SUPERSTART HELP
This app is intended to help students learn the SuperSTART framework.
It is provided for general informational purposes only. Please read my full disclaimer and privacy policy.
SuperSTART is an mnemonical framework built around the widespread START and JumpSTART mass-causality triage systems. To master them means to be able to recall the essential protocols at any time in the near or distant future.
Both START and JumpSTART are typically characterized as algorithms, step-by-step processes based on assessment criteria. SuperSTART uses the same algorithms and is easily adapted to START and JumpSTART regional nuances. SuperSTART is characterized by priority categories based on the mnemonic 3-2-1-0.
The numbers in 3-2-1-0 correspond to corresponding triage categories, treatment priorities, and assessment criteria:
| 3 - Red | Altered Mental Status or Respiratory Distress or Signs of Shock |
| 2 - Yellow | Mentally Sound but Not Walking |
| 1 - Green | Walking-wounded |
| O - Black |
The Black category is for anyone who is obviously dead or does not fit into the other categories. The Green category is for those who can walk and follow a simple command. The Yellow category is for anybody who is not able to walk, but is still alert, oriented, and relatively healthy. The Red category (the highest priority) is the category that needs the closet attention since it is the last one to separate the living from the dying and has the most complex criteria.
Any adult who is unable to follow a simple command (i.e. "Squeeze my hand") is categorized as Red. Any child who is completely unresponsive or responds to pain with incomprehensible sounds or with inappropriate posturing is categorized as Red. A child is generally considered to be a patient less than 8 years old.
Any adult breathing more than 30 time per minute or a child breathing less than 15 or more than 45 breaths per minute is considered to be in respiratory distress. And any patient of any age who is not breathing but starts after one or two (depending on protocol) attempts are made to open his or her airway is also considered to be in respiratory distress, regardless of rate. All of these patients are categorized as Red.
Children get special attention because getting them to breath is typically easier than getting an adult to breath. Therefore, a child with a pulse who does not start breathing after his or her airway is opened is given 5 rescue breaths as a final attempt at resuscitation. If breathing resumes, the child is categorized as Red.
Signs of shock are typically determined by altered metal status and respiratory distress, as explained above, and by the absence of a pulse in a breathing adult or child. A breathing child who has a capillary refill time of less than 2 seconds is also generally considered to be in shock. A breathing adult with a capillary refill time of less than 2 seconds in sometimes considered to be in shock depending on the prescribed protocol.
Other indications for shock might or might not be permitted under local protocols and might or might not be worthy of consideration in particular cases. These include cool, clammy, pale, ashen, or cyanotic skin; nausea or vomiting; enlarged pupils; weakness or fatigue; or dizziness, anxiousness, or anxiety. Patients who are susceptible to imminent shock, such those with severe burns, might also categorize a patient as Red depending on local protocols or the particular situation.
Clearly there is not and never can be a perfect triage system, but remembering your protocols and using sound judgement if you ever have to respond to a mass casualty incident will go a long way in helping our neighbors and in managing our stress.
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