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.

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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.

Component Topics

Disaster Triage — START & Color TagsEmergency Department Triage

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