Which tag color according to the disaster triage tag system is assigned to a client who has an immediate threat to life?

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

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

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:

• Red
• Yellow
• Green
• Black

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