Triage Systems: START, JumpSTART, SALT, and MASS Practice Questions

25 multiple-choice questions on Triage systems: START, JumpSTART, SALT, and MASS for paramedic and EMT students, from Chapter 48 (Incident Management and Mass-Casualty Incidents). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The main goal of primary triage at an MCI is to:

   1. A. Give full treatment to each patient seen
   2. B. Sort patients quickly by need for care
   3. C. Find out each patient's medical history
   4. D. Decide the final diagnosis for each patient
   Show answer

   Answer: B. Sort patients quickly by need for care

   Primary triage is a rapid sort, usually under a minute per patient, to decide who needs care first. Full assessment and treatment happen later in the treatment area, where patients are retriaged.

2. In START triage, the first step is to:

   1. A. Ask everyone who can walk to move to one area
   2. B. Check each patient's blood pressure in turn
   3. C. Count the respirations of every patient seen
   4. D. Assess the pupils of each unresponsive patient
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   Answer: A. Ask everyone who can walk to move to one area

   START begins by directing all patients who can walk to a designated area; they are tagged green (minor) for now. This quickly reduces the number of patients who need individual assessment.

3. During SALT triage, a 6-year-old is not breathing after you open her airway. SALT allows you to:

   1. A. Give 5 breaths, as JumpSTART does
   2. B. Start CPR for 2 minutes and then recheck
   3. C. Give 2 rescue breaths and check again
   4. D. Tag her dead without giving breaths
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   Answer: C. Give 2 rescue breaths and check again

   SALT's lifesaving interventions include opening the airway and, in a child, considering 2 rescue breaths. If the child is still not breathing after that, she is categorized as dead. Five breaths is the JumpSTART rule; mixing systems on one scene makes triage inconsistent. CPR ties up a rescuer and is not part of mass-casualty triage. Tagging her dead without the breaths skips the one quick pediatric step SALT allows.

4. Using START, you find a nonambulatory man who is not breathing. After you reposition his airway, he still does not breathe. You should tag him:

   1. A. Red (immediate) and give him 5 breaths
   2. B. Yellow (delayed) and come back to him
   3. C. Red and begin CPR until help arrives
   4. D. Black (deceased) and move on to others
   Show answer

   Answer: D. Black (deceased) and move on to others

   In adult START, a patient who does not breathe after the airway is repositioned is tagged black, and the rescuer moves on. Rescue breaths are a JumpSTART step for children, not adult START. A delayed tag is for patients who are breathing, perfused, and following commands. CPR ties up a rescuer while other patients who can be saved wait.

5. Using START, a woman is not breathing until you reposition her airway, and then she begins breathing. You should tag her:

   1. A. Yellow (delayed)
   2. B. Black (deceased)
   3. C. Green (minor)
   4. D. Red (immediate)
   Show answer

   Answer: D. Red (immediate)

   An adult who starts breathing only after airway repositioning is tagged red because she has an airway problem that needs immediate attention. If she stayed apneic, she would be tagged black.

6. A nonambulatory adult at a train crash has a respiratory rate of 36 breaths/min. Using START, you should tag him:

   1. A. Yellow (delayed)
   2. B. Green (minor)
   3. C. Red (immediate)
   4. D. Black (expectant)
   Show answer

   Answer: C. Red (immediate)

   In START, an adult respiratory rate greater than 30 breaths/min places the patient in the red category without further steps. Rates of 30 or less move you on to the perfusion check.

7. In START, the perfusion check for a nonambulatory adult breathing 20 breaths/min uses:

   1. A. Radial pulse or capillary refill
   2. B. Blood pressure by palpation
   3. C. Pulse oximetry and skin color
   4. D. Carotid pulse rate and its rhythm
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   Answer: A. Radial pulse or capillary refill

   START checks for a radial pulse or a capillary refill time over 2 seconds. An absent radial pulse or delayed refill means red; blood pressure and pulse oximetry take too long for primary triage.

8. Using START, a nonambulatory man breathes 22 breaths/min but has no radial pulse. You should:

   1. A. Tag him yellow and recheck his pulse later
   2. B. Tag him red and control any major bleeding
   3. C. Check his mental status before tagging him
   4. D. Start an IV and give a fluid bolus first
   Show answer

   Answer: B. Tag him red and control any major bleeding

   An absent radial pulse (or capillary refill over 2 seconds) means red in START, and the only care given is quick, lifesaving steps such as controlling major bleeding. Mental status is checked only when perfusion is adequate.

