November 15, 2003
"It is a race against time..."
You're first at the scene of a horrible, terrifying wreck. People are screaming in pain and fear, writhing in agony and despair. You freeze; you want to run, so many hurt people, where do you START? The woman with a broken femur sticking out of her thigh? The kid choking on his own blood, the other kids squirming like a bucket of blackfish? You feel overwhelmed and your mind is overloaded.
This is a problem all responders may face, sooner or later. Too many patients and too little resources, you will need to triage; (from the French word "to sort") and you need to do it fast.
In 1983 the Newport Beach Fire Dept. developed the START system. This stands for Simple Triage and Rapid Treatment. This triage system has been updated and has rapidly become "state of the art" for triage in the United States. The system comes in a red fanny pack, with about 35 colored and numbered triage tags along with some paramedic shears and tie wraps and some red reflective adhesive "Immediate" stickers. It is simple; it was designed for rescuers with basic first aid skills and it has been proven in the field.
First, as with any scene, ensure your safety! Then you want to move the "walking wounded." They get green tags. For example, Aeromed Delta did this in the April 2001 Nelson Island aircraft crash. Gene Wiseman, MICP, shouted, "everyone who can walk come over here." All but two of the patients then got up and walked over. He then knew which patients were the most serious.
Open the airway. If the patient is not breathing after a head tilt/chin lift and an oral pharyngeal airway insertion (OPA), this patient will get Black Tags (dead/dying).
Remember R.P.M. Respirations, Pulse, Mental Status.Then you check respirations. If respirations are over 30 a minute, the patient gets a Red Tag (immediate).
Check the patient's radial pulse. If they have none, they get a Red Tag (immediate).
Check the patient's mental status. If they are unable to follow simple commands, they get Red Tag (immediate).
Otherwise, all patients will get a Yellow Tag (delayed).
All red-tagged patients get the adhesive reflective sticker placed on them. This helps the responder keep track of the immediate patients in low light situations.
More information can be found a www.start-triage.com
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