FULL TRIAGE

FULL TRIAGE HELP

This app is intended to help students learn START and JumpSTART Triage.

It is provided for general informational purposes only. Please read my full disclaimer and privacy policy.

Triage in EMS generally describes the process of sorting mass casualty patients based on the severity of their conditions with the intent of prioritizing treatment and maximizing the number of survivors.

START is a mnemonic for "simple triage and rapid treatment," and is a widely-accepted triage system for adults. JumpSTART is a derivative of START that is intended for children approximately 2 through 8 years old. It takes into account differences in respiratory rates and the ability of children to more easily recover from apnea than adults. Both are based on the following 4 color-defined categories:

In both the START and JumpSTART triage systems, adults who can walk to a designated location and children who can walk and are oriented are classified as Green. The others are classified according to their respirations, perfusion, and mental status.

Adults who are not breathing and do not start after an attempt to open their airways are classified as Black. Those who start breathing are classified as Red.

Children who are not breathing, do not start breathing after an attempt to open their airways, and still do not start breathing after given 5 rescue breaths are classified as Black. Those who start breathing are classified as Red. This difficultly in absorbing this step is that a non-breathing child who could have a pulse would need to be left for dead in order to complete the triage.

Adults who are spontaneously breathing less than 30 times per minute, have a capillary refill time less than 2 seconds, and can follow simple instructions such as "Wiggle your fingers." or "Tell me your name." are classified as Yellow. All other adults are classified as Red.

Children who are spontaneously breathing more than 15 and less than 45 times per minute, have a capillary refill time less than 2 seconds, and are alert or respond to voice or localize pain are classified as Yellow. All other children are classified as Red.

Patient who can walk but are too disoriented to follow directions would be classified as Red.

To re-cap:

Red: Immediate Care, First Priority

1. A child who is unable to walk and is not breathing but starts breathing after his or her airway is opened.
2. A child who is unable to walk and is not breathing but has a pulse. The patient starts breathing after 5 rescue breaths.
3. A child who is unable to walk and is breathing less than 15 or greater than 45 times per minute.
4. A child who is unable to walk, is breathing within 15 to 45 times per minute, and has no palpable pulse.
5. A child who is unable to walk, is breathing within 15 to 45 times per minute, and has a palpable pulse. The child has an inappropriate or no response to pain.
6. An adult who is unable to walk and not breathing but starts breathing after his or her airway is opened.
7. An adult who is unable to walk and is breathing greater than 30 times per minute.
8. An adult who is unable to walk and is breathing less than 30 times per minute. A radial pulse is absent.
9. An adult who is unable to walk and is breathing less than 30 times per minute. A radial pulse is present. The patient can not follow simple instructions.

Yellow: Delayed Care, Second Priority

1. A child who is unable to walk, is breathing within 15 to 45 times per minute, and has a palpable pulse. The child is alert or responds to voice or localizes pain.
2. An adult who is unable to walk and is breathing less than 30 times per minute. A radial pulse is present. The patient can follow simple instructions.

Green: Walking Wounded, Third Priority

1. A child who is able to walk to a designated location.
2. An adult who is able to walk to a designated location.

Black: Dead or Dying, No Priority

1. A child who is unable to walk, is not breathing, and has no palpable pulse.
2. A child who is unable to walk and is not breathing but has a pulse. The patient does not start breathing after 5 rescue breaths.
3. An adult who is unable to walk, is not breathing, and does not start breathing after his or her airway is opened.

For very young patients or for patients with naturally occurring disabilities, first responders must refer to their local protocols or use their own judgment. For example, some areas define children as anyone younger than 12. And in some areas, children who are developmentally unable to walk are classified as Yellow unless they meet a Red or Black criterion.

Some protocols require two attempts to open an airway and in many protocols the capillary refill check has been replaced by a pulse check.

Of the various triage systems, none is perfect. For example, an alert, ambulatory patient with an arm amputation might be Green by START standards but should more realistically be Red. In these unusual cases, first responders must refer to their local protocols or use their own judgment.

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