9. Using START, a nonambulatory woman breathes 18 breaths/min, has a strong radial pulse, and cannot follow the command 'squeeze my hand.' You should tag her:

   1. A. Red (immediate)
   2. B. Yellow (delayed)
   3. C. Green (minor)
   4. D. Black (expectant)
   Show answer

   Answer: A. Red (immediate)

   If an adult in START cannot follow simple commands, she is red, because altered mental status suggests a head injury or shock. A patient who can follow commands with normal breathing and perfusion would be yellow.

10. Using START, a man with an open femur fracture cannot walk, breathes 24 breaths/min, has a radial pulse, and follows commands. You should tag him:

    1. A. Red (immediate)
    2. B. Green (minor)
    3. C. Yellow (delayed)
    4. D. Black (expectant)
    Show answer

    Answer: C. Yellow (delayed)

    A nonambulatory adult who passes all three START checks (RR 30 or less, radial pulse present, follows commands) is yellow. A painful, obvious injury tempts responders to overtriage, but his vital functions are intact for now.

11. The only treatments given during START triage are:

    1. A. Splinting fractures and dressing all wounds
    2. B. Starting IVs and giving pain medication
    3. C. Giving oxygen and placing a cervical collar on
    4. D. Opening the airway and stopping major bleeding
    Show answer

    Answer: D. Opening the airway and stopping major bleeding

    START allows only quick lifesaving steps: opening the airway (and placing a simple airway adjunct by protocol) and controlling severe bleeding, such as with a tourniquet or by having a walking patient hold pressure. Anything more slows triage for everyone else.

12. JumpSTART was designed for patients who are roughly:

    1. A. Under 1 year old
    2. B. 1 to 8 years old
    3. C. 8 to 14 years old
    4. D. 12 to 18 years old
    Show answer

    Answer: B. 1 to 8 years old

    JumpSTART is meant for children about 1 to 8 years old, or those who look like children. Older children and adolescents are triaged with adult START. Infants who cannot walk are assessed with JumpSTART and checked for obvious injuries.

13. JumpSTART changes the apnea step for children because:

    1. A. Their arrests are usually respiratory
    2. B. They rarely have significant external bleeding
    3. C. They cannot have their airway repositioned
    4. D. They tolerate apnea far better than adults do
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    Answer: A. Their arrests are usually respiratory

    Pediatric arrest is usually caused by respiratory failure, so an apneic child with a pulse may respond to a few rescue breaths. That is why JumpSTART adds rescue breaths where adult START would tag the patient black.

14. Using JumpSTART, a 5-year-old is not breathing after airway repositioning but has a palpable pulse. You should:

    1. A. Tag the child black and move to the next one
    2. B. Give 5 rescue breaths and reassess breathing
    3. C. Begin full CPR and call for a second rescuer
    4. D. Tag the child red without giving any breaths
    Show answer

    Answer: B. Give 5 rescue breaths and reassess breathing

    In JumpSTART, an apneic child with a pulse receives 5 rescue breaths (about 15 seconds). If breathing resumes, the child is tagged red; if not, black. Full CPR is not performed during triage.

15. Using JumpSTART, a 4-year-old begins breathing after 5 rescue breaths. You should tag the child:

    1. A. Yellow (delayed)
    2. B. Black (expectant)
    3. C. Red (immediate)
    4. D. Green (minor)
    Show answer

    Answer: C. Red (immediate)

    A child who starts breathing after rescue breaths has a critical airway or breathing problem and is tagged red. If the child had stayed apneic after the breaths, the tag would be black.

16. Using JumpSTART, a 6-year-old who cannot walk has a respiratory rate of 50 breaths/min. You should tag the child:

    1. A. Yellow (delayed)
    2. B. Green (minor)
    3. C. Black (expectant)
    4. D. Red (immediate)
    Show answer

    Answer: D. Red (immediate)

    JumpSTART uses a respiratory rate below 15 or above 45 breaths/min as the red criterion, since normal rates in children are higher than in adults. A rate of 50 is above that range.

17. In JumpSTART, the perfusion check for a child is a:

    1. A. Capillary refill time
    2. B. Blood pressure reading
    3. C. Skin color, moisture, and temperature
    4. D. Palpable peripheral pulse
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    Answer: D. Palpable peripheral pulse

    JumpSTART uses the presence of a palpable peripheral pulse because capillary refill is unreliable in cold settings and children. An absent peripheral pulse means red.

