Article Sidebar

Submitted
Feb 23, 2026
Accepted
Jun 2, 2026
Published
Jun 20, 2026
Download
pdf
Statistic
Read Counter : 0 Download : 0

Downloads

Download data is not yet available.

Main Article Content

Abstract

Background:


Emergency departments (ED) are often overwhelmed during mass casualty incidents (MCI). The trade-off between the speed of Simple Triage and Rapid Treatment (START) and the accuracy of the Canadian Triage and Acuity Scale (CTAS) poses a management dilemma. This study aims to evaluate and compare the effectiveness of START and CTAS in ED.


Methods: A systematic literature review (SLR) was conducted using the PRISMA guidelines. Sixteen publications from PubMed, Google Scholar, ScienceDirect, and PMC were evaluated with five main articles analyzed for direct comparison.


Results: The study shows that START is proven to be much faster (average of 33 seconds/patient) with high sensitivity in critical patients but has a high risk of under triage, whereas CTAS takes longer (138 seconds/patient) but excels in clinical accuracy and resource allocation precision. There is no single ideal instrument for MCI.


Conclusion: The implementation of a dual triage model using START at the ED entrance followed by CTAS in the care area is highly recommended to optimally balance response speed and patient safety.

Keywords

triage emergency departement mass casualty START CTAS

Article Details

Creative Commons License

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

How to Cite
Wardani, W. A., Mohades, A., & Huzaifah, Z. (2026). COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF THE START AND CTAS TRIAGE SYSTEMS IN DISASTER MANAGEMENT IN EMERGENCY DEPARTEMENT: A SYSTEMATIC LITERATURE REVIEW : DISASTER MANAGEMENT. INDONESIAN JOURNAL OF HEALTH SCIENCES RESEARCH AND DEVELOPMENT (IJHSRD), 8(1), 95–100. https://doi.org/10.36566/ijhsrd/Vol8.Iss1/365

References

  1. 1. Bazyar J, Farrokhi M, Salari A, Safarpour H, Khankeh HR. Accuracy of Triage Systems in Disasters and Mass Casualty Incidents; a Systematic Review. Arch Acad Emerg Med. 2022;10(1):e32.
  2. 2. Pivina L, Messova AM, Zhunussov YT, Urazalina Z, Muzdubayeva Z, Ygiyeva D, et al. Comparative analysis of triage systems at emergency departments of different countries: Implementation in Kazakhstan. Russian Open Medical Journal. 2021;10(3):e0301. doi:10.15275/rusomj.2021.0301
  3. 3. Curran-Sills G, Franc JM. A pilot study examining the speed and accuracy of triage for simulated disaster patients in an emergency department setting: Comparison of a computerized version of Canadian Triage Acuity Scale (CTAS) and Simple Triage and Rapid Treatment (START) methods. Canadian Journal of Emergency Medicine. 2017;19(5):365–71.
  4. 4. Lin YK, Chen KC, Wang JH, Lai PF. Simple triage and rapid treatment protocol for emergency department mass casualty incident victim triage. American Journal of Emergency Medicine. 2022;53:99–103. doi:10.1016/j.ajem.2021.12.034
  5. 5. Wisnesky UD, Kirkland SW, Rowe BH, Campbell S, Franc JM. A Qualitative Assessment of Studies Evaluating the Classification Accuracy of Personnel Using START in Disaster Triage: A Scoping Review. Front Public Health. 2022;10:676704. doi:10.3389/fpubh.2022.676704
  6. 6. Koşargelir M, Akpınar G. Comparison of triple triage system and CTAS (Canadian Triage and Acuity Scale) system in the emergency department. Journal of Surgery and Medicine. 2025;9(10):176–80. doi:10.28982/josam.8315
  7. 7. Abdul-Nabi SS, Hitti E. A review of mass casualty incident triage tools for hospital-based triage. Turk J Emerg Med. 2025. doi:10.4103/tjem.tjem_77_25
  8. 8. Purwadi H, Breaden K, McCloud C, Pranata S. The SALT and START Triage Systems for Classifying Patient Acuity Level: A Systematic Review. Nurse Media Journal of Nursing. 2021;11(3):413–27. doi:10.14710/nmjn.v1113.37008