START Triage

What Is START Triage?

START (Simple Triage And Rapid Treatment) is a mass casualty incident (MCI) triage method that assesses each patient in under 60 seconds using three criteria, commonly remembered as RPM: Respirations (present and under or over 30/min), Perfusion (radial pulse present or capillary refill under 2 seconds), and Mental status (ability to follow simple commands). Based on these three checks, each patient is assigned a color-coded priority: Red/Immediate (life-threatening but survivable), Yellow/Delayed (serious but stable), Green/Minor (walking wounded), or Black/Deceased (no respirations after airway repositioning). Patients who can walk on their own to a designated area at the start of the incident are typically triaged Green without individual assessment.

Why START Triage Matters on the Fireground

START's fixed 60-second, three-criteria assessment exists to prevent providers from spending disproportionate time on any single patient during the initial triage pass, since the goal of first-pass MCI triage is establishing priority order for the entire patient population, not delivering definitive treatment to the first patient encountered.

Relevant NFPA Standards

• NFPA 455: Standard for Emergency Medical Services (EMS)
• NREMT Standards: National Registry of Emergency Medical Technicians Practice Standards

Field Procedures & Tactical Steps

1. Direct all patients who can walk to a designated safe area; triage them Green/Minor without individual RPM assessment.
2. For remaining patients, assess Respirations first; reposition the airway if absent and reassess before triaging Black/Deceased.
3. Assess Perfusion via radial pulse or capillary refill.
4. Assess Mental status via ability to follow simple commands, then assign Red/Yellow/Green/Black priority based on all three criteria.

Common Context & Application

Used at mass casualty incidents to rapidly assign Red/Yellow/Green/Black treatment priority to a large patient population when providers are initially outnumbered by patients.

Frequently Asked Questions about START Triage