S.T.A.R.T. Disaster Triage-When 911 Can't Come

by Victoria Chames - Date: 2007-01-30 - Word Count: 1180 Share This!

What it is: All forms of triage are systems for identifying and sorting/classifying levels of severity of injury or illness. Every hospital Emergency Room has a limited number of beds and medical staffing so there is always a Triage Nurse to greet you at the door, so that those at risk for worsening or death can be prioritized and be treated first, while those whose condition is assessed to be minor, moderate, or non-life-threatening, can be sent to the waiting room to wait for their turn.
Disaster triage, though based on the same principles, is different in a number of ways. Most importantly, it must be faster (because there are so many injured at once, and because seconds or minutes may make the critical difference) and it must be simpler, so that it can be done by almost anyone, without medical knowledge or professional training.
S.T.A.R.T. multi-casualty triage is the system used by medical, rescue, and emergency personnel, both professional and volunteer, to make the best use of limited medical resources when the number of injured needing care exceeds the resources available. The goal is to "Do the most good for the most people." When performed in line with recognized standards of practice, in most countries triage is recognized and sanctioned by law.
"Our goal is to maximize the number (of people) who will survive the incident. Some patients will live no matter what medical care they receive, and some will die regardless of the care they receive. Others will die UNLESS they receive medical care immediately (but have a good chance of survival if they do). We Don't want to utilize valuable resources on people who are certain to die, nor on people who will survive without medical care. Our goal is to identify those who will survive the event with immediate care, and get it for them as soon as possible."
- from "Prehospital Triage" by Matthew R. Streger, BA, NREMT-P from EMS Magazine, The Journal of Emergency Care, Rescue, and Transportation.
The basic goals of S.T.A.R.T. (which stands for simple triage and rapid treatment/or transport) are to sort injured persons based on probable needs for immediate care, to give brief essential life saving interventions, and also, to recognize futility. In this way, a small number of emergency workers and helpers can determine and act upon those persons and conditions which will benefit most from the expenditure of the limited resources available.
The origin of triage in general goes back to the time of Napoleon, but the type of triage we will discuss here -S.T.A.R.T. triage, was developed by Newport Beach Fire Department and Hoag Memorial Hospital in Orange County California in the mid 1980's. Considered the Gold Standard of field and multi-casualty triage, S.T.A.R.T. is now practiced all over the world.
Why it is: Some injuries require immediate medical care. Serious trauma may require surgery within one hour of the injury, which has been called "the Golden Hour." Since surgeons can only treat one person at a time, when there are many more, they must be sent to a more distant hospital, because hospitals in the disaster area will be overrun or may be shut down by damage. So it becomes critical to identify these injured early. Also very important about S.T.A.R.T. triage - each injured person, while being triaged, is also minimally treated with life-saving procedures (such as opening blocked airways, controlling bleeding, positioning for airway safety, and treating for incipient shock).
"A system is needed to determine the severity of each patient quickly and accurately. It should be easy to learn, simple to remember (especially under stress) not require any diagnostic skills, and should allow the triage (caregiver) to immediately stabilize any basic life-threats encountered. The system most widely recognized and used is the S.T.A.R.T. System"
- from "Prehospital Triage" by Matthew R. Streger, BA, NREMT-P from EMS Magazine, The Journal of Emergency Care, Rescue, and Transportation.
How it is: S.T.A.R.T. triage is a fast, compact, simple, and very specific system for identifying and marking (or "tagging" because a color-coded tag is often used) the injured into four groups or levels of priority. As each one is triaged they are given brief, essential treatments as needed, and the Triager moves from person to person until all are looked at quickly and given the first-action treatments as needed. More care is given later, after rapid triage is done and help has been requested.
Disaster triage could be described as "choosing the best of the worst" because we are giving first priority to those who will actually benefit from it most - those who have a good chance to survive and recover IF they get help soon. We don't give first priority to the ones with minor injuries, because waiting will not change their outcome. We do not give it to the moderate injuries, because waiting will not change their outcome. We do not give it to the deceased, because waiting will not change their outcome. We give first priority to those where it makes the critical difference, and S.T.A.R.T. triage identifies those for us. We do not have to decide ourselves.

"Between 75% to 85% of fatalities occur within the first 20 minutes of the event, usually before EMS (911 emergency response) can arrive."
In the chaos and confusion of a disaster, a simple plan like this works, and has been proven in actual practice to save about 40% more lives since its inception more than 25 years ago. That's why it's used by Medical Rescue and Public Safety agencies in the U.S. and many countries worldwide. The S.T.A.R.T. triage you learn and use in Disaster First Aid is the same system they use, condensed and simplified for civilians and non-professionals. The average person may not have the same equipment professional rescuers carry, but s/he does have everything that's needed to do S.T.A.R.T. triage and save lives in those critical first minutes and hours while waiting for help to come.
S.T.A.R.T. Triage and Disaster First Aid are designed and intended for large, multi-casualty events where it's obvious that there will not be enough ambulances and paramedics for each and every one who is injured, and many must wait. So help must be rationed and applied where it will be the most effective and make the most difference. (Please note that Neither S.T.A.R.T. nor Disaster First Aid should be used as substitute for medical care at any time when that is available.)
Using the S.T.A.R.T. formula may be stressful, especially for civilians and volunteers, who though trained will not be very experienced in triage. It's important to remind everyone that they are not deciding the fate or outcome of any injured person, they are simply applying the time-tested and proven formula which makes the decisions for them. Knowing this gives direction, courage, and moral support not only to the citizen rescuer/helpers, but also to the hundreds of thousands of police, fire, ambulance and rescue crews throughout the world who use this formula every day in all multi-casualty emergencies. S.T.A.R.T. works. It does save the most lives that can be saved.


Related Tags: disaster, first aid, triage, disaster first aid

Victoria Chames is the author of the training course and book "Disaster First Aid - When 911 Can't Come." She served for eight years as a line firefighter for Alameda County O.E.S. Fire Department, and as a Fire Training Officer and Emergency Medical Services Officer and Trainer. Now retired from Fire Service she is a hospital Emergency Room Medical Technician and Program Director of Fire Med, a state of California EMSA approved Continuing Education program for EMTs and Paramedics, provider #01-0022. To visit the DFA website: http://www.disasterfirstaid.com

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