Simple Triage and Rapid Treatment

START; have developed by Hoag Hospital and Newport Beach Fire department in USA, a triage metode that can applied less than 60 second. The assesment based on :
1. Respiration
2. Perfusion (Circulation)
3. Mental status

These assessments are very ideal in a mass casualties condition. A rapid assessment made pre hospital personnel could make a rapid evacuation for the victims that need an intensive care. Treatment will only give to victims that have obstruction in the airway and or have massive bleeding from arteries.

START Categories
Start classifies the victims more rapidly and more accurate to one of four categories for treated. First step Of start is disparted victims with consious and can walk conditions. The victim will be asked to move from the danger area to the safe area, an area that have been marked as treatment area. The victims categorized as ”walking wounded” and tagged ”Green”. They will be treated after the severe victims treated.

• Red (immediate)
Assess breathing after airway checked and repositioned. The Victims that categorized in this if the breathing more than 30 time/minute, capillary refill delayed (more than 2 second), or the victim can not do a simple command

• Yellow (Delayed)
All victims that not in Red or Green

• Black Hitam (Deceased)
There are no breathing founded after cleared the airway.


START Procedure
1. Check Respiration
Assess the breathing frequency and adequately. If the victim does not breath, check the airway, clean the air way immediately as soon as found any obstruction. Head reposition sometimes needed for made airway clear, but must have attention with control of cervical. If the victim still does not breathe spontaneous, categorize as “Black”. But, if the victim breathes more than 30 times/minute, tagged as Red. If the victim breathe less than 30 times/minute, check perfusion immediately.

2. Check perfusion

The best metode taht could used to check perfusion is by checking capillary refill on the nail. The capillary refill more than 2 seconds is a sign for a bad circulation condition, tagged as Red. If the Capillary refill less than 2 seconds, check mental status immediately.

In a condition where capillary refills could not assessed, palpate the radialis artery. If the artery unpalpable, that probably mean the sistolic pressure is under 80mmHg and the victim probably in shock condition. Control bleeding immediately with direct pressure and elevate lower extremity. We can ask to another victim to do it.

3. Mental Status
Mental status used for the patient with adequate breathing and perfusion. For checking, use a siple command such as open and close your eyes, handful my hand. If the victim can nit follow the command, tagged as red. If the victim can follow the command, tagged as yellow. In this assessment, victim that have been tagged as green could assessed again.