Procedure 35 S.T.A.R.T. Triage 08/13/2019

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Questions and Answers

What is the primary purpose of the START method in triage?

To provide immediate medical treatment to all casualties on-site

To prioritize victims based solely on their level of consciousness

To rapidly categorize a large number of victims regardless of medical training (correct)

To assess victims based on their age and medical history

In the assessment of adults using the START method, what step follows the evaluation of respirations?

Begin administering treatment for those who can self-aid

Assess perfusion if the respiratory rate is less than or equal to 30/minute (correct)

Tag victims with triage ribbons immediately after assessment

Assess mental status before determining priority

Which color ribbon is used to indicate a victim who is deceased and non-salvageable?

Yellow

Red

Green

Black (correct)

What should be done first when triaging a non-ambulatory victim?

Assess and tag them according to their priority Signup and view all the answers

When using the JumpSTART method for pediatric patients, which of the following is NOT assessed as part of the RPM criteria?

Age of the victim Signup and view all the answers

If a victim is not breathing and obstruction removal doesn't establish breathing, what priority should they be given?

Black Signup and view all the answers

What is the maximum time allocated for assessing each victim in the START system?

60 seconds Signup and view all the answers

Which statement regarding the triage ribbons is true?

The green ribbon is used to tag minor injuries or ambulatory patients. Signup and view all the answers

What should be done if a victim displays no radial pulse and a capillary refill time greater than 2 seconds?

Prioritize as RED and move to the next patient. Signup and view all the answers

When should a tourniquet be applied according to the guidelines?

When major external bleeding is identified. Signup and view all the answers

Under which circumstances should a patient be prioritized as GREEN?

They are ambulatory and able to follow commands. Signup and view all the answers

What is the correct procedure if a pediatric victim is breathing but has a pulse?

Give 5 ventilations and monitor for a return of respiration. Signup and view all the answers

During the triage process, what action should be taken if a RED ribbon is produced?

Tag the patient and proceed to the next patient. Signup and view all the answers

What is NOT a recommended action during the triage phase?

Cutting off clothing to assess the wound site. Signup and view all the answers

Which scenario prioritizes a victim as YELLOW in the mental status assessment?

The victim is oriented x3 but non-ambulatory. Signup and view all the answers

What does the acronym RPM stand for in the context of the JumpSTART system?

Respirations, Perfusion, Mental status. Signup and view all the answers

If an infant is encountered and unable to walk or being carried, how should they be prioritized?

Prioritize as GREEN if stable and with no significant injury. Signup and view all the answers

Study Notes

Introduction to START Triage

START (Simple Triage and Rapid Treatment) method designed for rapid assessment of numerous victims.
Accessible for all personnel, independent of medical training.
Used by first responders at Mass Casualty Incidents (MCI) or Casualty Collection Points (CCP).
Pediatric adaptation known as JumpSTART, addressing children's physiological differences.

Triage Procedure - EMR/BLS

Initial Triage:
- Locate walking wounded and direct them to a safe area.
- Assign personnel to manage and keep walking wounded together.
- Assess non-ambulatory victims where they lie.
- Employ START for adults and JumpSTART for children during assessment.
- Use Triage Ribbons for priority tagging, representing colors:
  - RED: Immediate Care
  - YELLOW: Delayed Care
  - GREEN: Minor (ambulatory)
  - BLACK: Deceased
- When unsure, err on the side of higher priority (e.g., tag a Green/Yellow patient as Yellow).

START Triage System

Corral Walking Wounded:
- Gather walking wounded away from the incident site.
- Encourage self-aid for bleeding control.
Assessment Time:
- Each victim should be triaged in 60 seconds or less.
RPM Assessment (Respirations, Perfusion, Mental Status):
- Respirations:
  - Rate ≤ 30/minute: Proceed to Perfusion assessment.
  - Rate > 30/minute: Prioritize as RED.
  - If not breathing, open airway and insert airway adjuncts; prioritize as RED if breathing resumes.
  - If still not breathing, prioritize as BLACK.
- Perfusion:
  - Control major external bleeding, apply tourniquets as needed.
  - Record tourniquet application time visibly on the patient.
  - Assess radial pulse or capillary refill time (CR).
  - If pulse is present or CR ≤ 2 seconds: Proceed to Mental assessment.
  - If pulse absent or CR > 2 seconds: Prioritize as RED.
- Mental Status:
  - Check ability to follow commands and orientation (Oriented X3).
  - If ambulatory and Oriented X3: Prioritize GREEN.
  - If non-ambulatory but Oriented X3: Prioritize YELLOW.
  - If unable to follow commands or disoriented: Prioritize RED.

JumpSTART for Pediatrics

Direct walking wounded.
Stable RPM and ambulatory: Prioritize GREEN.
Stable RPM but non-ambulatory: Prioritize YELLOW.
Infants unable to walk: Use JumpSTART; if meeting no RED criteria, prioritize as GREEN.
JumpSTART RPM Assessment:
- Respirations:
  - Rate ≤ 45 or ≥ 15/minute: Proceed to Perfusion.
  - Rate outside this range: Prioritize as RED.
  - If not breathing but with pulse, administer ventilations; if breathing resumes: RED.
  - If still not breathing, prioritize as BLACK.
- Perfusion:
  - Similar to START; control bleeding with tourniquets and record application time.
- Mental Status:
  - Evaluate using AVPU (Alert/Verbal); if unresponsive prioritize as RED.

Special Considerations in Triage

First assessment that results in RED tag halts further evaluation.
Only manage immediate life threats like airway obstruction or severe hemorrhage in triage.
Encourage self-aid for bleeding control.
Triage personnel to carry minimal equipment (ribbons, bandages, tourniquets, airway adjuncts).
Avoid cutting clothing; apply tourniquet above bleeding site over clothing (“high & tight”).
Advanced interventions (wound packing, chest seals) occur after triage and tourniquet application.
Reassess non-MDFR personnel’s bleeding control measures only after triage completion.

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Description

This quiz explores the Simple Triage and Rapid Treatment (START) method for assessing multiple victims in emergency situations. It highlights the importance of rapid evaluation by first responders, emphasizing adaptations for children. Perfect for those interested in emergency management and medical response.