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START (Simple Triage and Rapid Treatment) sorts adult patients at a multiple-casualty incident in seconds each. Triage questions sit in the EMS Operations domain and reward following the steps in order.
The steps
- Can they walk? Direct everyone who can walk to a collection point. They are green (minor) for now.
- Are they breathing? If not, open the airway once. Still not breathing: black (deceased / expectant). Breathing after repositioning: red (immediate).
- Respiratory rate. Over 30 a minute: red.
- Perfusion. No radial pulse, or capillary refill longer than 2 seconds: red.
- Mental status. Cannot follow simple commands: red. Follows commands: yellow (delayed).
During triage the only treatments are quick ones: opening an airway and controlling severe bleeding. Anything more and you stop triaging — which is the trap in many of these items.
Common traps
- Treating instead of sorting. The correct action is almost always to assign a category and move to the next patient.
- Loud patients. A patient screaming in pain is breathing and perfusing; the quiet one may be the priority.
- Children. Pediatric patients are commonly triaged with a modified system (JumpSTART); read the stem for age.
- Re-triage. Categories change. A yellow patient can become red.
Practice it with the compare card in CinnaEMS, which sets START categories against clinical priority side by side.