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Mass Casualty Triage System START, and JumpSTART
This document provides information on triage systems and procedures. It defines triage as sorting patients based on treatment priority. The START and JumpSTART triage systems categorize patients as red/immediate, yellow/delayed, green/minor, or black/deceased based on their respiration, pulse, and mental status. It outlines how to rapidly assess and tag patients in a mass casualty event using these criteria in 3 sentences or less per patient to maximize survivability. The document recommends clearing walking patients first and prioritizing life-saving interventions for immediate patients before movement or additional treatment.
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Mass Casualty Triage System START, and JumpSTART
- 1. MR. JOVEN BOTINBILBAO Deputy Chief Nursing Officer Al Hayat National Hospital
- 2. • Define TRIAGEand explain when it is appropriate for use • List three reasons a patient triage and tracking system is required for successful operations • Categorize the Triage status of patients utilizing the START and JumpSTART Triage Systems • Explain the design and use of paper Triage Tags • Identify five capabilities of the paper Maryland Triage Tags
- 3. The sortingof and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors (from the French trier, to sort) (Merriam-Webster) Developed by Baron Dominique-Jean Larrey, Napoleon's Chief Surgeon, for use by the first ambulance corps—the ambulances volantes—during the early 1800s
- 4. • Sorting ofpatients to provide for the survival of the most patients • Assignment of resources in the most efficient method • Most severe survivable injuries receive rapid treatment • Accountability of patients
- 5. Simple Triage AndRapid Treatment Triage: A rapid approach to prioritizing a large number of patients JumpSTART Incident Site Triage Unit Secondary triage Casualty Collection Point/ Initial triage
- 6. • Triage shouldbe performed RAPIDLY • Utilize START/ JumpSTART Triage to determine priority • 30–60 seconds per patient • Affix tag on left upper arm, leg or neck
- 7. •Clear the “walkingwounded” with verbal instruction: If you can hear me and you can move, walk to… •Direct patients to the casualty collection point / initial Triage Area or treatment area for detailed assessment and medical care •Assign a Green Minor Manager to the area to control patients and manage area •Tag will be issued at the casualty collection point / initial Triage Area •These patients may be classified as MINOR
- 8. Now use START/JumpSTART to assessand categorize the remaining patients…
- 9. Immediate 1 Urgent 2 Delayed3 Dead 0 RED Yellow Green Black ColorPriority Treatment
- 11. Categorize the patients by assessingeach patient’s RPMs… Respirations Pulse/perfusion Mental Status
- 12. RESPIRATIONS Is the patientbreathing? Yes Adult – respirations > 30 = Red/Immediate Pediatric – respirations < 15 or > 45 = Red/Immediate Adult – respirations < 30 = check perfusion Pediatric – respirations > 15 and < 45 = check perfusion
- 13. No Reposition the airway… Respirationsbegin = IMMEDIATE/RED If patient is APNEIC Adult – deceased = BLACK Pediatric: Pulse Present – give 5 rescue breaths respirations begin = IMMEDIATE/RED absent respirations – deceased = BLACK RESPIRATIONS Is the patient breathing?
- 14. PULSE/PERFUSION Is the RADIALpulse present? Is capillary refill (CR) LESS than < 2 seconds? Yes Check mental status No Adult: Pulse absent or CR > 2 seconds patient = IMMEDIATE/RED Pediatric: No palpable pulse patient = IMMEDIATE/RED START/JumpSTART—RPM
- 15. MENTAL STATUS… Can thepatient follow simple commands? Yes Adult = Pediatric: alert, verbal, or pain response is appropriate = No Adult = IMMEDIATE / RED Pediatric – “P” pain causes inappropriate posturing or “U” unresponsive to noxious stimuli = IMMEDIATE/ RED START/JumpSTART—RPM
- 16. If the patientis IMMEDIATE/RED upon initial assessment…then, before moving the patient to the treatment area, attempt only life-saving interventions: Airway, Needle Decompression, Tourniquet, Antidote DO NOT ATTEMPT ANY OTHER TREATMENT AT THIS TIME START/JumpSTART
- 17. CAN YOU WALK ? Breathing? Respiratory Rate? 5 Rescue Breaths IMMEDIATE IMMEDIATE IMMEDIATE Expected / Deceased DELAYED MINOR SECONDARY TRIAGE ** ** Using the JS algorithm evaluate all children first who did not walk under their own power. Evaluate infants first in secondary triage using entire JS algorithm ! BREATHING Position Upper Airway APNEIC NO YES HAS A PULSE NO PULSE APNEIC ADULT NO YES YES BREATHING < 30 ADULT 15 - 45 PEDI > 30 ADULT 45 > OR < 15 PEDI ADULT CR >2 Sec or NO PALPABLE PULSE PEDI - NO PALPABLE PULSE IMMEDIATE “P” INAPPROPRIATE POSTURING OR “U” ( PEDIATRIC ) IMMEDIATE Perfusion ? DOESN’T OBEY COMMANDS ADULT Mental Status ? PEDIATRIC OBEY COMMANDS - ADULT “A”, “V”, OR “P”( APPROPRIATE) - PEDIATRIC Http://www . jumpstarttriage . comHttp ://www . starttriage. com PEDI Neurological Assessment A Alert V Responds to Verbal Stimuli P Responds to Painful Stimuli Unresponsive To Noxious Stimuli U Combined START/JumpSTART Triage
- 18. Adult Respirations > 30BPM CR > 2 seconds or no palpable radial pulse Cannot follow simple commands Pneumothorax Hemorrhagic Shock Closed Head Injury Pediatric Respirations < 15 or > 45 CR > 2 seconds or no palpable radial or brachial pulse Inappropriate “Pain” (e.g., posturing) or “Unresponsive”
- 19. Adult: respirations, capillaryrefill, and mentation are normal • Isolated burns • Extremity fractures • Stable other trauma • Most patients with medical complaints Pediatric: “A,” “V,” or appropriate “P” (e.g., withdrawal from pain stimulus)
- 20. • “Walking wounded” • Psychological casualties •Always look for children being carried and assess them
- 21. • This categoryis not currently in use and must not be utilized until approved by MIEMSS • It is included on the paper tags in anticipation of national recognition and acceptance in the future is for the patient that is not likely to survive even with emergent interventions
- 22. • Obvious mortalityor death (pulseless and apneic) • Decapitation • Blunt trauma arrest • Injuries incompatible with life (future ) • Brain matter visible (future ) BLACK Triage Category (Deceased)
- 23. • Triage allowsfor effective and efficient care, helping to increase the survivability for as many patients as possible • Assignment of resources will increase efficiency • Most severely injured patients will receive rapid treatment and transport in logical order • Ensures accountability of all patients • Allows for family reunification
- 26.
