UMEM Educational Pearls

Category: Misc

Title: START Triage

Keywords: Triage, Mass Causality (PubMed Search)

Posted: 12/31/2011 by Michael Bond, MD (Updated: 5/16/2022)
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START Triage

START triage is a simple system to implement that does not require any special equipment in order to determine who needs immediate, delayed or non-urgent care during a mass causality.

START stands for Simple Triage And Rapid Treatment. Patients are triaged based on 4 factors:

  • Ability to walk away from the scene
  • Respiration > or < 30 respirations per minute
  • Pulse (radial pulse present or not) or Capillary refill > or < 2 seconds
  • Mental Status – ability to follow simple commands or not

The steps are:

  1. If a patient can leave the scene they are minor and do not need immediate help. Category GREEN
  2. If there are no respirations or respirations > 30 they require immediate care Category RED
  3. Otherwise check pulse. If pulse is absent or capillary refill > 2 seconds they require immediate care Category RED
  4. Otherwise check mental status.  If they are not able to follow commands they need immediate care.  Category RED
  5. If they can follow commands they are delayed treatment. Category YELLOW

So those that can leave are green, those that do not meet any of the START criteria are YELLOW, and those with any of the four factors are RED or DEAD.