START Triage Game

Pre-game: review the didactic first

Before starting, review the MASCAL Triage Principles: START and SALT presentation for the full conceptual framework. The START algorithm reference is available as a collapsible panel within the game below.

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This tabletop tool presents 15 casualty vignettes. Apply the START triage algorithm to each. Choose a mode before starting.

Mode A — Individual Work through all 15 casualties solo. Immediate feedback, per-casualty timing, and a total elapsed time at the end. Mode B — Tabletop / Facilitator Display one vignette at a time for group discussion. Per-casualty timer visible to the room. Reveal answer on demand.

START Algorithm Reference

1. Can the casualty walk? YES → T3 Minimal
2. Is the casualty breathing?
   • NO → Reposition airway → Still no? → T4 Expectant
   • NO → Reposition airway → Now breathing? → T1 Immediate
3. Respiratory rate > 30/min → T1 Immediate
4. No radial pulse OR cap refill > 2 sec → T1 Immediate
5. Cannot follow simple commands → T1 Immediate
6. All above normal → T2 Delayed

Casualty 1 of 15

Casualty 0s Total 0:00

↺ Restart

T1 — Immediate T2 — Delayed T3 — Minimal T4 — Expectant

Correct answer:

Determining criterion:

Next Casualty →

Exercise Complete

↺ Restart (randomized order)

Facilitator Mode Casualty time 0:00

Jump to:

↺ Restart

Reveal Answer Next Casualty →

Determining criterion:

All 15 casualties complete.

↺ Restart

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Notes for facilitators (Mode B)

• Present the vignette narrative to the group. Allow 60–90 seconds for discussion.
• Ask participants to commit to a triage category before revealing the answer.
• After reveal, use the teaching point as a discussion prompt.
• Common teaching opportunities: vignettes 6 (agonal breathing + mental status), 11 (airway repositioning = T1), and 3/8 (multiple criteria both triggering T1).
• The “jump to” selector allows you to skip directly to a vignette by number for targeted review.

Source / doctrinal basis

The START algorithm used here follows the CHEMM/HHS START Adult Triage Algorithm and is consistent with the TCCC Guidelines (CoTCCC, Jan 2024). Vignettes are original instructional content developed for 1st Medical Battalion pre-deployment training.

The SALT algorithm (Sort, Assess, Lifesaving Interventions, Treatment/Transport) is an alternative framework recommended by some civilian MASCAL authorities. START is used here because it aligns with TCCC and DoD training standards. Both are addressed in the MASCAL Triage Principles presentation.