What are the colors for triage?

Disaster triage nursing review for students about the color-coded tags and the START method!

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Disaster Triage Nursing Lecture
Disaster Triage Nursing
Disaster Triage Color Tags
START Method
Related Questions
Standard sections

The goal of this review is to help you understand each of the four tag colors that make up the triage tagging system and how to use the START method to assign tag colors in a disaster situation. For exams, you want to be familiar with the following:

Meaning of the four tag colors (ex: the colors, who is seen first and so forth, what injury types are included)
How to apply the START method in scenarios you will be given on an exam (ex: a wounded individual is presenting with the following….what color tag is the wounded assigned using the START method?)

Don’t forget to test your knowledge on this content by taking the disaster triage nursing quiz.

Disaster Triage Nursing Lecture

Disaster Triage Nursing

Triage means to group or rank. In the emergency room (ER), patients are triaged based on their presenting signs and symptoms. The patients who have severe symptoms are seen immediately, while patients who don’t will have to wait to be seen.

In this review, we will be concentrating on triage related to a disaster situation. This is where there are many wounded individuals, but the personnel and resources available to treat those wounded are limited. Therefore, personnel and resources should be used wisely, and this is where the disaster color-coded triaging tagging system and START method can be helpful.

Disaster Triage Color Tags

There are four colors and a wounded individual will be tagged one color based on their health status. The four colors include:

To help you keep the meaning of the tag colors red, yellow, and green separated, think of a traffic light and what you do at the traffic light when it turns certain colors. The reason I include this is because many students get confused about these three colors on exams. The black tag color is easy to remember because black is most commonly associated with death, which is the meaning of this tag color.

Red Tag: Immediate

What do you do at a traffic light when it turns red? You stop! Therefore, when a patient is tagged red, STOP and get them treatment because they have first priority in receiving care.

Seen 1st
Injuries are life-threatening but they could possibly survive if they are immediately treated.
Severe alteration in breathing, circulation, and neuro/mental status
Conditions that would cause a wounded individual to be tagged red (think of conditions or systems of the body that if severely damaged could majorly alter the breathing, circulation, and neuro system)
- Spinal cord injuries: remember various areas of the spinal cord control breathing, brain and heart function…shock can occur like neurogenic, cardiogenic etc.
- Severe bleeding (internal or external): if the patient is treated immediately so the bleeding could be stopped and transfused with blood products they may live
- Major burns that affects a high percentage of the body: burns can affect the circulation and the respiratory system (depending on the burn type and where it’s located)
- Some types of major respiratory trauma: pneumothorax etc.

Yellow Tag: Delayed

What do you do at a traffic light when it turns yellow? You slow down or delay because you’re about to stop. Therefore, when a patient is tagged yellow their treatment is delayed but for only about an hour or so because they could turn critical based on their presenting injuries.

Seen 2nd (second priority)
Significant injuries BUT at this point their breathing, circulation, and mental status is within normal range but this could change.
Conditions:
- Bone fractures: major fractures that require medical treatment
- Integumentary damages: open wounds, deep lacerations etc.

Green Tag: Minor

What do you do at a traffic light when it turns green? You go! Many times these wounded individuals are termed the “walking wounded”. Therefore, these patients can get up and GO (move around). Their injuries are minimal.

Treatment can be delayed for several hours and some can treat themselves.
Breathing, circulation, mental status not expected to change

Black Tag: Expectant

Wounded is dying or expired.
Injuries are deadly to the point the individual will not survive.
Absence of breathing, circulation, mental status.

START Method

This method can help determine what tag color a wounded victim is assigned. START stands for “Simple Triage And Rapid Treatment”. This particular method is for the adult. It’s very easy to use and quick.

First, you want to look at the wounded individual and ask yourself “what is the wounded victim doing?” Are they able to walk around? OR Are they unable to walk or move?

If the wounded individual can walk around and move, their breathing, circulation, and mental status are within normal range. Therefore, they are tagged GREEN.

Walking? GREEN TAG

Unable to move or walk? Check these three things in this order: Breathing, Circulation, and Mental Status/Neuro. The wounded individual that cannot walk will be tagged either RED, YELLOW, or BLACK.

Breathing?

Yes, rate is greater than 30: RED TAG
Yes, rate is less than 30: check circulation
No, reposition airway:
- Still not breathing: BLACK TAG
- Yes: RED TAG

Circulation? (radial pulse present or less than 2 seconds capillary refill)

Yes: check mental status
No: RED TAG

Mental Status? (can they obey your commands?)

