THE EFFECTIVENESS OF START TRIAGE AS AN ALTERNATIVE TO ESI IN MANAGING MASS CASUALTY INCIDENTS (MCI) IN THE EMERGENCY DEPARTMENT: A SYSTEMATIC LITERATURE REVIEW

MANAGING MASS CASUALTY INCIDENTS
Al-Mohades ades 1 Indonesia ROR , Nadya Puteri 1 Indonesia ROR , Zaqyyah Huzaifah 1 Indonesia ROR
1 Universitas Muhammadiyah Banjarmasin ROR
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Published 2026-06-20
Vol. 8 No. 1 (2026) PAGES 81-86
DOI 10.36566/ijhsrd/Vol8.Iss1/363
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Background:

The Emergency Department (ED) frequently faces patient overcrowding during Mass Casualty Incidents (MCI). The Emergency Severity Index (ESI) is often considered too complex and time-consuming during patient surges. The Simple Triage and Rapid Treatment (START) method has been proposed as an alternative due to its rapid application. This study aims to evaluate the effectiveness of START compared to ESI in terms of speed, accuracy, and ease of use in disaster situations.

Methods: This study employed a Systematic Literature Review design based on the PRISMA 2020 guidelines. Searches were conducted in electronic databases for articles published between 2015 and 2025. Of 50 identified articles, 25 met the inclusion criteria and were analyzed.

Results: The findings indicate that START is significantly faster (less than 60 seconds per patient) than ESI (3–5 minutes) effectively reducing patient flow bottlenecks. While ESI shows high specificity for non-trauma cases, START demonstrates up to 100% sensitivity in identifying critically injured trauma patients. START also imposes a lower cognitive burden on nurses in high-stress conditions.

Conclusion: These findings support START as an effective alternative triage system during disaster response to manage trauma patient surges.

THE EFFECTIVENESS OF START TRIAGE AS AN ALTERNATIVE TO ESI IN MANAGING MASS CASUALTY INCIDENTS (MCI) IN THE EMERGENCY DEPARTMENT: A SYSTEMATIC LITERATURE REVIEW : MANAGING MASS CASUALTY INCIDENTS. (2026). INDONESIAN JOURNAL OF HEALTH SCIENCES RESEARCH AND DEVELOPMENT (IJHSRD), 8(1), 81-86. https://doi.org/10.36566/ijhsrd/Vol8.Iss1/363
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  1. 1. Ebrahimi M, Mirhaghi A, Mazlom R. Triage systems in mass casualty incidents and disasters: A review study with a look at the Iranian Red Crescent Society. J Inj Violence Res. 2021;13(1):55–66.
  2. 2. Bazyar J, Farrokhi M, Khankeh H. Accuracy of triage systems in disasters and mass casualty incidents: A systematic review. Trauma Mon. 2022;27(1):301–10.
  3. 3. Frankenberger W, Pascasio L. Triage accuracy in pediatrics using ESI: A multi-center retrospective analysis. J Emerg Nurs. 2024;50(2):210–8.
  4. 4. Hinson JS, Martinez DA, Cabral S. Accuracy of ED triage using ESI and independent predictors of under/over-triage in Brazil. American Journal of Emergency Medicine. 2018;36(11):2056–62.
  5. 5. Mirhaghi A, Roudbari M. Knowledge and performance of emergency nurses in triage of patients referring to emergency departments. Int Emerg Nurs. 2020;48:100803.
  6. 6. Mistry B, Stewart De Ramirez S, Kelen G. Reliability of the Emergency Severity Index (ESI) triage system: A systematic review. Ann Emerg Med. 2018;71(1):97–106.
  7. 7. Lin CH, Kao CY, Huang CY. Simple triage and rapid treatment (START) protocol for ED mass casualty incident victim triage: A retrospective analysis. Medicine (Baltimore). 2022;101(40):e30892.
  8. 8. Zachariah R, Ford N. Evaluation of emergency department triage scales in low- and middle-income countries: A systematic review. World J Emerg Med. 2019;10(3):133–42.
  9. 9. Alotaibi A, Alshammari M. Comparative accuracy of global triage systems in mass casualty and emergency care: A systematic review. Saudi Med J. 2024;45(2):115–25.

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Keywords
disaster triage emergency department mass casualty incident START Triage ESI Triage

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