JUMp STart - Simple Triage and rapid treatment
JUMP START TRIAGE
JumpSTART© Pediatric Mass Casualty Incident (MCI) Triage Tool is an objective triage system that addresses the needs of children and can be a resource tool when planning a triage process for pediatric patients. Although the JumpSTART© system parallels the START system, it takes into consideration the developmental and physiological differences of children by using breathing as the cornerstone for triage decisions. Adding a respiratory component to the triage system may increase triage time by 15-25 seconds, however, since the number of patients requiring a ventilatory trial would most likely be small, it is not thought to significantly affect overall triage time for an incident.
Additionally, since the physiologic indicators specified for START are not generally applicable to the pediatric victim, different criteria are needed to assess young patients. For example, neurological status under START depends on the patient’s ability to obey commands. This index is clearly not applicable to young children who lack the developmental ability to respond appropriately to commands.
The JumpSTART© Pediatric MCI triage system is designed for triaging infants and young children. Determining the appropriate system to use in the pre-adolescent and young teen population can be sometimes challenging, so the current recommendation is: If a victim appears to be a child, use JumpSTART; if a victim appears to be a young adult, use START.
JumpSTART© uses the same triage categories as START: IMMEDIATE, DELAYED, MINOR, and EXPECTANT/ DECEASED.
In children, because of anatomical/physiological reasons such as weak intercostal muscles or mechanical airway obstruction, apnea may occur rapidly. Thus circulatory failure usually follows respiratory failure. There may be a period of time when the child is apneic but continues to maintain a pulse. It is during this time that airway clearance and a ventilatory trial may stimulate spontaneous breathing. If spontaneous breathing begins, the child is categorized as IMMEDIATE for further treatment. If spontaneous breathing does not follow the initial ventilatory trial, the child is categorized as EXPECTANT/DECEASED or non-salvageable.
The triage steps of the JumpSTART© Pediatric MCI triage system are as follows:
Step 1:
All children who are able to walk are directed to an area designated for minor injuries where they will undergo a secondary and more involved triage. Infants carried to this area or other non- ambulatory children taken to this area must undergo a complete medical and primary evaluation using modifications for non-ambulatory children to ascertain triage status
Step 2:
a) All remaining non-ambulatory children are assessed for the presence/absence of spontaneous breathing. If spontaneous breathing is present, the rate is assessed and the triage officer moves on to step three.
b) If spontaneous breathing is not present and is not triggered by conventional positional techniques to open the airway, palpate for a pulse (peripheral preferred). If no pulse is present, patient is tagged DECEASED/EXPECTANT and the triage officer moves on.
c) If there is a palpable pulse, the rescuer gives five breaths (approximately 15 sec.) using mouth to mask barrier technique. If the ventilatory trial fails to trigger spontaneous respirations, the patient is tagged EXPECTANT/DECEASED and the triage officer moves on. However, if respirations resume, the patient is tagged IMMEDIATE and the triage officer moves on without providing any further ventilations.
Step 3:
If the respiratory rate is 15-45/minute, proceed to checking perfusion. If the respiratory rate is less than 15 (less than 1/every 4 seconds) or faster than 45/minute or irregular, tag as IMMEDIATE and move on.
Step 4:
Assess perfusion by palpating pulses on a (seemingly) uninjured limb. If pulses are palpable, proceed to
Step 5:
If there are no palpable pulses, the patient is tagged IMMEDIATE and the triage officer moves on.
Step 6:
At this point all patients have “adequate” ABCs. The triage officer performs a rapid AVPU assessment of mental status. If the patient is Alert, responds to Voice, or responds appropriately to Pain (withdraws from stimulus or pushes away), the patient is tagged DELAYED and the triage officer moves on. If the patient does not respond to voice and responds inappropriately to pain (moans or moves in a non-localizing fashion) or is Unresponsive, an IMMEDIATE tag is applied and the triage officer moves on to the next patient.
NOTE: All patients tagged EXPECTANT/DECEASED, unless clearly suffering from injuries incompatible with life, should be reassessed once critical interventions for IMMEDIATE and DELAYED victims are completed.