START & JumpSTART Triage systems

Question 1

First responders using START evaluate victims and assign them to one of the following four categories:

Answer 1

• Deceased/expectant (black)
• Immediate (red)
• Delayed (yellow)
• Walking wounded/minor (green)

Question 2

Identifying/Responding to ambulatory and non-ambulatory patients

What determines that a patient is classified as deceased and given a black tag?

Answer 2

Responders arriving to the scene of a mass casualty incident may first ask that any victim who is able to walk relocate to a certain area, thereby identifying the ambulatory, or walking wounded, patients.

Non-ambulatory patients are then assessed. The only medical intervention used prior to declaring a patient deceased is an attempt to open the airway. Any patient who is not breathing after this attempt is classified as deceased and given a black tag. No further interventions or therapies are attempted on deceased patients until all other patients have been treated.

Question 3

Patients who are breathing and have any of the following conditions are classified as immediate:

Answer 3

• Respiratory rate greater than 30 per minute;
• Radial pulse is absent, or capillary refill is over 2 seconds;
• Unable to follow simple commands
• All other patients are classified as delayed.

Question 4

The JumpSTART algorithm

Answer 4

Step 1: Identify ambulatory patients

• As with START, the triage clinician begins by instructing everyone who can walk to move to a designated area for treatment. All patients who are able to do this are immediately tagged green (minor). These patients are then fully triaged by a clinician assigned to the green area (secondary triage).
• In the JumpStart system, infants are evaluated first in secondary triage, using the entire JumpStart algorithm. Other children who did not walk on their own, but were carried to the treatment area, are evaluated next.

Step 2: Is the patient breathing?

Yes

• ​If the patient is breathing, the clinician proceeds to step 3.

​No

• As with START, an airway maneuver is first attempted. If the child starts breathing on their own, they are triaged red (immediate).
• However, unlike START, patients who do not have a spontaneous return of respirations following an airway maneuver are not immediately triaged Black. First the clinician feels for a peripheral pulse. If the child is apneic with no peripheral pulse, they are triaged black (deceased/expectant).
• If the child does have a palpable peripheral pulse, the clinician delivers five assisted ventilations. If the child remains apneic, they are triaged black. If the child has a return of spontaneous respirations, they are triaged red.

Step 3: Assess respiratory rate, perfusion, and mental status

The child is triaged red if:

• Their respiratory rate is under 15, or over 45; or
• They have no peripheral pulse; or
• Their mental status is age-inappropriate
  
  • Mental status is assessed using the AVPU scale. Age-inappropriate mental statuses include inappropriate responses to pain or unresponsiveness
  • Age-inappropriate mental status also includes posturing
    ​

To be triaged yellow, the child must (All 3 must apply):

• Have a respiratory rate between 15 and 45; and
• Have a palpable peripheral pulse; and
• Have an age-appropriate mental status (A, V, or P on the AVPU scale)