🚨 Chapter 2: Emergency Triage 5-Level Acuity · JumpSTART · S.T.A.B.L.E.

Red · Orange · Yellow · Green · Blue · Mass Disaster Triage (JumpSTART) · S.T.A.B.L.E. Post-Triage Stabilization

🏥 Emergency Triage: Prioritization Saves Lives

🔴 RED - Critical (immediate)
🟠 ORANGE - Emergent
🟡 YELLOW - Semergent
🟢 GREEN - Standard/Non-urgent
🔵 BLUE - Fast track
🔴 Level 1: RED (Critical)
Immediately life-threatening. Requires emergency resuscitation. Examples: cardiac arrest, severe respiratory failure, shock, status epilepticus, unconscious child.
🟠 Level 2: ORANGE (Emergent)
High risk for deterioration. Needs rapid assessment (within 10-15 min). Examples: severe respiratory distress, significant trauma, diabetic ketoacidosis, febrile neonate.
🟡 Level 3: YELLOW (Semergent)
Stable but potential to decompensate. Wait time 30-60 min. Examples: moderate dehydration, asthma exacerbation without severe distress, simple fracture.
🟢 Level 4: GREEN (Standard)
Stable, non-urgent. Can wait >1 hour. Examples: mild fever, otitis media, minor laceration.
🔵 Level 5: BLUE (Fast track)
Very minor complaints. Can be seen in fast-track clinic. Examples: medication refill, minor rash, school physical.
📋 JumpSTART Mass Casualty Triage
Used in disasters: MOVE (Move, Assess, Sort, Send). Categories: IMMEDIATE (red), DELAYED (yellow), MINIMAL (green), EXPECTANT (black). Ambulatory children go to green.
📌 Key Pearls: Triage is dynamic — reassess frequently. High-risk patients: oncology, cardiac history, infants <3 months, central lines. The triage nurse does "across-the-room" assessment to pick up critically ill patients at a glance.

⚕️ S.T.A.B.L.E. Technique — After Triage & Before Transport

Once a child is triaged (especially RED/ORANGE), the S.T.A.B.L.E. mnemonic ensures safe stabilization before PICU admission or transport.

🩸 S - Sugar (Glucose)
Maintain normoglycemia (45–150 mg/dL).
• Hypoglycemia: D10W 2-5 mL/kg IV bolus, then D10 infusion.
• Hyperglycemia: avoid excessive dextrose; treat underlying stress.
🔍 Hypoglycemia mimics shock/seizures — always check bedside glucose.
🌡️ T - Temperature
Maintain normothermia (36.5–37.5°C).
• Hypothermia: radiant warmer, warm IV fluids.
• Hyperthermia: antipyretics, cooling measures.
⚠️ Hypothermia worsens coagulopathy and acidosis.
🫁 A - Airway
Secure and maintain patent airway.
• Position, suction, airway adjuncts. Reassess ETT position if intubated.
• Provide humidity, secure ETT, monitor for obstruction.
🚨 After triage, re-evaluate airway continuously.
❤️ B - Blood Pressure
Maintain age-appropriate BP & perfusion.
• Treat hypotension with 20 mL/kg fluid boluses, vasoactive infusions.
• Target MAP > 5th percentile for age.
📊 ScvO2 >70% indicates adequate oxygen delivery.
🧪 L - Lab Work
Timely labs guide ongoing management.
• ABG/VBG: pH, pCO2, pO2, lactate, HCO3.
• Electrolytes, iCal, Mg, Phos, BUN, Cr, glucose, CBC, coagulation.
💞 E - Emotional Support
Family-centered care & staff debriefing.
• Keep parents informed, allow presence during stabilization when safe.
• Debrief team after critical events. Reduces moral distress.

🩺 Step-by-Step: Emergency Triage Protocol

1
Across-the-room assessment (Doorway observation)
Consciousness (alert/irritable/unresponsive), Breathing (work of breathing, cyanosis), Colour (pallor/mottling/cyanosis). Pick up RED/ORANGE instantly.
2
Triage vital signs & categorization
Measure HR, RR, BP, SpO2, sensorium (AVPU). Assign colour code: RED (immediate life threat), ORANGE (emergent), YELLOW (semergent), GREEN (non-urgent), BLUE (fast track).
3
High-risk modifiers (up-triage)
Oncology/immunocompromised, cardiac history, infants <3 months, diabetic/metabolic illness, central line → higher acuity even if vitals appear stable.
4
Apply S.T.A.B.L.E. (for RED/ORANGE)
🩸 Sugar → check POC glucose, treat hypoglycemia. 🌡️ Temperature → maintain normothermia. 🫁 Airway → secure/patent. ❤️ BP → fluid/vasoactives. 🧪 Labs → ABG, electrolytes. 💞 Emotional support → update family.
5
Mass casualty / Disaster triage (JumpSTART)
Ambulatory children → GREEN (minimal). Non-ambulatory → assess breathing, pulse, AVPU. Assign IMMEDIATE (red), DELAYED (yellow), EXPECTANT (black).
6
Continuous reassessment
Triage is dynamic — children can decompensate rapidly. Re-triage if clinical status changes. Document triage category and reassessments.