side by side comparison
Triage Systems: ED Triage vs Disaster Triage (START) — Different Rules for Different Situations
Your nursing instinct says treat the sickest patient first — and in the ED, that's correct. In a mass casualty, that instinct kills people. The NCLEX will hand you a disaster scenario and tempt you to pick the most critical patient; the correct answer is the most salvageable one.
Comparison
Side-by-side2 compared
Dimension
ED Triage (ESI)
Disaster Triage (START)
Guiding principle
- Sickest first — highest acuity gets resources
- ★Greatest good for the greatest number
Category system
- 5 levels (ESI 1–5) by acuity + resources
- 4 tags: RED, YELLOW, GREEN, BLACK
Seen first
- ESI 1 — resuscitation (arrest, intubation)
- RED — immediate & survivable (tension pneumo)
Lowest priority
- ESI 5 — non-urgent (refill, minor complaint)
- ★BLACK — expectant/dead; CPR not performed
Resource mindset
- Unlimited resources; all eventually treated
- Scarce resources sent to highest survival yield
Who triages
- Experienced ED RN (≥ 2 yr)
- Any trained responder at the scene
Reassessment
- Continuous re-triage in the waiting area
- Rapid 30–60 sec/victim; reassess after all
Guiding principle
ED Triage (ESI)
- Sickest first — highest acuity gets resources
Disaster Triage (START)
- ★Greatest good for the greatest number
Category system
ED Triage (ESI)
- 5 levels (ESI 1–5) by acuity + resources
Disaster Triage (START)
- 4 tags: RED, YELLOW, GREEN, BLACK
Seen first
ED Triage (ESI)
- ESI 1 — resuscitation (arrest, intubation)
Disaster Triage (START)
- RED — immediate & survivable (tension pneumo)
Lowest priority
ED Triage (ESI)
- ESI 5 — non-urgent (refill, minor complaint)
Disaster Triage (START)
- ★BLACK — expectant/dead; CPR not performed
Resource mindset
ED Triage (ESI)
- Unlimited resources; all eventually treated
Disaster Triage (START)
- Scarce resources sent to highest survival yield
Who triages
ED Triage (ESI)
- Experienced ED RN (≥ 2 yr)
Disaster Triage (START)
- Any trained responder at the scene
Reassessment
ED Triage (ESI)
- Continuous re-triage in the waiting area
Disaster Triage (START)
- Rapid 30–60 sec/victim; reassess after all
★ marks the fact that sets a column apart.
Clinical Pearl
ED = sickest first. Disaster = most salvageable first. BLACK tag means no CPR — save who you can save.
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