- 28. An improvised explosivedevice is detonated at a large outdoor sporting event. At least 50 people are confirmed injured. EMS is on scene, but patients begin to arrive at your hospital before EMS. Triage and “Tag” the following patients.
- 29.
- 30.
- 31. Eviscerated bowel Multiple penetrating woundsto chest & head Brain matter exposed Unresponsive to tactile stimuli
- 32. Eviscerated bowel Multiple penetrating woundsto chest & head Brain matter exposed Unresponsive to tactile stimuli
- 33. Abd. Tenderness and minorpenetrating trauma Ambulating A & O x 3 RR 24 Strong radial pulse
- 34. Abd. Tenderness and minorpenetrating trauma Ambulating A & O x 3 RR 24 Strong radial pulse
- 35. Multiple penetrating injuries, bloodin ears Responds only to pain Airway clear RR 20 Strong Radial pulse
- 36. Multiple penetrating injuries, bloodin ears Responds only to pain Airway clear RR 20 Strong Radial pulse
- 37. Extremity fractures, blood inears A & O x 3 RR 26 Strong radial pulse
- 38. Extremity fractures, blood inears A & O x 3 RR 26 Strong radial pulse
- 39. Child, screaming Minor lacs,blood in ears RR 30 Moving all extremities
- 40. Child, screaming Minor lacs,blood in ears RR 30 Moving all extremities
- 41. Amputated fingers, head injury A& O x 3 Dizzy RR 24 Smells like beer
- 42. Amputated fingers, head injury A& O x 3 Dizzy RR 24 Smells like beer
- 43. Chest pain, SOB Notrauma noted RR 34 Shallow Weak radial pulse
- 44. Chest pain, SOB Notrauma noted RR 34 Shallow Weak radial pulse
- 45. Blood in nose,mouth and ears Not breathing
- 46. Blood in nose,mouth and ears Not breathing What would you do?
- 47. Blood in nose,mouth and ears Not breathing RR 10 with manual opening
- 48. Some penetrating trauma Unresponsive Apneic Noradial pulse Carotid 130/min
- 49. Some penetrating trauma Unresponsive Apneic Noradial pulse Carotid 130/min
- 50. Arterial bleed fromleg Responsive to pain RR 34 No radial pulse Carotid 130/min
- 51. Arterial bleed fromleg Responsive to pain RR 34 No radial pulse Carotid 130/min
- 52.
- 53.
- 54. Deviate trachea RR 40 Weakradial pulse +JVD Cyanosis
- 55. Deviate trachea RR 40 Weakradial pulse +JVD Cyanosis
- 56. Open fracture ofRUE Non-ambulatory A & O x 3 RR 26 Strong radial pulse
- 57. Open fracture ofRUE Non-ambulatory A & O x 3 RR 26 Strong radial pulse
- 58. 100% TBS burns(partial and full) A & O x 2 RR 36 Coughing Strong radial pulse
- 59. 100% TBS burns(partial and full) A & O x 2 RR 36 Coughing Strong radial pulse
- 60. CP, SOB Slurred speech Rsided weakness A & O x 1 RR 24 Strong radial pulse
- 61. CP, SOB Slurred speech Rsided weakness A & O x 1 RR 24 Strong radial pulse
- 62. Avulsion RUE Arterial bleed A& O x 2 RR 30 “I’m thirsty”
- 63. Avulsion RUE Arterial bleed A& O x 2 RR 30 “I’m thirsty”
- 64. Open fractures BLE Bloodin ears A & O x 3 RR 28 Strong radial pulse
- 65. Open fractures BLE Bloodin ears A & O x 3 RR 28 Strong radial pulse
- 66. Hysterical, screaming Blood inears A & O x 3 RR 36 Strong radial pulse
- 67. Hysterical, screaming Blood inears A & O x 3 RR 36 Strong radial pulse
- 68. Child Cyanotic from nippleline up Apneic
- 69. Child Cyanotic from nippleline up Apneic
- 70. • Increase familiarity/proficiencyof the START and Jump START triage methodologies • Increase familiarity with the Tag Triage System • Train with a standardized methodology and system