A charge nurse is implementing the START (Simple Triage and Rapid Treatment) system during a mass casualty incident at a local hospital. Which patient should receive the highest priority for immediate treatment?
1A 45-year-old male who is walking and complaining of severe back pain, with stable vital signs
2A 30-year-old female who is unconscious, not breathing, and has no palpable pulse
3A 25-year-old male with multiple lacerations who is alert and oriented but bleeding moderately
4A 35-year-old female with compromised airway, rapid breathing at 35/min, and weak pulse✓ 정답
해설
In START triage, the patient with compromised airway, rapid respirations (35/min), and weak pulse is immediate (red) due to severe respiratory distress requiring urgent airway management. Other patients have lower priority: walking wounded (green/minor), unconscious/apneic (black/expectant), or moderate bleeding (yellow/delayed).
Clinical Judgment
This question evaluates the application principles of the START system in a disaster triage situation. The key is to prioritize patients with the highest likelihood of survival through immediate intervention. The START algorithm sequentially assesses ambulation → respiration → perfusion → mental status. The patient in option 4 shows airway injury, a rapid respiratory rate of 35 breaths per minute (exceeding the normal 12-20), and a weak pulse, placing them in the Red/Immediate category. This indicates a high chance of survival with just airway management and breathing support, thus the highest treatment priority.
Memory Tip
Mnemonic for remembering START triage: RPM (Respiration-Perfusion-Mental Status).
1. Respiration: >30 breaths/min or <10 breaths/min = RED.
2. Perfusion: Capillary refill time (CRT) >2 seconds or absent pulse = RED.
3. Mental Status: Unable to follow simple commands (e.g., "Open your eyes") = RED.
*All ambulatory patients are GREEN.
KR vs US
In Korea, similar disaster triage systems (e.g., 4-color tag system) are used during mass casualty incidents, but there may be differences in specific algorithms and the level of training standardization. For the NGN, it is important to know the detailed criteria of the US standard protocol, START.
Clinical Practice GuideSTART is designed to assess one patient within 60 seconds. The assessment must proceed in order: 1) Say "Anyone who can walk, come this way" to first filter out ambulatory (Green) patients. 2) For patients without breathing, open the airway; if still no breathing, attach a Black tag. 3) If breathing but exceeds 30 breaths per minute, immediately assign a Red tag. 4) If breathing is 10-29 breaths/min, check perfusion (capillary refill or radial pulse); if greater than 2 seconds or no pulse, assign Red. 5) If perfusion is normal, check mental status; if unable to follow commands, assign Red; if able to follow, assign Yellow (delayed).
CautionThe most common pitfall in SATA (Select All That Apply) questions is forgetting to classify "a patient without breathing before attempting to open the airway" as Black (expectant/deceased). In START, a patient must have no breathing even after airway opening maneuvers to be tagged Black. Also, remember that "a patient who can walk but has severe pain" (option 1) is Green (minor) and is excluded from immediate treatment priority.
START (Simple Triage and Rapid Treatment) — A standardized system for rapidly triaging patients in mass casualty situations. It sequentially assesses ambulation, respiration, perfusion, and mental status to classify patients as Immediate (Red), Delayed (Yellow), Minor (Green), or Expectant/Deceased (Black).
Triage — The process of classifying patients to determine treatment priorities under limited resources. In disaster situations, the goal is to save the maximum number of lives based on survivability and treatment needs.
Airway Compromise — A condition where the airway is partially or completely blocked, preventing air from effectively entering the lungs. It is one of the life-threatening factors with the highest priority in disaster triage.
Tachypnea — Abnormally rapid breathing of more than 20 breaths per minute in adults. In the START classification, a respiratory rate exceeding 30 breaths per minute is used as a key criterion for requiring immediate treatment (Red).
Capillary Refill Time — The time it takes for blood color to return after pressing on the fingertip or nail. If it takes more than 2 seconds, it indicates a perfusion problem and is one of the criteria for classifying into the Red category in the START triage system.