed in one of the following four categories:

• Immediate: RED
• Delayed: Yellow
• Minor: Green
• Dead/Dying: Black

It is estimated that when working in pairs of two, EMS professionals can effectively triage 1 patient in 30 seconds. One thing that tends to get EMS professionals in trouble at the scene of MCI’s, is they get sucked into treatment. With the START triage method, EMS professionals are very limited on the type of treatment they can provide. Possible treatment includes:

• Open an airway via the H-T/C-L method
• Insertion of an OPA
• Application of direct pressure to stop bleeding

What constitutes an “IMMEDIATE” patient classification?

A patient who is critically injured and must be transported as soon as resources allow

• Respirations: greater than 30 per minute
• Perfusion: No radial pulse or a capillary refill time >2 seconds
• Mental Status: Unable to follow simple commands

What constitutes a “DELAYED” patient classification?

A severely injured patient who needs evaluation and treatment but may not require immediate transport

• Any patient who cannot walk, but has respiratory drive, and are within normal limits with RPM

What constitutes a “MINOR” patient classification?

Patients requiring minor treatment or prophylactic evaluation

• Any ambulatory patient
• It is important to remember that this is an initial classification and may be changed later 

What constitutes a “DECEASED” patient classification?

• Any patient who does not have respiratory effort after attempting to open the airway
• Any patient who will die before appropriate treatment is available

Remember this simple saying…

• 30 : 2 : Can Do

• Are the respirations greater or less than 30/minute?
• Is the cap refill time greater or less than 2 seconds?
• Can the patient follow simple command?

Asking yourself these questions during each rapid assessment at an MCI will help insure they’re initially triaged appropriately.