Disaster
Medical System
Triage
System
Function 7: Coordination of Pre-Hospital Emergency
Services
Element 7.2: Triage systems and methods
Guideline 7.2.1: START Triage System
TRIAGE SYSTEM
I. PURPOSE
The purpose of this policy
is to specify a uniform method for initial evaluation of patients during
multiple casualty incidents or disaster.
Division 2.5, Health and
Safety Code, Section 1797.150-152
A.
Triage refers to the process of
sorting sick and injured people on the basis of urgency and type of condition
so they can be routed to appropriate facilities for medical treatment.
B.
Simple Triage and Rapid
Treatment (START) refers to a specific triage method that evaluates patients’
respiratory, circulatory and neurological function and categorizes them in one
of four care categories.
A.
START
is the triage method that shall be used by first-arriving responders for
initial and secondary field triage in defined MCI or disaster situations.
B.
Initial
triage takes priority over emergency treatment in the field setting.
C.
Emergency
care administered by triage teams is restricted to opening the airway,
controlling severe hemorrhage and elevating patients’ lower extremities.
D.
Personnel
assigned to treatment areas will perform secondary triage and continue
utilizing the triage tag.
E.
Field
responders will utilize standard triage tags as specified in the Disaster Medical Systems Standards and
Guidelines.
A.
Initial
triage, using the categories of Immediate, Delayed, Minor, and
Dead/Non-salvageable, will be assigned to first-in responders other than law
enforcement officers. Personnel
assigned to triage will function individually.
B.
All
possible victims involved in the incident are to be quickly examined and tagged
whether they appear injured or not injured.
All victims must be tagged.
C. Personnel will perform the basic triage examination, categorize the patient, and attach the appropriate tag in 60 seconds or less.
D. Non-ambulatory casualties should be triaged where they lie, unless they are in an unsafe area that requires their immediate movement.
E. Ambulatory patients are separated from the general group at the start of triage by stating “Anyone who can walk…” followed by an area assignment to which the patients will walk.
F. Triage tags are attached to casualties near the head. The removed portions of the tag should be delivered to the Medical Group/Medical Branch to assist in the determination of resource requirements.
G. Initial triage personnel will perform the following procedures and move to the next victim:
1.
Open
the obstructed airway
2.
Stop
arterial bleeding
3.
Elevate
lower extremities
H. Minor casualties may be asked to assist with casualties needing critical treatment (e.g., maintain airway, maintain bleeding control).
I. When all patients have been triaged, triage team members will be reassigned.
J. Casualties will be re-triaged on arrival at the treatment area; triage categories may be modified based on this examination.
K. Following re-triage, treatment teams will provide stabilizing care and document actions and observations on the triage tag.
L. Priority for transportation will be given to casualties tagged immediate following evaluation and necessary stabilization in the treatment area, not delaying transport for stabilization.
M. If the triage priority of the patient changes, the bottom
portion of the tag should be removed, leaving the injury information and adding
a new tag identifying the new triage priority and the reason for change.
A.
All
individuals with potential to function as field responders and all receiving
hospital Emergency Department personnel should receive training in START
triage.
B.
Consideration
should be given to the routine, regular use of START, including the tagging of
patients, to assure familiarity of field personnel with the technique. For example, on the second Wednesday of
every month, all providers triage and tag all patients seen that day, in
addition to providing the usual field evaluation and care.
C.
Triage
tags should be standard equipment in all first response vehicles and transport
units.