Understanding the START Triage Method
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ScribdTranslationsUnderstanding the START Triage Method
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ScribdTranslationsSTART METHOD
WHAT IS THE START METHOD?
The START (Simple Triage And Rapid Treatment; Simple Triage and Rapid Treatment
Quick Treatment) is the most commonly used triage method around the
world ([Link] et al., 1994). It is a simple, fast method and
systematized based on the ability to walk, evaluation of
breathing, circulation and level of consciousness.
Known as method 30 - 2, in which '30' assesses the capacity
respiratory in one minute, '2' the quality of peripheral perfusion in 2
seconds and 'can do' the level of consciousness of this victim to proceed
the commands of the rescuers.
Using these parameters, the victims are divided into four.
service priorities, represented through colors: red,
yellow, green and black.
WHAT IS THE START METHOD?
Sorting tactics should be used when personnel resources
and the materials are insufficient in the face of an accident that involves
several victims. For example, in a bus accident, with several
victims, where the immediately available resources are
insufficient, screening is necessary. Unlike, in a
building collapse, where there are several victims trapped in
rubble, the rescue is slow and each victim may receive
full medical care and be properly transported to
hospital, not needing urgent triage procedure.
The Ministry of Health defines as a recommendation the performance of
triage in cases of events with more than five victims.
IDENTIFICATION CORES
RED CARD
Immediate assistance:victims with injuries
serious, but with a chance of survival.
They have a high priority for service.
withdrawal from the scene and transportation.
IDENTIFICATION CORES
In the area designated for victims with a Red Card, everyone goes.
patients with immediate life risk who will have a progression
favorable if medical care is initiated immediately.
Here are also the patients who need transportation.
fast to the hospital.
Patients with: shock; amputations; arterial injuries;
severe hemorrhage; inhalation injuries; burns on face; injury
facial and eye injuries; intra-abdominal injuries; respiratory failure;
tension pneumothorax; extensive soft tissue injuries;
second degree burns greater than 20% to 40%, or third degree greater
from 10 to 30%;
IDENTIFICATION CORES
YELLOW CARD
May I wait: victims with injuries
moderate. They can wait a while in the scene
until definitive treatment. Example: members
fractured.
IDENTIFICATION CORES
The area designated for victims with a Yellow Card goes to those
victims who need some medical assistance on site and
hospital transport posterior, however that do not have life risk
immediate.
Patients with: Fractures; mild, moderate TBI; burns
minors; abdominal and thoracic trauma; injuries with
bleeding that requires sutures.
IDENTIFICATION CORES
GREEN CARD
Elevate:victims with minor injuries, who
they can roam and help other victims
weakened. These victims are the ones who usually
cause some problems, as they are
wandering, scared and in pain. One should
invest in psychological support and guidance so that
do not overload the tertiary health service.
Example: diffuse abrasions on the body.
IDENTIFICATION CORES
In the area designated for victims with a Green Card, there go the victims who
they present small lesions, they are usually sitting or
walking, without risk to life and that can be assessed
outpatient. They are the patients who cause the most problems in
After the accident, they are usually in pain and in a state of shock.
they tend to be uncooperative.
They are patients with: contusions; hematomas; abrasions; small
injuries.
IDENTIFICATION CORES
BLACK CARD
Dead:victims who do not respond to
simple procedures, such as opening airways
airborne and with critical injuries that indicate
imminent death. Example: patient in cardiac arrest
cardiac, exposure of brain mass.
IDENTIFICATION CORES
In the area designated for victims with a Black Card, the victims go to
death. In those situations where there is an imbalance between the
medical resources and the number of victims, all patients with
severe traumas, with little chance of survival, too
they go to this priority area.
Patients are: deceased; multiple severe traumas; burns
of 2nd and 3rd degree extensive.
IDENTIFICATION CARDS
START METHOD TECHNIQUES - APPLICATION
The technical assessment, as described above, is the responsibility of the first crew that
arrive at the accident site, secure the area, and begin the
preliminary triage, while requesting support, aiming to save the most
number of imminent death victims. Thus, the rescuers should
realizara a triagem observando aRESPIRAÇÃO, PERFUSÃO e
LEVEL OF CONSCIOUSNESS.
BREATHING
Evaluate respiratory rate and the quality of breathing of the
victims. If the victim is not breathing, check for the presence of bodies
strangers causing airway obstruction. Remove dentures and
loose teeth. Align the head while taking care of the cervical spine. If after
this procedure does not initiate respiratory efforts, BLACK card.
If breathing starts, RED card.
The victim breathes at a frequency greater than 30 movements.
respiratory per minute, RED card. Victims under
30 respiratory movements per minute are not classified in this.
At the moment, one must evaluate the perfusion.
PERFUSION
Capillary filling is the best method to assess perfusion.
Press the nail bed or lips and release. The color should return.
within 2 seconds. If it takes more than 2 seconds, it is a sign
of inadequate perfusion, REDcard. If the color returns
within 2 seconds the victim is not classified until it is evaluated
level of consciousness.
LEVEL OF CONSCIOUSNESS
It is used for victims who have breathing and perfusion.
adequate. The rescuer requests simple commands like "Close the
"Eyes"; "Squeeze my hand"; "Stick out your tongue." If the victim
does not obey these commands, REDcard. If the victim
obey these commands, YELLOWcard. The GREENcard is
used for patients who are walking, or who are not
frame me in one of the situations above
AFTER THE CATEGORIZATION OF THE VICTIMS,
WHAT SHOULD BE DONE?
Victims should be directed to priority areas, which
they have the same colors defined according to the categorization
the victims (red, yellow, green, and black). The pre-service
hospitals generally delimit these areas with extended tarps in
ground, in a safe area, for the second part to be carried out.
triage, confirming the categorization and starting the treatment of
medical team for later transport.
PRIORITY AREA
WORK AREAS
The so-called work zones have their applicability in providing service to
major emergencies and have the following objectives:
Assist in maintaining a service methodology in a way
organized and safe;
reduce the harmful effects of the occurrence on people, the environment and
heritage;
direct the operations and movements of the incident;
minimize the number of people and equipment to the strictly necessary;
control access to people who can or should be nearby or not
of the occurrence, due to its activity or degree of connection with the
emergency.
The work areas are classified into 3 groups: Hot Zone, Zone
Morna and Zone
HOT ZONE
Area immediately surrounding the incident, extending up to a
limit that prevents the effects of occurrences on people or equipment
outside this area.
Access to the interior of this area should be limited exclusively to
those people who specifically will attend to the emergency, that is,
service fittings and all necessary materials to address the situation.
Vehicles may or may not enter, when effectively employed, after the
that, they must leave this area. This area must be
necessarily marked.
WARM ZONE
In this area, the equipment and personnel should be located for the
hot zone support. It must be a location immediately adjacent to
Hot Zone should enable communication and, whenever
possible, the observation of the Hot Zone.
It is necessary to establish a control access corridor in this area and
exit of personnel and materials.
COLD ZONE
In this area will be the command post, as well as all the
necessary supports for incident control.
It is a place of restriction of access to the public, but permitted to
people and the authorities that are related to the occurrence, but
that will not act directly in the intervention.
In this area will be the reserve and medical support equipment of
triage.