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
Link Copied!
Published 2026-06-20
Vol. 8 No. 1 (2026) PAGES 81-86
DOI 10.36566/ijhsrd/Vol8.Iss1/363
Views / Downloads 158 98

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
Download data is not yet available.
  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.

Copyright (c) 2026 INDONESIAN JOURNAL OF HEALTH SCIENCES RESEARCH AND DEVELOPMENT (IJHSRD)

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Copyright Rights & Permissions Guide

Reproducing Published Material from other Publishers

It is absolutely essential that authors obtain permission to reproduce any published material (figures, schemes, tables or any extract of a text) which does not fall into the public domain, or for which they do not hold the copyright. Permission should be requested by the authors from the copyright holder (usually the Publisher, please refer to the imprint of the individual publications to identify the copyright holder).

Permission is required for:

  1. Your own works published by other Publishers and for which you did not retain copyright.
  2. Substantial extracts from anyones’ works or a series of works.
  3. Use of Tables, Graphs, Charts, Schemes and Artworks if they are unaltered or slightly modified.
  4. Photographs for which you do not hold copyright.

Permission is not required for:

  1. Reconstruction of your own table with data already published elsewhere. Please notice that in this case you must cite the source of the data in the form of either “Data from…” or “Adapted from…”.
  2. Reasonably short quotes are considered fair use and therefore do not require permission.
  3. Graphs, Charts, Schemes and Artworks that are completely redrawn by the authors and significantly changed beyond recognition do not require permission.

Obtaining Permission

In order to avoid unnecessary delays in the publication process, you should start obtaining permissions as early as possible. If in any doubt about the copyright, apply for permission. JNH cannot publish material from other publications without permission.

The copyright holder may give you instructions on the form of acknowledgement to be followed; otherwise follow the style: “Reproduced with permission from [author], [book/journal title]; published by [publisher], [year].’ at the end of the caption of the Table, Figure or Scheme.

Every mansucript should be accompanied by "Copyright Transfer Agreement" prior to the article publication

Dimension Badge

Downloads

Downloads
Crossmark Badge
Crossmark Badge
Section
Articles
Keywords
disaster triage emergency department mass casualty incident START Triage ESI Triage

Similar Articles

31-40 of 59

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)