18. Using JumpSTART, a 3-year-old has a respiratory rate of 30 breaths/min and a palpable peripheral pulse, but responds to pain only with posturing. You should tag the child:

    1. A. Yellow (delayed)
    2. B. Green (minor)
    3. C. Red (immediate)
    4. D. Black (expectant)
    Show answer

    Answer: C. Red (immediate)

    JumpSTART uses AVPU. A child who is unresponsive, or who responds to pain only with posturing or a nonlocalizing response, is red, even with a normal respiratory rate (15 to 45) and a pulse. Yellow requires age-appropriate mental status: alert, responds to voice, or localizes pain. Green is for children who can walk, or nonambulatory infants without red or significant injury findings. Black is for children who stay apneic after the airway is opened and rescue breaths are given.

19. An infant at a daycare fire cannot walk because of age. Using JumpSTART, the infant breathes normally, has a pulse, is alert, and has no obvious injuries. The infant may be tagged:

    1. A. Red (immediate)
    2. B. Green (minor)
    3. C. Black (deceased)
    4. D. Yellow (delayed)
    Show answer

    Answer: B. Green (minor)

    Infants who cannot walk because of developmental age are assessed with JumpSTART; if they meet delayed criteria and have no significant external injury, they may be tagged green. They still must be reassessed and kept with a caregiver or responder.

20. SALT triage begins with a global sort in which patients are asked to:

    1. A. Walk, then wave, before assessment
    2. B. Give their names and dates of birth
    3. C. Raise their hands if they feel pain
    4. D. Stay still so their pulses can be read
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    Answer: A. Walk, then wave, before assessment

    In SALT, patients who can walk are assessed last, those who can wave or move purposefully next, and those who are still or have obvious life threats first. The global sort sets the order of individual assessment.

21. At a nerve agent release, SALT individual assessment finds a nonambulatory man with copious secretions and twitching. A lifesaving intervention SALT allows before you assign his category is:

    1. A. Endotracheal intubation
    2. B. An antidote autoinjector
    3. C. An IV line with diazepam
    4. D. Full skin decontamination
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    Answer: B. An antidote autoinjector

    SALT allows only quick lifesaving interventions that are within the provider's scope, use equipment at hand, and do not require staying with the patient: controlling major hemorrhage, opening the airway, chest decompression, and autoinjector antidotes. An atropine-pralidoxime autoinjector takes seconds and treats the life threat. Intubation and IV access with diazepam take too long and keep the rescuer from other patients. Decontamination happens in the decon corridor and is not a triage intervention; antidotes may be given before decon.

22. Using SALT, a man is breathing, has a peripheral pulse, and obeys commands, but has respiratory distress. Given current resources, he is likely to survive. He is tagged:

    1. A. Delayed
    2. B. Minimal
    3. C. Expectant
    4. D. Immediate
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    Answer: D. Immediate

    In SALT, failing any of the four checks (obeys commands or moves purposefully, peripheral pulse, no respiratory distress, hemorrhage controlled) and being likely to survive with current resources makes a patient immediate. Expectant is used only when survival is unlikely given the resources at hand.

23. SALT differs from START in that it includes a separate category for patients who are alive but:

    1. A. Able to walk away from the incident area
    2. B. Hurt with minor cuts and bruises
    3. C. Unlikely to survive given the resources
    4. D. Waiting at the scene for their family
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    Answer: C. Unlikely to survive given the resources

    SALT has an expectant (often gray) category for living patients unlikely to survive given current resources. They receive comfort care and are reassessed as resources improve. START groups them with the dead in black.

24. The MASS triage acronym stands for:

    1. A. Move, assess, sort, send
    2. B. Monitor, assess, splint, send
    3. C. Move, airway, stabilize, ship
    4. D. Mark, assess, support, see
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    Answer: A. Move, assess, sort, send

    MASS (move, assess, sort, send) begins by asking those who can walk to move to one area, then those who can wave, before assessing those who cannot move. It uses the ID-ME categories: immediate, delayed, minimal, expectant.

25. Overtriage at an MCI, such as tagging many minor patients red, is harmful mainly because it:

    1. A. Causes patients to be assessed more slowly
    2. B. Diverts resources from truly critical patients
    3. C. Prevents minor patients from leaving the scene
    4. D. Makes triage tags harder to read for the crews
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    Answer: B. Diverts resources from truly critical patients

    Overtriage fills red treatment areas and ambulances with patients who could wait, which delays care for those who are truly critical. Undertriage, the opposite error, risks preventable deaths among patients who are tagged too low.