You arrive on scene to a massive pile-up involving a school bus and two tractor-trailers. There are dozens of patients, screaming and scattered across the highway. You can’t treat them all at once, and backup is minutes away. This is where START Triage becomes your most critical tool to bring order to chaos.

What is START Triage?

START Triage (Simple Triage and Rapid Treatment) is a standardized method used by first responders to quickly manage Mass Casualty Incidents (MCIs). It is designed to sort patients into four categories based on the severity of their injuries so that limited resources can do the most good for the most people. The system relies on a rapid assessment using RPM: Respiration, Perfusion (circulation), and Mental status.

Why START Triage Matters in the Field

In an MCI, the goal shifts from “doing everything for everyone” to “doing the greatest good for the greatest number.” If you spend 20 minutes stabilizing one patient with minor injuries while three others bleed to death nearby, you have failed the triage process. START Triage provides a systematic approach to ensure those who need immediate life-saving intervention get it first, while those who can wait are safely categorized.

What You’ll Actually See

You will move rapidly through patients, spending no more than 60 seconds per person. First, you’ll command all walking wounded to move to a designated area. For non-ambulatory patients, you will check breathing, then perfusion, then mental status.

“Everyone who can walk, move to the sidewalk! You, stay there, I’m checking you next. You’re not breathing? Open airway… still not breathing? You’re black tag, move on.”

Common Pitfall & Pro Tip

⚠️ Pitfall: Getting stuck trying to treat critical injuries during the initial triage pass. Remember, you are sorting, not treating. Do not start an IV or intubate during triage unless it takes seconds and saves a life immediately.

💡 Pro Tip: If a patient is not breathing, open their airway. If they start breathing, they are an “Immediate” (Red). If they don’t, they are “Expectant” (Black). This simple intervention can save a life that would otherwise be tagged as deceased.

Memory Aid for START Triage

Remember “30-2-Can Do”:

• 30: Respirations greater than 30 per minute?
• 2: Capillary refill or radial pulse absent for more than 2 seconds?
• Can Do: Can they follow simple commands?

If the answer is “No” to all, they are “Delayed” (Yellow). If the answer is “Yes” to any, they are “Immediate” (Red).

NREMT Connection

Expect MCI scenarios on the exam where you must apply the START algorithm to prioritize a list of patients for transport or treatment. You must know the order of assessment: RPM.

Related Concepts

While START is the standard for adults and adolescents, you will use JumpSTART for pediatric patients, as their physiology differs significantly. You will also likely utilize triage tags to visually communicate the patient’s category to other EMS providers and hospital staff.

Quick Reference

✓ Key Steps: RPM (Respirations, Perfusion, Mental status) ✓ Priority level: System-based (Immediate, Delayed, Minimal, Expectant) ✓ Treatment considerations: • Ambulatory patients -> Minimal (Green) • RPM failure -> Immediate (Red) • No RPM failure -> Delayed (Yellow) • Apneic after airway opening -> Expectant (Black)

When the scene overwhelms your resources, remember that speed and sorting save lives. Master START Triage now so you don’t freeze when the pressure is on.