Overview

START (Simple Triage and Rapid Treatment) is a mass casualty incident (MCI) field system that sorts each victim in under 60 seconds. The mindset is the opposite of everyday ED/ESI triage: you do the greatest good for the greatest number, not sickest-first. The assessment order is RPM — Respirations, Perfusion, Mental status — and tagging happens the instant a criterion is met. Only quick life-saving steps (open the airway, control major bleeding) are performed during the sweep; no CPR and no individual treatments.

Technique

START algorithm — RPM (tag the moment a criterion is met)

Can walk?Yes -> GREEN (minor / walking wounded) — Step 1 sort
RespirationsNone after airway repositioning -> BLACK; RR <10 or >30 -> RED
PerfusionCap refill >2 sec OR absent radial pulse -> RED
Mental statusCannot follow simple command -> RED
Passes all threeBreathing, perfusing, follows commands -> YELLOW (delayed)

Interpretation

START color tags — criteria

MeaningSTART criterion

GreenMinorAmbulatory — walks to designated area

YellowDelayedBreathing 10-30, cap refill <2 sec, follows commands

RedImmediateRR <10 or >30, cap refill >2 sec or no radial pulse, or no commands

BlackExpectantNot breathing after airway repositioning

Meaning

Green: Minor
Yellow: Delayed
Red: Immediate
Black: Expectant

START criterion

Green: Ambulatory — walks to designated area
Yellow: Breathing 10-30, cap refill <2 sec, follows commands
Red: RR <10 or >30, cap refill >2 sec or no radial pulse, or no commands
Black: Not breathing after airway repositioning

Patient Teaching

Walking sort precedes individual assessment

First action clears the largest group from the scene

Tag and move on

Under 60 sec per victim; do not defer or reassess during the primary sweep

Re-triage after the primary sweep

Conditions change; reassess once initial sort is complete

Disaster triage vs ESI

START maximizes survivors; ESI treats the sickest first

Report Nowescalate immediately

Pulseless MCI victim tagged Red

Cardiac arrest in a disaster is Black/expectant — no CPR

Ambulatory victim tagged Red

Walking overrides dramatic injury; ambulation = Green

Failed mental status mis-tagged Yellow

Cannot follow commands = Red, even with normal RR and perfusion

Yellow victim deteriorating to Red

Escalate and re-tag immediately

Scene-safety hazard

Unsafe scene halts triage; responders are not casualties

Clinical Pearl

RPM — Respirations, Perfusion, Mental status. If they walk, they're Green; if they don't breathe after airway repositioning, they're Black. No CPR in a disaster — you do the greatest good for the greatest number.

Disaster Triage — START & Color Tags

Overview

Technique

Interpretation

Patient Teaching

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.

Key Distinctions

Clinical Pearl

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