START 2 FINISH Hospital Triage System

A catastrophic event happens and you're on your own. Help is on the way but you don't know when it will arrive. How do you increase patient surge capacity within the hospital? How do you maximize the use of what you have available at that moment?

Since 9-11, the nation's preparedness and response agencies have made significant progress in command, control and coordination efforts. Agencies that previously worked independently now work towards a share a common focus, language and resource management systems. Education, training and equipment have been provided to EMS and healthcare to assist with the management of chemical, biological and trauma patients, pandemic events and other surge capacity events. Great steps have been made to increase communication by means of hardware and increase interagency cooperation.

Despite the improvements within the communities, there remains a misperception as to when the disaster response is over. Many community responses activities conclude at the scene and consider the event "all clear" once patients are transported from the scene to the hospital. Research by Dr. E. Auf der Heide (1998) refutes the traditional planning assumption that a patient will be properly triaged, stabilized and appropriately distributed to area hospitals.

There are many process challenges in the management of patient flow from the disaster scene to the hospital and then throughout the hospital itself during a mass casualty event. The challenges that remain are a result of lack of triage training, lack of corporate knowledge of ‘the plan’, independent processes of resource management, and MCI training with just enough authenticity to check off a box somewhere.

The START2Finish® model is a resource management tool to maximize use of three resources existing in a hospital at all times: manpower, space and supplies. Effective management of these resources results in an increase in patient care surge capacity. Studies have proven that in major disasters approximately 54 % of the victims arriving at hospitals have not been triaged. Most hospitals do not train their Emergency Services (ER) personnel in mass casualty triage. The START2Finish® model teaches and utilizes the nationally recognized pre-hospital triage system START (Simple Triage and Rapid Treatment) and JumpSTART (pediatric population) as an implementation tool for the model. The model continues the color-coding process of the existing red, yellow, green and black colors, which equate to the initial triage category of the patient and assigns those colors to receiving treatment stations within the hospital.

It also pre-designates the staffing by those colors which correlate with their credentialing. An additional benefit of designating staff is they are designated by function, not title. For example a business office manager may be an escort in the GREEN STATION. Any person can identify their function, as well as their work station because that person is wearing a S2F vest which is green and is labeled ESCORT.

The model, and its process delivery, training and support products can be purchased separately or as an entire package. The model elements are:

Manual The START2Finish® Surge Capacity Response Model for Healthcare, Version 4. Bound, full color manual that describes the principles of the model, implementation and training, its integration with TJC, Incident Command, START and JumpSTART training. The Table of Contents of the manual are:

Table of Contents

• Introduction

• History & Lessons Learned (Module 1)

• START (Module 2)

• The Triage Tag

• JumpSTART (Module 3)

• A Community Plan

• START2Finish Application (Module 4)

• Stations

  • Green

  • Yellow

  • Red

  • Black

• Joint Commission and S2F model application (Module 5)

• Incident Command (Module 6)

• Conclusion

• Suggested Implementation Schedule

• References and Resources (templates for manpower allocation by "pre-credentialing" staff types, receiving station supply cart items, traffic pattern considerations, suggest station locations)

CD The CD includes:

• Templates for manpower allocation by "pre-credentialing" staff types

• Cart supply list for every station

• Job action sheets for every position in all four treatment stations

• Manual as a word doc

• Training power point of the S2F model

• Support and information docs related to mass casualty events: mass fatality management ; excessive heat injury guidelines; evacuation and mass casualty guidelines

Products (Order online at TriageTools.com)

• Vest kits with CD of Job Action Sheets

• Vets kits with small, printed laminated JAS (condensed)

• Sign kits -directional cones for triage, and the 4 stations

• Colored tarps to cover carts or patient designation areas

• Triage cards, tags, fanny packs

Packages for purchase

1. "Train-the-Trainer": The package includes site training on the model and its principles. The DMC team will meet with facility staff to discuss materials (CD materials), review implementation steps and timelines and train the internal training team.

2. On-site Implementation: In conjunction with your team, DMC staff will:

   1. Implements steps in Train-the-Trainer package

   2. Brief the internal emergency response planning team

   3. identify the layout and footprint of the receiving disaster stations

   4. train lead personnel that staff each station

   5. train house staff or specific departments (your choice)

   6. assure interface of sites with the hospital’s emergency operations plan and command structure

3. S2F Product Package: Each package size contain a vests kit, Job Action Sheet’s (CD or print), directional signage kits, labeled shoulder bags, four triage fanny packs and 100 laminated pocket triage cheat sheets for your primary triage staff. For size reference, see products.

4. Write the S2F process and response into the Emergency Operations Plans and tie each aspect to a particular The JC Emergency Management Standard. We will provide a NTE proposal after review of Emergency Operations Plan.

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