Triage in 2017

Triage in 2017

Triage: This might be one of the most stressful things that an individual responder may be asked to do during a Mass Casualty Incident and will become a defining moment in their career in one way or another. Proper triage of patients is going to set the tone for how well and how quickly that Mass Casualty Incident is resolved.


Because you make life or death decisions for a group of people, making that decision over and over again every ~30 seconds. Was that decision made correctly? In the aftermath, that second guessing that goes on could be the difference between someone who sleeps soundly at night or someone who loses sleep, becomes irritable with family, gets a divorce, becomes an alcoholic, commits suicide. Stress is real. Listen to the radio traffic from any Mass Casualty Incident that’s posted on YouTube and you’ll hear the stress in the voice of the one who gets assigned triage.

The Status of Triage

Most organizations in the CONUS utilize START triage. There are many resources out there as a guide for START triage, so we will give a quick overview. The mnemonic to utilize for START triage is 30/2/Can Do under the RPM method.

  1. Ask “who can walk? Walk to me/over here.” These patients are tagged Green

  2. Assess Respirations. Apnic? Open the airway and reassess. Continued apnic patients are Black. If they have return of spontaneous respirations they are Red.

  3. Respirations >30? Red

  4. Respirations less than 30? Check pulse or cap refill.

  5. Radial pulse absent? Red. OR Cap refill >2 seconds? Red

  6. Radial pulse OR cap refill < 2? Check mental status

  7. Follows simple commands? No: Red. Yes: Yellow

If a patient earns a color somewhere, assign it and move on. The remainder of the algorithm does not need to be completed.

But that’s a lot to remember…

Demystifying Triage

In teaching TECC classes all across the country, I’ve asked students many times if their department uses START triage. When they say ‘yes,’ I then ask them to recite it and it gets botched one way or another. This is something they are going to be called to do during a stressful event but they have trouble doing it in the classroom setting. If the pressure of being put on the spot in front of the class is too much to recall START triage, then looking down at someone who’s severely injured will be much less stressful…

Why is it so difficult to remember? Because it only gets used in those once-a-career calls. Mass Casualty Incidents don’t occur often. Those that make CNN happen even less frequently. The San Bernardino, Orlando, Boston, Blacksburg, Binghamton, Newtown, Ft. Hood and Nice, France events all had more than 10 patients. These are events that have happened in the last 10 years. Additionally, the patient count and frequency of events has increased over the last 16 years according to the FBI study on Active Shooter Incidents.

Two Tools

So we are going to utilize two tools to help ensure these situations are resolved as best as possible.