Triage Methodologies: START vs SALT
Uploaded by
carloshgmedeirosTriage Methodologies: START vs SALT
Uploaded by
carloshgmedeiros17/09/2019 Comparison of START and SALT triage methodologies to reference standard definitions and to a field mass casualty simulation.
- P…
PubMed
Format: Abstract
Am J Disaster Med. 2017 Winter;12(1):27-33. doi: 10.5055/ajdm.2017.0255.
Comparison of START and SALT triage methodologies to reference
standard definitions and to a field mass casualty simulation.
Silvestri S1, Field A2, Mangalat N3, Weatherford T4, Hunter C5, McGowan Z6, Stamile Z7, Mattox T8, Barfield
T8, Afshari A9, Ralls G10, Papa L11.
Author information
1 Program Director, Orlando Health Emergency Medicine Residency, Orlando Regional Medical
Center, Orlando, Florida; Associate EMS Medical Director, Orange County EMS System,
Orlando, Florida.
2 Resident, Emergency Medicine, University of Arizona, Tucson, Arizona.
3 Clinical Instructor, Department of Emergency Medicine, University of Texas-Houston, Texas,
Houston.
4 Fellow, Pediatric Emergency Medicine, Orlando Health, Orlando, Florida.
5 Health Services Director, Orange County Government, Orlando, Florida; Associate EMS Medical
Director, Orange County EMS System, Orlando, Florida.
6 Pediatric Emergency Medicine, Orlando Health, Orlando, Florida.
7 Emergency Department, Tuba City Regional Health Care, Tuba City, Arizona; Emergency
Department, Flagstaff Medical Center, Flagstaff, Arizona.
8 University of Central Florida College of Medicine, Orlando, Florida.
9 Resident, Emergency Medicine, Emory University, Atlanta, Georgia.
10 Public Safety Director, Orange County Government, Orlando, Florida; EMS Medical Director,
Orange County EMS System, Orlando, Florida.
11 Director of Academic Clinical Research, Attending Emergency Physician, Orlando Regional
Medical Center, Orlando, Florida; Professor, University of Central Florida College of Medicine,
Orlando, Florida; Associate Professor, Florida State University College of Medicine, Orlando,
Florida.
Abstract
OBJECTIVES: We compared Sort, Assess, Lifesaving Intervention, Treatment/Transport (SALT)
and Simple Triage and Rapid Treatment (START) triage methodologies to a published reference
standard, and evaluated the accuracy of the START method applied by emergency medical
services (EMS) personnel in a field simulation.
DESIGN: Simulated mass casualty incident (MCI). Paramedics trained in START triage assigned
each victim to green (minimal), yellow (delayed), red (immediate), or black (dead) categories.
These victim classifications were recorded by investigators and compared to reference standard
definitions of each triage category. The victim scenarios were also compared to the a priori
classifications as developed by the investigators.
SETTING: MCI field simulation.
MAIN OUTCOME MEASURE:
https://www.ncbi.nlm.nih.gov/pubmed/28822212/?fbclid=IwAR3Ocrxw00gPVeYJKUytkHwfB8a9cICFNyIEXzo_gLIsSkyw3iAFAYNWDuE 1/2
17/09/2019 Comparison of START and SALT triage methodologies to reference standard definitions and to a field mass casualty simulation. - P…
Comparison of the correlation of START and SALT triage methodologies to reference standard
definitions. Another outcome measure was the accuracy of the application of START triage by
EMS personnel in the field exercise.
RESULTS: The strongest correlation to the reference standard was SALT with an r = 0.860 (p <
0.001) and κ = 0.632 (p < 0.001). START and SALT triage systems agreed 100 percent on both
black and green classifications. There were significant correlations between the field triage and
both START and SALT methods (p < 0.001, respectfully). SALT had a significantly lower
undertriage rate (9 percent [95%CI 2-15]) than both START (20 percent [95%CI 11-28]) and field
triage (37 percent [95%CI 24-52]). There were no significant differences in overtriage rates.
CONCLUSIONS: In our study, the SALT triage system was overall more accurate triage method
than START at classi-fying patients, specifically in the delayed and immediate categories. In our
field exercise, paramedic use of the START methodology yielded a higher rate of undertriage
compared to the SALT classification.
PMID: 28822212 DOI: 10.5055/ajdm.2017.0255
[Indexed for MEDLINE]
Publication type, MeSH terms
LinkOut - more resources
https://www.ncbi.nlm.nih.gov/pubmed/28822212/?fbclid=IwAR3Ocrxw00gPVeYJKUytkHwfB8a9cICFNyIEXzo_gLIsSkyw3iAFAYNWDuE 2/2
