The START system is a rapid triage method used during mass-casualty incidents when there are more patients than available rescuers or resources. This cheat sheet helps students understand how responders sort patients quickly, safely, and consistently. It focuses on decision-making, color categories, and the basic checks used to assign treatment priority.
These concepts are important for emergency medicine, public safety, disaster response, and health science pathways.
START stands for Simple Triage and Rapid Treatment, and it uses a fast assessment of respiration, perfusion, and mental status. Patients are first separated by whether they can walk, then non-walking patients are checked for breathing, circulation, and ability to follow commands. The main triage colors are green for minor, yellow for delayed, red for immediate, and black for deceased or expectant.
The goal is to do the greatest good for the greatest number while using limited time and supplies.
Key Facts
- START stands for Simple Triage and Rapid Treatment, a system used to sort many patients quickly during a mass-casualty incident.
- The first START step is to ask all patients who can walk to move to a safe area, and these patients are initially tagged green.
- If a non-walking patient is not breathing, open the airway; if breathing begins, tag the patient red, and if breathing does not begin, tag the patient black.
- A respiratory rate greater than 30 breaths per minute in an adult is tagged red because it suggests severe distress or shock.
- Perfusion is assessed by capillary refill greater than 2 seconds or absent radial pulse, and either finding makes the adult patient red.
- If the patient cannot follow simple commands, the patient is tagged red because altered mental status can signal poor brain perfusion or serious injury.
- A non-walking adult patient who is breathing 30 times per minute or less, has adequate perfusion, and can follow commands is tagged yellow.
- Triage tags can change after reassessment because patient condition, resources, and scene safety may change over time.
Vocabulary
- Triage
- Triage is the process of sorting patients by urgency of need when medical resources are limited.
- START
- START is a rapid adult triage system based on walking ability, breathing, perfusion, and mental status.
- Mass-casualty incident
- A mass-casualty incident is an emergency with more patients than the available responders, equipment, or transport can immediately manage.
- Perfusion
- Perfusion is the delivery of blood and oxygen to body tissues, often estimated in START by radial pulse or capillary refill.
- Respiratory rate
- Respiratory rate is the number of breaths a person takes per minute, with greater than 30 breaths per minute indicating red priority in adult START.
- Triage tag
- A triage tag is a color-coded label used to communicate a patient's treatment and transport priority.
Common Mistakes to Avoid
- Treating the first patient seen before sorting the scene is wrong because START prioritizes rapid assessment of all patients before detailed care.
- Tagging every serious-looking injury red is wrong because START uses specific findings such as breathing rate, perfusion, and mental status, not appearance alone.
- Forgetting to open the airway in a non-breathing patient is wrong because START requires one airway repositioning attempt before assigning black.
- Using adult START cutoffs for children is wrong because pediatric patients may require a different system such as JumpSTART.
- Assuming a triage tag is permanent is wrong because patients must be reassessed as their condition or available resources change.
Practice Questions
- 1 An adult patient cannot walk, is breathing 36 times per minute, has a radial pulse, and follows commands. What START color should be assigned?
- 2 An adult patient cannot walk, is breathing 24 times per minute, has capillary refill of 4 seconds, and follows commands. What START color should be assigned?
- 3 A non-walking adult patient is not breathing. After the airway is opened, the patient begins breathing. What triage color is assigned and why?
- 4 Why does START focus on rapid sorting instead of complete diagnosis during a mass-casualty incident?