Tiny Tip: START Triage Protocol RPM – 30 – 2 – Can Do

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If you’re like me, you appreciate the value of triage systems in emergency medicine and prehospital care but find it hard to remember the components of each. The START Triage (Simple Triage And Rapid Treatment) protocol was designed to quickly assess victims of mass casualty, categorising them into four colour-coded groups that communicate the urgency of treatment.1

Patients designated ‘green’ are the walking wounded; these individuals can move and follow commands. They should be directed to a safe area to await further assessment and treatment. Patients in the ‘black’ group are not breathing, even after appropriate repositioning of the airway. These patients do not receive treatment.

The two intermediate categories – ‘red’, which designates patients who must receive immediate care, and ‘yellow’, which designates patients who may receive delayed care – require a more in-depth assessment of respiration, circulatory status, and mentation.1

RPM – 30 – 2 – Can Do 

RPM – 30 – 2 – Can Do was created as a memory aid for the components of the exam that separate ‘red’ patients from ‘yellow’ patients. Each of the first three letters in the mnemonic coordinates with one of the latter three components. In other words:

  • R: indicates that patients who are suitable for delayed treatment must have a Respiratory Rate of less than 30.
  • P: reminds us that adequate Perfusion is indicated by a capillary refill of less than 2seconds.
  • M: suggests to us that Mental status is adequate if the patient is able to follow commands. That is, the adequately-mentating patient Can Do what they are asked.

Patients with any of the ‘RPM’ features (respiratory rate greater than 30, delayed capillary refill, or altered mental status) belong in the ‘red’ category and warrant immediate control of life-threatening hemorrhage or airway obstruction.1 Those that do not fit in the green, red, or black categories are designated ‘yellow’ and are the priority after ‘red’ patients have been addressed.

By their very nature, mass casualty situations are stressful and happen when we are least prepared. The simple mnemonic RPM – 30 – 2 – Can Do may help you remember the important components of the system when you need them. Of course, a single approach does not work for everyone. Brent Thoma offers a different perspective and a more in-depth look at the START system in this post.

References

1.
Rosen P. Rosen’s Emergency Medicine. Elsevier; 2018.
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Sarah Luckett-Gatopoulos

Sarah Luckett-Gatopoulos

Senior Editor at BoringEM
Luckett is a resident at McMaster University. Interested in literacy, health advocacy, creative writing, and near-peer mentorship.
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Mark Woodcroft

Mark Woodcroft

Mark is a family medicine resident in Collingwood, ON. He has interests in emergency medicine and hematology. When he's not in the ED, he can be found enjoying the great outdoors on his skis, bike, and paddle board.
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