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You are here: Home > Triage Guidelines > START Adult Triage Algorithm

START Adult Triage Algorithm

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START adult triage algorithmD Link to Reference 1 Link to Reference 1

Adopted from http://www.start-triage.com/

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Background information

  • START was developed by the Newport Beach Fire and Marine Department and Hoag Hospital in Newport Beach, California in 1983. 2
  • Initially it used the ability to obey commands, respiratory rate, and capillary refill to assign triage category.
  • Modifications to START in 1996 by Benson et. al. substituted radial pulse for capillary refill, with a report of improved accuracy, especially in cold temperature. 1
  • The Benson revision (START - SAVE [Secondary Assessment of Victim Endpoint]), also incorporates additional factors that determine "survivability" over time as the event progresses and assumes limited response resources. 1
  • There has been limited rigorous scientific review of various forms of mass casualty incident triage used around the world. 1,4
  • New methods of triage using new algorithms have been proposed, but not tested in the field 5,6
  • At present START remains the most commonly used mass casualty triage algorithm in the US.

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References

  1. Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE-a new method of dynamic triage for victims of a catastrophic earthquake. Prehospital Disaster Med. 1996; Apr-Jun; 11(2): 117-24 [PubMed Citation]
  2. START Support Services (Newport Beach, CA Fire Department, Commercial site, no endorsement implied)
  3. Alternative version of START algorithm (Critical Illness & Trauma Foundation, Inc., 2001)
  4. Cone DC, Koenig KL. Mass casualty triage in the chemical, biological, radiological, or nuclear environment. Eur J Emerg Med 2005; 12:287-302 [PubMed Citation]
  5. Garner A, Lee A, Harrison K, Schultz CH. Comparative analysis of multiple-casualty incident triage algorithms. Annals of Emergency Medicine [PubMed Citation]
  6. Sacco WJ, Navin DM, Fiedler KE, et al. Precise Formulation and Evidence-based application of resource-constrained triage. Acad Emerg Med 2005, 12(8):759-770 [PubMed Citation]
  7. Cone DC, MacMillan DS. Mass-casualty triage systems: A hint of Science. Acad Emerg Med 2005, 12(8): 739-741 [PubMed Citation]
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U.S. Department of Health & Human Services Office of the Assistant Secretary for Preparedness and Response National Library of Medicine