START Triage is meant to be EASY!

There is more than one way to draw an algorithm.


The START triage system is a method of quickly and efficiently classifying victims of a mass casualty incident (MCI) based on the severity of their injuries. It was developed in the early 1980’s by the Newport Beach Fire and Marine Department and Hoag Hospital.

The system assesses patients using three simple criteria.

  • Their ability to follow commands,
  • Their respiratory status,
  • Their perfusion status

The START Triage system has been in use for 40 years now because it is

  • simple. It only requires three criteria and one mnemonic device.
  • It is fast and efficient.
  • It is adaptable and flexible. It can be used in various settings and scenarios, such as natural disasters, terrorist attacks, industrial accidents, or mass shootings.
  • It is proven effective. Several studies have  shown that it improves survival rates compared to other triage methods
START Triage Visualization

It can be even easier!

START Triage is most oftenpresented as a flow chart with multiple decision points and it takes some practice to work through it and figure out exactly how the flowchart applies in different circumstances.

Not everyone learns this way though so, here is another way to visualize and understand the algorithm.

Recall that the process begins with the responders arriving on scene  and establishing command. Then, the rescuers announce that anyone who is able should proceed to a designated location.

Anyone who is able to do this is considered “walking wounded”. From here, it is helpful to think of the algorithm as a pathway from green to yellow. ( The “yellow” patients are those that are wounded but that are not critical).

There are only two ways to branch off of the main path.

  1. The patient is apneic even after the airway is opened (Black)
  2. The patient does not meet the RPM criteria (Red)


Start Triage Vertically

To learn more about triage and MCI’s…

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Practice START Triage sorting!

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