Transcript START & a “Little” JumpSTART

START &
JumpSTART Triage
Joe Immermann, EMT-P, BBA
With thanks to:
Joy Erb Moser, RN BSN CEN
START
Aim of Triage…
Greatest Good for the
Greatest Number
START
 START facilitates patient triage in 60
seconds or less
 Assess
 Ventilation
 Perfusion
 Mental status
Correct Life Threats
 Blocked airways
 Severe bleeding
START Assessments
1. Ambulation
2. Respirations
3. Perfusion
4. Mental status
Respiratory
 Check ventilation rate and adequacy
 Check for foreign objects causing
airway obstruction
 Reposition to open airway
Perfusion
 Check capillary refill in nail beds or
 Palpate radial pulse
Mental Status
 Ask patient to follow simple commands
 Open and close eyes
 Touch finger to nose
Triage Categories
 Green—Minor/Ambulatory
 Red—Immediate
 Yellow—Delayed
 Black—Dead or
nonsalvageable
Minor (GREEN)
 Separate from the general group at
the beginning of the triage
operation. (“Walking wounded”)
 Direct patients away from the
scene to a designated safe area.
 Consider using these patients to
assist in treatment of those patients
tagged as immediate.
Immediate (RED)
 Ventilations present only after
repositioning the airway.
 Respiratory rate greater than 30
per minute.
 Delayed capillary refill (> 2
seconds)
 Unable to follow simple commands.
Delayed (YELLOW)
 Any patient who does not fit into either
the immediate or minor categories.
Deceased (BLACK)
 No ventilations present even after
attempting to reposition the airway.
Pediatric MCI Patients
JumpSTART
 Results in less over-triage by
acknowledging differences in kids.
 Addresses the emotional burden of
tagging a child as “deceased” by
allowing two extra steps.
Pediatric MCI Patients
If the victim looks like a child, use
JumpSTART. If the victim looks like
a young adult, use START.
--Dr. Lou Romig
Pediatric MCI Patients
 Not all children can walk
 Respiratory rates may be normal at >
30/minute
 Capillary refill influenced by
environment
 Obey commands? Kids??
Breathing?
 If breathing spontaneously, go on to the
next step: assessing respiratory rate.
 If apneic or with very irregular breathing,
open the airway using standard
positioning technique.
 If positioning results in resumption of
spontaneous respirations, tag the
patient RED and move on.
Pulse Check: Apneic Child
 Physiological reason to believe an
apneic child may still have a pulse.
Pulse Check: Apneic Child
 If no breathing after airway opening,
check for peripheral pulse (child may
retain pulse while apnic longer than
adult).
 If no pulse, tag patient BLACK and
move on.
Pulse Present
 Provide 5 breaths with a mouth-tobarrier device.
 If breathing returns, child is tagged as
RED (Immediate).
 If no spontaneous respirations return,
the child is tagged BLACK.
Spontaneous Respirations
 Check respiratory rate:
 <15 or > 45 are considered critical:
tag patients as RED
 Respiratory rate between 15-45:
Check pulse
Children with spontaneous
respirations but no palpable pulse
(in the least injured limb) are tagged
Immediate (RED).
Mental Status Assessment
 Quick AVPU:
 Alert (YELLOW)
 Verbal Stimuli (YELLOW)
 Physical Stimuli (YELLOW)
 Unconscious (RED)
Non-Ambulatory Patient
Modifications
 Infants who normally can’t walk yet
 Children with developmental delay
 Children with acute injuries preventing
them from walking
 Children with chronic disabilities
Non-Ambulatory Patient
Modifications
 Evaluate with JS algorithm
 If RED criteria, tag as RED.
 If YELLOW criteria, assess for external
signs of significant injury.
 If no significant external signs, tag as
GREEN.
 If significant external sign of injury are
found, tag as YELLOW.
Deceased (BLACK) Patients
Unless clearly suffering from
injuries incompatible with life,
victims tagged in the BLACK
category should be reassessed
once critical interventions have
been completed for RED and
YELLOW patients.
START/JumpSTART Differences
 Apneic children are rapidly assessed for
sustained circulation.
 Apneic children with circulation receive a
brief ventilatory trial as an additional airway
opening and stimulating maneuver.
 Respiratory rates are adjusted. (15-30-45)
 Peripheral pulse is substituted for cap refill.
 AVPU is used to assess mental status.
Patient #1: Tammy Teacher
 Unresponsive
 RR—36/min
 No airway obstruction
 CRT > 4 seconds
TRIAGE: Green/Red/Yellow/Black
Patient #2: Pre-School Paula
 RR > 48/min
 Weak pulse
 Responds to pain
TRIAGE: Green/Red/Yellow/Black
Patient #3: Pre-School Sam
 No Respiratory effort
 Faint pulse
 Unresponsive
TRIAGE: Green/Red/Yellow/Black
Patient # 4: Tom Teacher
 Ambulated to curb, holding Jenny &
Libby
 RR—28/min
 CRT 2 seconds
 Alert; following commands
TRIAGE: Green/Red/Yellow/Black
Patient # 5: P.S. Jenny
 Held by Tom Teacher
 Crying for “Mommy”
 RR—38/min
 Pulse present
 Clinging to Tom
TRIAGE: Green/Red/Yellow/Black
Patient # 6: P.S. Libby
 Held by Tom Teacher
 RR—32/min
 Pulse present
 Responds to verbal & tactile stimuli
TRIAGE: Green/Red/Yellow/Black
Patient # 7: P.S. Mikey
 RR—28/min
 Palpable pulse
 Responds to tactile stimulation
TRIAGE: Green/Red/Yellow/Black
Patient # 8: P.S. Lucas
 RR—8/min
 Pulse weak
 Unconscious
TRIAGE: Green/Red/Yellow/Black
Patient # 9: P.S. Ashley
 RR—36/min
 No palpable pulse
TRIAGE: Green/Red/Yellow/Black
Patient # 10: P.S. Troy
 Crying for Teacher; walked to Tom
 RR—30/min
 Pulse present
 Scared of EMT
TRIAGE: Green/Red/Yellow/Black
Questions?