S.T.A.R.T. Triage S.T.A.R.T. Logo and Algorithm reprinted with permission of Hoag Memorial Hospital Presbyterian and Newport Beach Fire Department.

S.T.A.R.T. Triage

S.T.A.R.T. Logo and Algorithm reprinted with permission of Hoag Memorial Hospital Presbyterian and Newport Beach Fire Department.

Course Objectives

• Define MCI

• Describe Levels of On-scene Triage for MCI

• Describe the Use and Purpose of START Triage as an Initial Triage System

• Describe the Accepted Use of START Triage Tags

MCI

Multi Casualty Incident

• An accident or emergency that overwhelms local response capability

ICS

• Creates and provides for compatibility and integration of all responding agencies

ICS

Incident Command System

• Structural approach to emergency response– Personal Roles– Lines of Authority– Effective Communication

MCI?

• Multi Casualty Incident

• Mass Casualty Incident

• MVI Multi or Mass Victim Incident

Field Triage

Accomplish the greatest medical good for the greatest number of people

Effective Field Triage

• Medically responsible

• Rapid

• Simple

• Smooth Transitions

Field Triage ConsortiumMedical Command

Triage Treatment Transport

Primary Triage

Tertiary Triage

Secondary Triage

Speed

Accuracy

Organization

3 Assessments

VentilationPerfusionCognition

2 TreatmentsAirway MaintenanceHemorrhage Control

RESPIRATION

NONE YES

REPOSITION AIRWAY

ASSESS RESPIRATIONS/VENTILATION

NONE

DECEASED

YES

IMMEDIATE

< 30/MINUTEASSESS

PERFUSION

> 30/MINUTE

IMMEDIATE

PERFUSION

< 2 SECONDSASSESS

MENTAL STATUS

> 2 SECONDSCONTROL BLEEDING

IMMEDIATEED

MENTAL STATUS

FOLLOWS SIMPLECOMMANDS

DELAYED

FAILS TO FOLLOWSIMPLE COMMANDS

IMMEDIATE

RESPIRATIONS/VENTILATION

NONE YES

REPOSITION AIRWAY

ASSESS RESPIRATIONS/VENTILIATION

NONE

DECEASED

YES

IMMEDIATE

< 30/MINUTEASSESS

PERFUSION

> 30/MINUTE

IMMEDIATE

PERFUSION

< 2 SECONDSASSESS

MENTAL STATUS

> 2 SECINDSCONTROLBLEEDING

IMMEDIATE

MENTAL STATUS

FOLLOWSSIMPLE

COMMANDS

FAILS TO FOLLOWSIMPLE

COMMANDS

DELAYED IMMEDIATE

START

WHERE YOU

STAND

Walking Wounded

Primary Triage

• Rapid patient assessment and tagging

• Immediate live sustaining care, as necessary

Secondary Triage

• Document, reassess and sort patients by treatment needs

• Provide medical treatment as appropriate and available

Tertiary Triage

• Reassess condition of patients relevant to resources, transportation and medical facilities

• Determine priority for disposition of patients from incident site

Normal Pediatric Vital Signs

Age Heart Rate Systolic BP RespirationNewborn 100-160 50-70 30-60

1-6 weeks 100-160 70-95 30-606 months 90-120 80-100 25-40

1 year 90-120 80-100 25-403 years 80-120 80-110 20-306 years 70-120 80-110 18-25

10 years 60-90 90-120 15-20

Exercise Objectives

• Rapid and accurate application of START Triage during an MCI