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Emergency Triage Guidelines

Emergency triage guidelines are used to aid first responders when dealing with an incident where there are multiple victims with various degrees of injury. The system, first developed in the 1700s, has been refined and used at such large-scale incidents as terrorist attacks on the World Trade Center, the bombing of a federal building in Oklahoma City, and the Interstate 35 bridge collapse in Minneapolis.

  1. The Facts

    • The term "triage" comes from the French verb trier, which means to separate or sort. The concept is used in the medical field to simply and quickly identify the most severely injured people in a multicasualty situation. The idea of triage was pioneered by French surgeon Dominique Jean Larrey to organize the care of wounded soldiers during the Napoleonic wars in the 1790s.

    Types

    • The goal of emergency triage guidelines is simple: quickly direct medical attention to the people who need it most. The most common system is the Simple Triage and Rapid Treatment (START) format, which was created in 1983 by Hoag Hospital in Newport Beach, California, and the Newport Beach Fire Department, according to Start-Triage.com. The START system helps prepare emergency personnel to quickly organize their resources to handle mass-casualty emergencies. The guidelines are based on simple tests for respiration, pulse and mental status. There are separate versions for children. The U.S. Centers for Disease Control and Prevention (CDC) also has a field triage system, which is similar but focused on making sure victims of traumatic injuries get to the proper treatment centers.

    Time Frame

    • Using the START system, trained emergency medical service personnel can triage each patient in one minute or less, assessing and classifying each victim into one of four categories with a color-coded system that indicates the severity of injuries. At a mass-casualty incident, victims who can walk and talk are tagged green, and moved to an area away from the most severe. One by one, rescuers visit each victim. If the person is not breathing, they make one attempt to reposition the victim's head to open his airway. If the person doesn't begin breathing automatically, he is tagged black, or dead. Those who are breathing but unconscious, have a weak pulse, and perhaps exhibit an altered mental state are tagged red for immediate care. Victims get a yellow tag if their mental state is OK, meaning their treatment will be delayed.

    Benefits

    • When dealing with victims of traumatic injuries---anything from car accidents to terrorist incidents---EMS personnel refer to the "Golden Hour." The key is to get such victims from the accident site to the operating room within one hour. Triage guidelines help meet those goals and save lives as a result. CDC research indicates that the risk of dying from traumatic injuries is 25 percent lower when the victim is sent to the appropriate trauma center based on field triage decisions made on the scene.

    Considerations

    • When using triage guidelines, EMS personnel assume the responsibility of making life-and-death decisions very quickly. As a result, they are directing immediate help to those who can benefit most, but are giving lower priority to those who may die in any event.

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