Yes: YELLOW TAG
No: RED TAG

References:

START Adult Triage. (2019). [Ebook] (p. 1). Retrieved from https://chemm.nlm.nih.gov/StartAdultTriageAlgorithm.pdf

The START (simple triage and rapid treatment) system is widely used for response to a mass casualty. First responders bring victims, who are placed in one of four categories: BLACK (deceased/expectant): Injuries are incompatible with life. Should not be moved forward to the collection point. RED (immediate): Severe injuries but high potential for survival with treatment. First to be taken to the collection point. YELLOW (delayed): Serious injuries, but not immediately life-threatening. GREEN (walking wounded): Minor injuries.

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A triage tag is a tool first responders and medical personnel use during a mass casualty incident. With the aid of the triage tags, the first-arriving personnel are able to effectively and efficiently distribute the limited resources and provide the necessary immediate care for the victims until more help arrives. Triage tags were first introduced by Baron Dominique Jean Larrey, a French surgeon in Napoleon's army.[citation needed]

Typical triage tag used for emergency mass casualty decontamination.

Simple triage and rapid treatment (START) is a strategy that the first responders and medical personnel employ to evaluate the severity of injury of each victim as quickly as possible and tag the victims in about 30–60 seconds. The triage tags are placed near the head and are used to better separate the victims so that when more help arrives, the patients are easily recognizable for the extra help to ascertain the most dire cases.

A triage tag is two-sided, but the actual layout of the sections vary between and within countries and between governmental agencies. Design is often in the form of a fold-able card, to allow the state of the victim to be clearly visible. It is now common to use triage tags to allow first responders to have a better handle of the victims during a triage. There is no universal agreement in the design of triage tags, so each authority has implemented their own version to meet their needs.

Dynamic

Popular Triage Tags including Disaster Management Systems' All Risk® Triage Tags, Cruciform and the Smart Tag allow casualties to be re-triaged without having to replace the tag.

Standard sections

Typically, the basic sections of a triage tag may include:

A section informing medical personnel of the patient's vital signs along with the treatment administered.
A section on the patient's demographics such as gender and residential address, and the patient's medical history.
A section with a full pictorial view of the human body. The medical personnel indicate which parts of the body are injured.
The four colors of triage:

Black	Expectant	Pain medication only, until death
Red	Immediate	Life-threatening injuries
Yellow	Delayed	Non-life-threatening injuries
Green	Minimal	Minor injuries

Other features may include:

tear off sections to label the victim properly in terms of severity of injury and to inform other medical personnel, that may arrive later, of the victim's status.
main body for the first responders to fill out during their assessment of the patient. This portion will stay with the patient.
peel off stickers to keep a record of what transportation or treatment was provided to the victim.

Benefits

A benefit in using the triage tag, besides improved traffic flow and effectively distributed care among injured patients, is data collection and dissemination. The fill-in slots on the triage tags do not need to be filled out all at once. Information can be obtained and added onto the triage tag throughout the triage, and referred to as needed.

If a patient's medical condition changes while still in triage, medical personnel can simply tag the patient again with the updated information and label the tags sequentially. The other option is to use a tag which can be altered so that the priority level can go up or down. This eliminates the need to re-tag the patient.

Examples

METTAG system in Japanese

The US military as well as many countries in the world use the MT-137 design by METTAG, while Maryland and New Jersey use their customized version.
Medical Emergency Triage Tags (METTAGs) https://tacda.org/mettag-triage-tags/ were developed in the early 1970s by The American Civil Defense Association, and are widely used among the U.S. military, federal, state, and local agencies, among others. The original MT-137 is a universal triage tool presenting no language or literacy barriers and can be used in the field by anyone of any nationality with minimal training or hands on experience. The MT-501 also by METTAG is a triage tag patterned after the S.A.L.T. triage algorithm which is Sort, Assess, Life-saving Interventions, and Treatment/Transport. The S.A.L.T. system has been adapted by the National Highway Traffic Safety Administration (NHTSA). The CB-100 is a Chemical Biological emergency triage tag which is used for Chem/Bio/Hazmat usage, Decon/Evac usage, and A-E Triage System. METTAG is owned and operated by TACDA, which is an acronym for The American Civil Defense Association. It is a 501(c)3 corporation that teaches civil defense concepts. Membership is free. https://tacda.org/
The Cruciform triage card, used in the UK including the North Sea oil industry, by the Royal London Hospital during the 7 July 2005 London bombings and by medical and paramedical organisations worldwide. The International Cruciform has been produced for the Canada/North America (with appropriate terminology adjustments), and translated versions of the card are available for European and Asian markets. The Cruciform Evacuation System is a variation of the system applying Triage to mass planned and unplanned evacuation scenarios (e.g. hospital evacuations).
The Smart Tag from TSG Associates. Adopted by the State of New York in 2004, the British Military in 2002, used by London Ambulance Service in the 7 July 2005 London bombings and by the combined forces Afghanistan in 2006. The tag is also used in Philadelphia, Boston and Nevada, and is mandated for use across the States of Connecticut and Massachusetts.