Triage
JumpSTART Pediatric MCI Triage
Pediatric-specific triage modifications for children in mass-casualty events when adult START criteria do not apply.
Why pediatric triage differs
Children have higher baseline respiratory rates, smaller blood volumes, and different behavioral responses to stress than adults. The CDC’s child injury prevention resources stress that trauma systems must account for age-specific physiology when allocating scarce resources.1 JumpSTART adapts START for patients roughly 1 year through adolescence, with infant-specific algorithms handled separately in many jurisdictions.
Ambulatory children are sorted to minor, as in START. Apneic children receive five rescue breaths first—pediatric airways often obstruct from positioning or reversible causes. If apnea persists after repositioning and breaths, expectant tagging may apply under extreme resource scarcity; if breathing resumes, reassess using perfusion and mental status criteria.
Applying JumpSTART on scene
Respiratory rate thresholds differ from adult START: rates over 45 or under 10 in children not crying tag immediate. Capillary refill over two seconds, absent distal pulses, or cool extremities signal immediate perfusion failure. Mental status is evaluated with the AVPU scale—unresponsive or responds only to pain tags immediate; verbal or alert responses support delayed tagging when other steps are normal.
EMS providers should document triage tag, time, and location assigned for reunification and family support.2 Emotional caregivers and missing guardians are common at pediatric MCIs; triage officers coordinate with incident command for family zones separate from treatment areas.
Practice this skill
Apply what you read with a hands-on JumpSTART Triage drill — instant feedback on every scenario.
