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The START triage system has been around for a few decades, but most of the research done on it has applied triage retrospectively–which is to say, to patients who have data in trauma patient registries.  That makes it really refreshing to see a new study of how START is applied in the real world.

The study looked at the use of the START triage that happened after a train crash (which coincidentally happened about 1 hour before a scheduled countywide MCI drill–talk about timing).

First, the things START was good at in this study:  making sure that red patients were transported first (on average, they arrived at hospitals an hour earlier than yellows and greens) and making sure that all sick patients made it into the red category.  It was also good at sorting lesser-injured patients into the green category:  of 58 patients traiged green, 55 were treated and released within 24 hours.

The one major problem with START actually seems to be that it’s too good at picking up heavily injured patients.  It does such a good job, in fact, that of 22 patients triaged red, only 2 truly needed immediate lifesaving intervention, although another 14 were admitted for at least 24 hours.  (Part of this might be due to human nature:  7 patients triaged as yellow or red were documented as walking on scene, which technically would have made them green.) 

Overall, more than half of all patients were overtriaged by study definitions.  This may not seem like a big deal until you realize that local EDs could be swamped with that initial wave of reds–and it could be really, really useful to find a way to make that “red” category more specific.  The trick is how to do that without making the triage tool too complicated to use on a chaotic scene.