S.T.A.R.T.

Simple Triage and Rapid Treatment The Race Against Time

LESSON OBJECTIVES:
Describe what to do when first arriving at a Multi-Casualty Incident Triage an injured patient in less than one minute Describe how to use patients with minor injuries to assist with basic first-aid Demonstrate how to use a Triage Tag

The Golden Hour

One hour from the time of injury to the time of Advanced Trauma Life Support What is Advanced Trauma Life Support? Definitive Medical Care

The Triage Tag

A tag used by triage personnel to identify and document the patients medical condition and treatment Also used to keep track of where the patient was transported to

What do I do now?

Where do I START when I first arrive onscene? Evaluate the incident and call for additional help Begin to collect information

SCENE SAFETY

Your safety comes first, then help the patient Evaluate hazards and report them to the other responders If you get hurt, you cant help anyone else

START WHERE YOU STAND WITH THE FIRST PATIENT YOU ENCOUNTER

TRIAGE BASICS
Respirations Perfusion Mental Status
30

CAN DO

TRIAGE BASICS

To remain calm and work as a team is the best way to help the most number of patients Remain objective and use proper criteria when evaluating the patients condition Do not let emotions decide the patients status

REMEMBER

When youre all revved up

Remember:

R P M

MINOR

The first level of triage, walking wounded

Everyone who can walk, get up and move over there These patients with minor injuries may be able to assist with first-aid
How does this differ from our normal operations?

EVALUATE RESPIRATIONS
All Walking Wounded

MINOR

RESPIRATIONS
NO YES

Position Airway

Under 30/min.

Over 30/min.

NO

YES

PERFUSION

IMMEDIATE

DECEASED

IMMEDIATE

EVALUATE PERFUSION
PERFUSION
Radial Pulse Absent OR Capillary Refill over 2 Seconds Radial Pulse Present OR Capillary Refill under 2 Seconds

Control Bleeding

MENTAL STATUS

IMMEDIATE

EVALUATE MENTAL STATUS

MENTAL STATUS
Can't Follow Simple Commands Can Follow Simple Commands

IMMEDIATE

DELAYED

IMMEDIATE

START assessment is designed to identify the IMMEDIATE patients IMMEDIATE patients are at risk for early death and need to be transported as soon as possible

DECEASED

After someone is tagged DECEASED what do you do with them? If they are blocking access to other patients, they need to be moved Otherwise, leave them where they are until the coroner arrives

DELAYED

If the patient passes the RPM assessment, they are placed in the DELAYED category DELAYED does not mean that they dont have serious injuries DELAYED patients must be frequently reassessed

CENTRAL TREATMENT AREA

IMMEDIATE and DELAYED patients who are awaiting transport should be moved to a centralized treatment area. The central treatment area results in a more efficient use of medical supplies and personnel

START MNEMONIC

An easy way to remember the START assessment numbers that go with RPM is

30-2-Can Do

RPM
R

30 2 Can Do

All Walking Wounded

MINOR

RESPIRATIONS
NO YES

Position Airway

Under 30/min.

Over 30/min.

NO

YES

PERFUSION
Radial Pulse Absent OR Capillary Refill over 2 Seconds

IMMEDIATE

DECEASED

IMMEDIATE

Radial Pulse Present OR Capillary Refill under 2 Seconds

Control Bleeding

MENTAL STATUS
Can't Follow Simple Commands Can Follow Simple Commands

IMMEDIATE

IMMEDIATE

DELAYED

Are there any questions about how to perform START Triage?