What color tag should an adult patient with tachypnea be assigned according to the START protocol?

START Protocol Triage for Adult Patient with Respiratory Rate of 45/min

An adult patient with a respiratory rate of 45/min should be assigned a RED tag according to the Simple Triage and Rapid Treatment (START) protocol.

Understanding START Protocol Triage Categories

The START protocol is designed for mass casualty incidents to quickly categorize patients based on severity. The protocol uses four color-coded categories:

• RED (Immediate): Critical, life-threatening injuries requiring immediate attention
• YELLOW (Delayed): Serious injuries requiring medical attention but can wait
• GREEN (Minor): Walking wounded with minor injuries
• BLACK (Deceased/Expectant): Dead or unlikely to survive given available resources

Assessment Algorithm for START Protocol

1. Initial Assessment: Can the patient walk?

   • If yes → GREEN tag
   • If no → Continue assessment

2. Respiratory Assessment:

   • Is the patient breathing?
     • If no → Open airway
       • If breathing starts → RED tag
       • If still not breathing → BLACK tag
     • If yes → Check respiratory rate
       • If respiratory rate >30/min → RED tag
       • If respiratory rate <30/min → Continue assessment

3. Circulatory Assessment:

   • Check radial pulse or capillary refill
     • If absent radial pulse or capillary refill >2 seconds → RED tag
     • If pulse present and normal capillary refill → Continue assessment

4. Neurological Assessment:

   • Check mental status (follows simple commands)
     • If unable to follow commands → RED tag
     • If follows commands → YELLOW tag

Application to This Patient

In this scenario, the adult patient has a respiratory rate of 45/min, which is significantly above the threshold of 30 breaths per minute used in the START protocol. This severe tachypnea indicates respiratory distress and potential respiratory failure, requiring immediate medical intervention.

Important Considerations

• Tachypnea (respiratory rate >30/min) is one of the earliest indicators of physiological decompensation and is treated as a critical finding in mass casualty triage.
• The START protocol is designed to be simple and rapid, focusing on identifying patients who need immediate intervention to survive.
• In a mass casualty incident, resources are limited, and the goal is to do the greatest good for the greatest number of patients.
• Once a RED tag is assigned, no further assessment is needed until the patient reaches definitive care.

Common Pitfalls to Avoid

• Don't be distracted by other less critical vital signs when a single RED criterion is met.
• Avoid spending too much time with any single patient during initial triage.
• Remember that the START protocol is only for initial sorting - a more detailed assessment will occur at the treatment area.
• Don't upgrade or downgrade triage categories based on subjective impressions - stick to the objective criteria of the protocol.