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Prehospital, Disaster, and Administration

During an emergency medical services (EMS) ride along, your team receives a call for multiple injured patients after an explosion at a city building. When you arrive at the scene, there is an incident commander (IC) who instructs you that there are dozens of injured casualties and delegates you to help triage the wounded according to the simple triage and rapid treatment (START) system. You are directed to a secure area where the fire department EMS has brought dozens of injured office workers. You approach a patient who has several abrasions on his torso, face, and extremities. He has no spontaneous respirations. You perform a chin lift and note chest wall movement and audible spontaneous respirations.

What color triage tag would you assign this patient?

a. Green

b. Yellow

c. Red

d. Blue

e. Black

The answer is c. In mass-casualty incidents, one of the most vital components of triage is to assign the appropriate acuity level of injury in an easy to implement, standardized, and efficient manner. The most widely used triage system is the START system that focuses on assessing three parameters. These are as follows:

  1. Respirations

  2. Perfusion

  3. Mental status

Patients are assessed based on these three parameters and then assigned a colored triage tag corresponding to one of the following triage categories:

  • Immediate: immediate care and transfer necessary

  • Delayed: delayed transfer and care until all “reds” are cleared

  • Minor: “walking wounded” and lowest priority to transfer

  • Deceased: dead at the scene from nonsurvivable injuries

Patients who are wounded but are able to walk on scene are given a green tag (a) signifying a low priority and are attended to or transferred last. Next, patients are assessed for ability to breathe. If they are not breathing, the airway is positioned. If breathing resumes, they are labeled “red” (c) as depicted in the previously mentioned example. If no spontaneous breathing resumes, they are labeled “black” (e). If they are breathing spontaneously and have an RR greater than 30 breaths/minute, they are assigned a red tag (c). In patients with a spontaneous RR below 30 breaths/minute, next their perfusion is assessed by checking a radial pulse and capillary refill. If there is no radial pulse or if the capillary refill is greater than 2 seconds, they are assigned a red tag (c). For those with a radial pulse or capillary refill under 2 seconds, the next step is a brief mental status examination in which they are asked to follow simple commands (eg, squeeze the examiner’s hand). If they cannot do this, they are given a red ...

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