Homebush Triage Standard Using Simple Triage Assessment and Rapid Transport (START) and Secondary Assessment of Victim Endpoint (SAVE)

 

Considerations:

(1) Utilize medical resources on critically ill patients with a reasonable probability of survival.

(2) Limit use of medical resources on patients who will probably die or whose final outcome will not be affected by immediate care.

(3) Repeated assessment is necessary since an initial assessment may underestimate the severity of injury.

(4) The dead and any human body parts should be clearly labeled and not transported to active treatment areas.

 

Homebush Triage Classification	Priority	Priority Code	Color
dead	not applicable	E (echo)	black
dying	terminal care only	D (delta)	white
not urgent	low	C (Charlie)	green
urgent	high	B (bravo)	yellow/gold
immediate	top	A (alpha)	red

 

 

Simple Triage and Rapid Treatment (modified START)	Designation
Anyone who does not breath with simple airway maneuvers	dead
Anyone who can walk	not urgent
Anyone who (a) cannot walk (b) can obey commands (c) has a rapid radial pulse, AND (d) has a respiratory rate < 30 breaths per minute	urgent
Anyone else	immediate

 

where:

• The original START used capillary refill time (<= vs > 2 seconds) rather than a radial pulse.

 

Secondary Assessment of Victim Endpoint (SAVE, Table 4, page 606)

(1) patients with poor prognosis

(2) patients with outcome unlikely to be altered by immediate care

(3) special categories

 

Patients with poor prognosis:

(1) Glasgow coma score < 8 in an adult with significant head injury (text indicates a pediatric patient with low GCS if hypoxia and hypotension present)

(2) chest trauma with abnormal vital signs

(3) abdominal trauma with refractory hypotension

(4) burns with < 50% probability of survival

(5) adults > 60 years of age with burn and significant inhalation injury

 

Patient with outcome unlikely to be affected by immediate care:

(1) Mangled Extremity Severity Score (MESS, described later in chapter): A score >= 7 indicates poor chance of limb salvage and amputation is probable.

(2) spinal trauma (requires care not usually accessible in an emergency situation)

(3) a pre-existing condition

 

Special categories

(1) health care workers with minor injuries who would be able to assist in the medical response if simple treatment is provided.

(2) non-traumatic emergencies