Study objectives: Disaster preparedness and response has taken on a new urgency because of recent world events. Aspects of a disaster response that have not been fully evaluated or assessed for validity include triage and triage systems. A commonly used system is the modified Simple Triage and Rapid Treatment (START). In this system, patients are triaged to 1 of 4 categories: red, immediate care; yellow, delayed care; green, “walking wounded”; and black, unsalvageable. The START triage system is frequently used by disaster medical assistance teams (DMAT), and is the system used by the New Mexico DMAT (NMDMAT) during deployments. However, this model has not been assessed previously to determine whether it is a useful or appropriate tool in a DMAT deployment. Our goal is to determine whether the START system commonly used by DMATs is a useful predictor of patient referral and transportation needs in disasters. To our knowledge, this is the first evaluation of this triage tool in DMAT deployments.

Methods: This is a retrospective cohort review of all patients treated by the NMDMAT after Hurricane Andrew (Florida, August 1992), Hurricane Iniki (Hawaii, September 1992), the Northridge Earthquake (California, January 1994), and the Houston flood caused by Tropical Storm Allison (Texas, June 2001). Medical records were reviewed for triage category, disposition, and mode of transportation. Patients were assigned 1 of 4 triage categories according to urgency for medical care: green, yellow, red, or black. Disposition was assigned to 1 of 2 categories: home or referral to additional medical care. Transportation was also assigned to 1 of 2 categories: private vehicle or emergency medical services (EMS). Data were compared for statistical significance using a χ² test for trend.

Results: One thousand six hundred fifty-eight patients treated during these disaster events were assigned the following triage categories: green 1,363 (82.2%), yellow 236 (14.2%), red 55 (3.3%), and black 0. A total of 226 (13.6%) patients required disposition to additional medical care: green 123 (9.0% of category, 7.4% of total), yellow 236 (31.4% of category, 4.5% of total), and red 29 (52.7% of category, 1.7% of total). Of these patients with a reported method of transportation, a total of 66 (46.2%) were transported by EMS: green 13 (20.3% of category), yellow 30 (55.6% of category), and red 23 (92.0% of category). All categories were statistically different (P<.005).

Conclusion: A relatively low percentage of disaster patients treated by a DMAT team at 4 major deployments required referral for additional medical care. Compared with the green triage category, patients assigned a red triage category were 5 times more likely to require referral for additional medical care and nearly 5 times more likely to require EMS transportation. In this first-of-its-kind examination of the START system, a higher-acuity START category was associated with an increased likelihood of transfer to a hospital and may continue to be a useful tool in this respect in future DMAT deployments.