What Is START Triage?

G. Wiesen
G. Wiesen
Woman holding a book
Woman holding a book

Simple Triage and Rapid Treatment (START) is a form of triage typically utilized in the US at emergency or disaster scenes to quickly evaluate and provide proper assistance to those at the scene. START triage is a form of simple triage in which injured people are analyzed to determine their medical needs, and then assigned priority for treatment based on those needs. This is a standardized system that can easily be memorized and used by emergency medical workers, as well as non-medical emergency personnel. START triage utilizes four simple categories for prioritization: immediate care, delayed care, minor injuries, and deceased.

While START triage is similar to other forms of simple triage, it is a particular methodology that has been standardized and can be easily memorized and followed by emergency workers. Much like other forms of triage, it consists of a system by which injured people at the scene of a disaster or emergency can be analyzed and assigned priority for treatment. The START triage system was developed by the Hoag Hospital and the Newport Beach Fire Department of Newport Beach, California. It was designed as a form of triage that could quickly be used at the scene of an emergency, such as an earthquake.

START triage begins with a rapid analysis of the people at the scene of a disaster or emergency. This should take less than one minute, and first responders at such a scene are instructed to perform triage before providing any medical assistance. If help is given to individuals before triage is fully employed, then those who are most in need may be ignored in favor of those who were found first. START triage also employs the concept of the “golden hour,” which indicates that severely injured people at an emergency are more likely to survive if given proper treatment and life support within the first hour.

The use of START triage begins with an analysis of injured people; the “walking wounded” in need of little assistance are given the lowest priority. Those who are not breathing are evaluated next. If efforts to open the airway are successful and respiration begins then they are prioritized for immediate care, if such efforts fail then they are considered deceased. People who are breathing but are breathing extremely rapidly or lacking a radial pulse are typically given immediate prioritization as well. Those with a radial pulse, but who cannot follow simple commands are also prioritized for immediate care, while those who can follow simple commands are given delayed care prioritization.

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