A Quick Overview

In mass casualty incidents (MCIs), triage is essential to quickly assess and prioritize patients based on the severity of their conditions. Two widely used triage systems in EMS are START (Simple Triage and Rapid Treatment) and SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport). While both aim to maximize survival with limited resources, they differ in approach and application.

START Triage: The Basics

Developed in the 1980s, START triage is widely used in prehospital MCI response. It categorizes patients into four color-coded groups based on RPM (Respiration, Perfusion, and Mental Status):

• Red (Immediate): Life-threatening injuries, but salvageable with immediate care.
• Yellow (Delayed): Serious injuries that can wait for treatment.
• Green (Minor): Walking wounded; minimal care needed.
• Black (Expectant/Deceased): No signs of life or injuries incompatible with survival.

START is fast and simple, allowing EMS to triage large numbers of patients in under 60 seconds each. However, it may over-triage or under-triage some patients due to its rigid criteria.

SALT Triage: A More Comprehensive Approach

SALT triage, endorsed by the CDC, expands on START by incorporating a global sorting phase, lifesaving interventions, and a broader range of clinical decision-making. The steps are:

1. Sort: Patients who can walk move to a designated area; remaining patients are assessed where they lie.
2. Assess: Primary assessment using a structured algorithm.
3. Lifesaving Interventions: Immediate interventions such as airway maneuvers, hemorrhage control, and auto-injectors.
4. Treatment/Transport: Patients are categorized into five groups:
   • Immediate (Red) – Critical, urgent intervention needed.
   • Expectant (Gray) – Low chance of survival, comfort care given.
   • Delayed (Yellow) – Requires treatment but not immediately life-threatening.
   • Minimal (Green) – Walking wounded.
   • Dead (Black) – No signs of life.

SALT is more flexible and clinically refined than START, making it better suited for complex MCIs and integration into hospital-based triage.

Which One Should EMS Use?

• START is effective for fast-moving, high-volume MCIs, especially in prehospital settings where speed is critical.
• SALT provides a more refined triage approach with built-in interventions, making it ideal for interagency coordination and larger-scale incidents.

EMS agencies should train in both systems and adapt based on local protocols and incident needs. The key to success in any triage system is practice, efficiency, and adaptability in the field.

🚑 Stay ready, stay sharp, and save lives! 🚑