Multiple injured clients arrive after a multi-vehicle crash. The nurse applies START for adults and JumpSTART for children. Which initial triage assignments are correct? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
START rapidly sorts adults using the ability to walk, respirations, perfusion, and mental status. A respiratory rate below 10/min, poor perfusion, or inability to follow commands leads to an Immediate assignment (Choices 1 and 5). A walking client is initially Minor even when an injury requires later reassessment (Choice 2). A nonambulatory adult whose respirations, perfusion, and command-following remain within START thresholds is initially Delayed (Choice 3). An apneic adult who does not breathe after airway repositioning is assigned the deceased/expectant category rather than Immediate (Choice 4). In JumpSTART, an apneic child with a palpable pulse receives 5 rescue breaths; return of spontaneous breathing leads to an Immediate assignment (Choice 6). All mass-casualty triage decisions require repeated reassessment as conditions and resources change.
Clinical Judgment The mass-casualty triage goal is the greatest good for the greatest number, not maximal care for any one patient. Use RPM — Respirations, Perfusion (radial pulse or capillary refill), Mental status (follows commands) — to sort adults in under 60 seconds each.
Memory Tip Adult START → no breaths after airway open = Black. Pediatric JumpSTART (ages 1–8) → 5 rescue breaths after airway open; if breathing returns = Red, if not = Black.
KR vs US US disaster systems mandate START/SALT training for ED nurses. In Korea the equivalent role usually falls to dispatch teams (DMAT) at the scene, but NCLEX-RN expects the staff nurse to know triage colors and apply them when patients arrive at the ED door.
Clinical Practice GuideThe CDC and FEMA endorse SALT (Sort-Assess-Lifesaving-Treatment-Transport) as the national mass-casualty standard, integrating START and JumpSTART. Lifesaving interventions during SALT include opening the airway, controlling major hemorrhage, decompressing tension pneumothorax, and giving 2 rescue breaths to a child — not advanced procedures.
CautionCommon NCLEX traps: applying adult START rescue rules to a child, treating a walking fracture as Red, and forgetting that Black means expectant, not deceased — interventions still happen later if resources allow.
START Triage — Simple Triage And Rapid Treatment, the adult mass-casualty triage system using RPM (Respirations, Perfusion, Mental status). Outputs four categories: Red (Immediate), Yellow (Delayed), Green (Minor), Black (Expectant). Goal is under 60 seconds per patient. NCLEX exam tip: respiratory rate over 30 or under 10, capillary refill over 2 seconds, or inability to follow commands all tag Red.
JumpSTART Triage — The pediatric variant of START for ages 1 to 8. Key differences: respiratory rate cutoffs are 15–45 (instead of adult 10–30); if there is no breathing after airway repositioning, give 5 rescue breaths — return of breathing tags Red, no return tags Black. NCLEX exam tip: rescue breaths are pediatric only — never apply to adults.
SALT Triage — Sort-Assess-Lifesaving-Treatment-Transport — the FEMA/CDC-endorsed national mass-casualty triage method that incorporates START and JumpSTART. The Lifesaving step adds four time-limited interventions (open airway, control hemorrhage, decompress chest, give 2 rescue breaths to a child) before the final color tag. NCLEX exam tip: SALT is the umbrella; START and JumpSTART are tools inside it.