Protocol: SIMPLE TRIAGE & RAPID TREATMENT (S.T.A.R.T.)

Original Effective Date: 01/01/2001 | Revised Date: 01/01/2002

INTRODUCTION:

As an EMT approaches a small number of patients, their normal tendency is to treat the patient who appears to be most in need of care and to remain with that patient. Until the rescuer is faced with a Multiple-Casulty Incident (MCI), this philosophy of attending to the most critical patient remains valid. However, as the number of patients exceeds the number of rescuers, a new philosophy takes over - the philosophy of providing the most benefit to the greatest number of patients. In general, a disaster or MCI exists when the number of patients exceeds the normal capacity of the EMS system. MCI conditions are in effect whenever the imbalance exists between resources and patient needs. During these times, decisions must be made about care priortities and based on limitation of field intervention.

BASIC LIFE SUPPORT

PROCEDURE ENTRY

  1. Contaminated patients are NOT tagged until decontaminated.
  2. When rescuer entering casulty area has ambulatory patients, they are tagged GREEN (minimal) and then directed to a designated treatment/secondary area.

ASSESSMENT

  1. Assess RESPIRATIONS for rate and adequacy. If a patient is not breathing, check for foreign objects causing obstruction in the mouth. Remove dentures if they are loose. Reposition the head, using c-spine precautions if this does not delay assessment. If this procedure does not result in spontaneous respirations. Tag the patient BLACK (D.O.S). If the patients respiratory rate is greater than 30, they are tagged RED (Immediate). If respirations are present and less than 30, assess perfusion.
  2. Assess PERFUSION. Check the patient's radial pulse. The presence of a radial pulse is a rough indicator of a systolic BP > 80mm Hg. An alternative indicator is the measurement of capillary refill. Refill should be <2 sec. If there is no radial pulse, the patient must be tagged RED (Immediate). If there is a radial pulse, assess mentation.
  3. Assess MENTAL STATUS. The rescuer should ask the patient to follow two simple commands. (i.e.- "open and close your eyes" or "squeeze my hands"). If the patient cannot follow these commands, they are tagged RED (Immediate). If the patient can follow commands, they are tagged YELLOW (Delayed).

EXCEPTIONS

      Rescuers injured should be tagged RED (Immediate) and removed from the scene ASAP to reduce associated stress to their partners/associates.

       

        Emotionally uncontrollable patients should be tagged RED (Immediate) and removed from the scence to avoid an "accelerated emotional" crisis.

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