| What it is: All forms of triage are systems for | | | | easy to learn, simple to remember (especially |
| identifying and sorting/classifying levels of severity | | | | under stress) not require any diagnostic skills, and |
| of injury or illness. Every hospital Emergency | | | | should allow the triage (caregiver) to immediately |
| Room has a limited number of beds and medical | | | | stabilize any basic life-threats encountered. The |
| staffing so there is always a Triage Nurse to | | | | system most widely recognized and used is the |
| greet you at the door, so that those at risk for | | | | S.T.A.R.T. System" |
| worsening or death can be prioritized and be | | | | - from "Prehospital Triage" by Matthew R. |
| treated first, while those whose condition is | | | | Streger, BA, NREMT-P from EMS Magazine, The |
| assessed to be minor, moderate, or | | | | Journal of Emergency Care, Rescue, and |
| non-life-threatening, can be sent to the waiting | | | | Transportation. |
| room to wait for their turn. | | | | How it is: S.T.A.R.T. triage is a fast, compact, |
| Disaster triage, though based on the same | | | | simple, and very specific system for identifying |
| principles, is different in a number of ways. Most | | | | and marking (or "tagging" because a color-coded |
| importantly, it must be faster (because there are | | | | tag is often used) the injured into four groups or |
| so many injured at once, and because seconds or | | | | levels of priority. As each one is triaged they are |
| minutes may make the critical difference) and it | | | | given brief, essential treatments as needed, and |
| must be simpler, so that it can be done by almost | | | | the Triager moves from person to person until all |
| anyone, without medical knowledge or professional | | | | are looked at quickly and given the first-action |
| training. | | | | treatments as needed. More care is given later, |
| S.T.A.R.T. multi-casualty triage is the system used | | | | after rapid triage is done and help has been |
| by medical, rescue, and emergency personnel, | | | | requested. |
| both professional and volunteer, to make the best | | | | Disaster triage could be described as "choosing |
| use of limited medical resources when the number | | | | the best of the worst" because we are giving |
| of injured needing care exceeds the resources | | | | first priority to those who will actually benefit |
| available. The goal is to "Do the most good for | | | | from it most - those who have a good chance to |
| the most people." When performed in line with | | | | survive and recover IF they get help soon. We |
| recognized standards of practice, in most | | | | don't give first priority to the ones with minor |
| countries triage is recognized and sanctioned by | | | | injuries, because waiting will not change their |
| law. | | | | outcome. We do not give it to the moderate |
| "Our goal is to maximize the number (of people) | | | | injuries, because waiting will not change their |
| who will survive the incident. Some patients will | | | | outcome. We do not give it to the deceased, |
| live no matter what medical care they receive, | | | | because waiting will not change their outcome. We |
| and some will die regardless of the care they | | | | give first priority to those where it makes the |
| receive. Others will die UNLESS they receive | | | | critical difference, and S.T.A.R.T. triage identifies |
| medical care immediately (but have a good | | | | those for us. We do not have to decide |
| chance of survival if they do). We Don't want to | | | | ourselves. |
| utilize valuable resources on people who are | | | | "Between 75% to 85% of fatalities occur within |
| certain to die, nor on people who will survive | | | | the first 20 minutes of the event, usually before |
| without medical care. Our goal is to identify those | | | | EMS (911 emergency response) can arrive." |
| who will survive the event with immediate care, | | | | In the chaos and confusion of a disaster, a simple |
| and get it for them as soon as possible." | | | | plan like this works, and has been proven in actual |
| - from "Prehospital Triage" by Matthew R. | | | | practice to save about 40% more lives since its |
| Streger, BA, NREMT-P from EMS Magazine, The | | | | inception more than 25 years ago. That's why it's |
| Journal of Emergency Care, Rescue, and | | | | used by Medical Rescue and Public Safety |
| Transportation. | | | | agencies in the U.S. and many countries worldwide. |
| The basic goals of S.T.A.R.T. (which stands for | | | | The S.T.A.R.T. triage you learn and use in Disaster |
| simple triage and rapid treatment/or transport) | | | | First Aid is the same system they use, |
| are to sort injured persons based on probable | | | | condensed and simplified for civilians and |
| needs for immediate care, to give brief essential | | | | non-professionals. The average person may not |
| life saving interventions, and also, to recognize | | | | have the same equipment professional rescuers |
| futility. In this way, a small number of emergency | | | | carry, but s/he does have everything that's |
| workers and helpers can determine and act upon | | | | needed to do S.T.A.R.T. triage and save lives in |
| those persons and conditions which will benefit | | | | those critical first minutes and hours while waiting |
| most from the expenditure of the limited | | | | for help to come. |
| resources available. | | | | S.T.A.R.T. Triage and Disaster First Aid are |
| The origin of triage in general goes back to the | | | | designed and intended for large, multi-casualty |
| time of Napoleon, but the type of triage we will | | | | events where it's obvious that there will not be |
| discuss here -S.T.A.R.T. triage, was developed by | | | | enough ambulances and paramedics for each and |
| Newport Beach Fire Department and Hoag | | | | every one who is injured, and many must wait. |
| Memorial Hospital in Orange County California in | | | | So help must be rationed and applied where it will |
| the mid 1980's. Considered the Gold Standard of | | | | be the most effective and make the most |
| field and multi-casualty triage, S.T.A.R.T. is now | | | | difference. (Please note that Neither S.T.A.R.T. nor |
| practiced all over the world. | | | | Disaster First Aid should be used as substitute for |
| Why it is: Some injuries require immediate medical | | | | medical care at any time when that is available.) |
| care. Serious trauma may require surgery within | | | | Using the S.T.A.R.T. formula may be stressful, |
| one hour of the injury, which has been called "the | | | | especially for civilians and volunteers, who though |
| Golden Hour." Since surgeons can only treat one | | | | trained will not be very experienced in triage. It's |
| person at a time, when there are many more, | | | | important to remind everyone that they are not |
| they must be sent to a more distant hospital, | | | | deciding the fate or outcome of any injured |
| because hospitals in the disaster area will be | | | | person, they are simply applying the time-tested |
| overrun or may be shut down by damage. So it | | | | and proven formula which makes the decisions |
| becomes critical to identify these injured early. | | | | for them. Knowing this gives direction, courage, |
| Also very important about S.T.A.R.T. triage - each | | | | and moral support not only to the citizen rescuer |
| injured person, while being triaged, is also minimally | | | | helpers, but also to the hundreds of thousands of |
| treated with life-saving procedures (such as | | | | police, fire, ambulance and rescue crews |
| opening blocked airways, controlling bleeding, | | | | throughout the world who use this formula every |
| positioning for airway safety, and treating for | | | | day in all multi-casualty emergencies. S.T.A.R.T. |
| incipient shock). | | | | works. It does save the most lives that can be |
| "A system is needed to determine the severity | | | | saved. |
| of each patient quickly and accurately. It should be | | | | |