START Triage...

EMTecBOB

EMTecBOB

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In START Triage, a victim is tagged red if they are breathing more than 30 per minute. - Why is this considered an "immediate" threat to life?
 
Because it is outside the normal range of respirations for an adult, which could indicate a soon to be life threatening problem with breathing.
 
Think for a minute. Why do you breath? How do you breath? How does the molecules exchanged during breathing get moved around the body? How does the body compensate if any of that goes wrong?
 
I understand that it is out of norm. I was just wondering why someone with no other obvious signs of life threats, would be tagged red just because they were breathing fast. After all, if I had just been in a traumatic event, I might be breathing fast without a dent in the fender.
 
Because at the point that you are assessing them, they have already failed at being able to walk and do not qualify for a green tag, there is going to be something else going on with them.
 
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EMTecBOB said:
I understand that it is out of norm. I was just wondering why someone with no other obvious signs of life threats, would be tagged red just because they were breathing fast. After all, if I had just been in a traumatic event, I might be breathing fast without a dent in the fender.
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Would you still be breathing that fast 6-10 minutes (urban...much longer for rural or remote) later when EMS arrives? If so, then there is a problem, hence the red tag.
 
START is kinda silly. Just think of it as
"insufficient respiration" (rate and/or depth) = RED
Because you might not really be stopping to take a rate in a real triage situation.

Also, peripheral cap refill is a horrible measure for most patients in many environments. Try central cap refill (like gums).
 
OK...it is now making more sense to me. And you guys make great points....not walking, breathing fast? Could be something really bad going on, after all, even shock kills.

What got me to thinking about this was the fact that > 30/min respiration's seemed to be so arbitrary. But I was not thinking about it in the context of a traumatic event with a significant MOI.

Thanks guys

Keep warm, keep safe, don't keep the EMT's awake.
 
Linuss said:
Everyone dies from shock.
Click to expand...


That is a good observation. If I remember correctly, on my dads full death certificate, it listed step by step what caused death...ending in cardiogenic shock. - It all comes down to the pump stopping, or having nothing left to pump...which also causes it to stop.
 
It used to get me too, now I just think about all the good times. - BTW, hug em while you got em.
 
EMTecBOB said:
It used to get me too, now I just think about all the good times. - BTW, hug em while you got em.
Click to expand...

Yeah i agree, my dad died of a suspected MI earlier this year

we didnt get an autopsy so they didnt list the steps of what happened
 
EMTecBOB said:
What got me to thinking about this was the fact that > 30/min respiration's seemed to be so arbitrary.
Click to expand...

Any hard cutoff level is, by its nature, arbitrary.
 
Because the patient is breathing at a rapid rate, and not enough oxygen is
reaching the alveoli. Therefore inadequate oxygen exchange
 
There is a reason that START is used, because it is a standard system so that everyone is trained the same way. You can disagree with their exact criteria, but if that's the system that your service is using you better be doing it by the book. You don't want to be in court explaining "oh, I know START uses cap refill, but I decided to use my own way of checking perfusion for making the patient a red." People straying from the protocols is why there is such variety in how the exact same patients are triaged by different people.

The protocols are cut and dried and simple for a reason, so you don't have to think much when you have 30 injured an are trying to assess each in less than a minute.

Oh, and keep count of how many of each color you've tagged. It pisses me off when my students just tagged 20 people and have no idea how many reds and yellows they have. (The others I'm less worried about. Greens are "do I need a bus or two" and there will be plenty of time to count the black tags later.
 
There is a reason that START is used, because it is a standard system so that everyone is trained the same way. You can disagree with their exact criteria, but if that's the system that your service is using you better be doing it by the book. You don't want to be in court explaining "oh, I know START uses cap refill, but I decided to use my own way of checking perfusion for making the patient a red." People straying from the protocols is why there is such variety in how the exact same patients are triaged by different people.

The protocols are cut and dried and simple for a reason, so you don't have to think much when you have 30 injured an are trying to assess each in less than a minute.

Oh, and keep count of how many of each color you've tagged. It pisses me off when my students just tagged 20 people and have no idea how many reds and yellows they have. (The others I'm less worried about. Greens are "do I need a bus or two" and there will be plenty of time to count the black tags later.
 
Sure... a triage protocol developed for us by Californian urban firefighters 3 minutes from the ER is what we should be using during a rural Colorado winter 3 hours from a trauma center just so we can all be standardized. :wacko:

Our protocols are viewed by guidelines and many things get fuzzy in an MCI.
 
That's not what said. If start doesn't fit well with your local situation your medical director should chose something else. But if as a department it's been decided that you are going to do START, than you should be doing start as it is written.

It's percisely because things get "fuzzy" at an MCI that systems like START have very clear algorythms, because you don't have to think as much or make as many on the fly decisions. Yes, things will get messed up, and people will tweak the triage enough on their own. But I don't think people should be planning on going into a future MCI and making up their own triage criteria on the fly.
 
Not familiar with STAT triage just had to look it up.

In my experience in MCIs respiratory rate of 30 isnt usually a reliable finding and capillary refill never is.
 
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