II. Indications

  1. Mass Casualty Incident (MCI) triage method targeted for use in children

III. Background

  1. JumpSTART Triage system is the most commonly used pediatric Mass Casualty Incident (MCI) triage system in the United States
  2. Adult patients are best triaged with the START Triage or SALT Triage protocols

IV. Categories: Triage

  1. Minor (Green)
    1. "Walking wounded" with minor injuries
    2. Status not expected to deteriorate over days
  2. Delayed (Yellow)
    1. Urgent transport and care (may be delayed up to 1 hour)
    2. May include serious and potentially life-threatening wounds
    3. Status not expected to deteriorate during the delay
  3. Immediate (Red)
    1. Immediate care for life threatening injuries
    2. Requires medical attention within minutes for survival
    3. Includes injuries affecting airway, breathing and circulation
  4. Expectant (Black)
    1. Victim is unlikely survive based on injuries and available resources
    2. Palliative Care with pain medications should be considered

V. Evaluation

  1. Walking Wounded
    1. Triage to minor (and secondary triage process)
  2. Assess Respirations
    1. No respiratory effort
      1. Position airway
      2. Indications to triage to Immediate
        1. Spontaneous breathing after airway positioning OR
        2. Palpable pulse AND spontaneous breathing after 5 rescue breaths given
      3. Indications to triage to Expectant
        1. No respiratory effort after positioning airway AND
        2. No palpable pulse OR No spontaneous breathing after 5 rescue breaths
    2. Spontaneous Breathing
      1. Triage to Immediate, if Respiratory Rate <15/min or >45/min
      2. Assess pulse (see below) if Respiratory Rate 15-45/min
  3. Assess Pulse
    1. Pulse absent
      1. Triage to immediate
    2. Pulse present
      1. Assess neurologic status (see below)
  4. Assess Neurologic Status
    1. See AVPU Scale
    2. Indications to Triage to Immediate
      1. Posturing (or other innapropriate response to pain, P) or
      2. Unresponsive (U)
    3. Indications to Triage to Delayed
      1. Alert (A) response or
      2. Verbal (V) response or
      3. Appropriate pain (P) response

VI. Reources

  1. JumpSTART Pediatric MCI Triage Tool (Dr. Lou Romig)
    1. http://www.jumpstarttriage.com/The_JumpSTART_algorithm.php
  2. DHS CHEMM JumpSTART Flowsheet
    1. http://chemm.nlm.nih.gov/startpediatric.htm

VII. References

  1. Seeyave and Bradin (2014) Crit Dec Emerg Med 28(12): 2-13
  2. Romig (2002) JEMS 27(7):52-63 [PubMed]

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