Trauma
Trauma Triage & the START System
Mass-casualty sorting principles from CDC field triage guidance and standardized START methodology.
Individual vs. mass-casualty triage
Routine EMS triage identifies the sickest patient in a small scene. Mass-casualty incidents (MCIs) invert priorities: do the greatest good for the greatest number when resources are overwhelmed. The CDC’s field triage guidelines inform both trauma center destination decisions and physiologic urgency.1
FEMA’s National Incident Management System (NIMS) provides the command structure—incident command, staging, and unified communications—that makes triage tags meaningful.2
START in practice
Simple Triage and Rapid Treatment (START) uses respiration, perfusion (radial pulse or capillary refill), and mental status (AVPU) to assign immediate, delayed, minor, or expectant categories. Walkers with minor injuries may be directed to a collection point, freeing responders for critical patients.
AEMTs often staff triage sectors during MCIs. Clear tagging, one-way patient flow, and frequent re-triage prevent category drift as patients deteriorate or improve.
Integration with transport
Triage without transport is sorting without care. Coordinate ambulance staging, helicopter requests, and hospital notifications through the operations section.
Document triage category, time, and reassessments. After-action reviews improve the next response.
