Disaster Triage — START & Color Tags
When 50 casualties arrive at once, your normal ABCs assessment is too slow. START triage gives you 60 seconds per victim to sort the living from the dying — and the order is different than you think.
Core Concept
START (Simple Triage and Rapid Treatment) is a mass casualty incident (MCI) triage system designed for field use when victims overwhelm available resources. It categorizes victims in under 60 seconds using three rapid assessments in this exact order: respirations, perfusion (capillary refill or radial pulse), and mental status. The categories are color-coded: Black (expectant/deceased) — not breathing even after repositioning the airway. Red (immediate) — respiratory rate >30, capillary refill >2 seconds (or absent radial pulse), or unable to follow simple commands. Yellow (delayed) — injured but stable, can wait for treatment. Green (minor/walking wounded) — the very first step is to call out 'Everyone who can walk, move to this area,' which immediately clears all Green patients before you touch anyone. This is the critical distinction from everyday triage: you sort to do the greatest good for the greatest number, not save the sickest patient first. A victim in cardiac arrest during an MCI is tagged Black, not Red — resuscitation of one person costs resources that could save many.
Watch Out For
Don't confuse START triage with ED triage (ESI): ED triage ranks by acuity to treat the sickest first; START triage allocates scarce resources to maximize survivors. Students mistakenly want to start CPR on a pulseless MCI victim — in START, that victim is Black, not a resuscitation candidate. The first action in START is directing walking wounded (Green), not assessing the most visibly injured.
Clinical Pearl
RPM — Respirations, Perfusion, Mental status. That's the START assessment order. If they walk, they're Green. If they don't breathe after airway repositioning, they're Black. No CPR in a disaster.
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