START

Simple
Triage
And
Rapid
Treatment

OLEH :

Ns. MOHAMMAD ALI HAMID, S. Kep., M.

Kes.

Overview
Apa itu START ?
Dimana harus memulai START ?
Satu pasien pada satu waktu
Algoritma START Triage
Skenario pasien

A Simple Approach
Simple
Triage
And
Rapid
Treatment

Pada sekitar 1980 metode START di kenalkan di

California oleh Hoag hospital and Newport Beach Fire
and Marine.
START memberikan kemudahan pada penolong,
pendekatan yang simple, step-by-step untuk
menangani pasien dalam jumlah besar dengan
berbagai derajat cidera.

A Simple Approach
Simple
Triage
And
Rapid
Treatment

Pengkajian dan penanganan awal pada masingmasing pasien dilakukan dalam waktu 30 detik.
Penanganan awal hanya terbatas pada mengatasi
kondisi yang mengancam jiwa dengan segera.
(seperti pembebasan jalan napas dan mengontrol
perdarahan hebat)

A Simple Approach
Label Triase

Simple
Triage
And
Rapid
Treatment

Label triase diletakan pada masing-masing

pasien yang telah di pilah. Label triase
menunjukkan status pasien dan derajat
kebutuhan penanganan pasien.

Minor
Delayed
Immediate
Deceased

There are a variety styles and sizes of Triage Tags

METTAG
Kode Warna Korban

Label ini
menunjukkan
identifikasi
Penanganan medis
dan prioritas
transportasi
pasien.

A Simple Approach
Label Triase

Simple
Triage
And
Rapid
Treatment

Label prioritas triase di desain Tear-Off.

Label yang tidak digunakan di sobek,
menyisakan label status penanganan pasien
saat ini.

Label terakhir pada

pasien ini menunjukkan
prioritas IMMEDIATE
Label tak terpakaii di
sobek

A Simple Approach
Label Triase

Simple
Triage
And
Rapid
Treatment

Setiap label prioritas di kode dengan warna

tertentu untuk mempermudah proses
identifikasi dari kejauhan

DECEASED
IMMEDIATE
DELAYED
MINOR

Where to START
Sejak anda tiba di TKP, pertama pastikan
lingkungan aman. Kemudian mulai dengan
mengarahkan walking wounded menjauh dari
lokasi menuju area evakuasi dan area penanganan.
Labeli meraka dengan label MINOR (GREEN)

Where to START
Mulai dimana anda berdiri- mulailah melakukan
triase dari pasien yang paling dekat dengan
anda. Mintalah bantuan dari orang lain dan atau
korban cidera. Mereka dapat di manfaatkan
untuk membantu mengontrol perdarahan,
membantu mempertahankan kepatenan jalan
napas atau memegang c-spine traction.
Jangan terlalu lama pada satu pasien.
Bergeraklah cepat dari pasien ke pasien
Kaji

RPMs pada tiap pasien !!!

Respirations
Perfusion
Mental Status

One Patient at a Time

RPM
KAJI RESPIRASI
Jika pasien tidak bernapas, maka Open the
Airway
Jika pasien masih tidak bernapas...
Labeli sebagai DECEASED (BLACK)
Lalu... bergegaslah pada pasien berikutnya...

OBSTRUCTION

Kansas Airway Supplement

Kansas BEMS EMS Educator Task

13

Head Tilt Chin Lift

Kansas Airway Supplement

Kansas BEMS EMS Educator Task

14

Jaw Thrust

Kansas Airway Supplement

Kansas BEMS EMS Educator Task

15

One Patient at a Time

RPM
KAJI RESPIRASI
Jika pasien bernapas, Assess the Rate
Jika RR >30
Labeli dengan IMMEDIATE (RED)
Bergegaslah pada pasien berikutnya

Jika RR <30
kajilah PERFUSION

One Patient at a Time

RPM
KAJI PERFUSI
Jika nadi radialis tidak teraba (atau)
Capillary Refill Time (CRT) > 2 detik
Maka labeli dengan IMMEDIATE (RED)
Pindahlah pada pasien berikutnya
Jika nadi radialis teraba (atau)
Capillary Refill Time (CRT) < 2 detik
Maka kaji MENTAL STATUS

One Patient at a Time

RPM
KAJI MENTAL STATUS
Jika pasien tidak dapat mengikuti perintah (atau)
mengalami gangguan status mental (atau)
tidak sadar...
Labeli dengan IMMEDIATE (RED)
Begegaslah pada pasien berikutnya
Jika pasien mampu mengikuti perintah sederhana,
Labeli dengan DELAYED (YELLOW)
Pindahlah pada pasien berikutnya

Algoritma START

Skenario Pasien#1
Simple
Triage
And
Rapid
Treatment

Pasien tidak dapat menggerakkan dan merasakan

kakinya
RR 24 x/menit
Nadi Radialis 100 x/menit
Sadar dan orientasi
Bagaimana anda men triase pasien ini ?

Skenario Pasien#1
Simple
Triage
And
Rapid
Treatment

Pasien tidak dapat menggerakkan dan merasakan

kakinya
RR 24 x/menit
Nadi Radialis 100 x/menit
Sadar dan orientasi
DELAYED (YELLOW)

Skenario Pasien #2
Simple
Triage
And
Rapid
Treatment

Terdapat tumpahan darah pada pakaiannya

RR 36x/menit
CRT 1,5 detik
Sadar dan orientasi
Bagaimana anda men triase pasien ini ?

Skenario Pasien #2
Simple
Triage
And
Rapid
Treatment

Terdapat tumpahan darah pada pakaiannya

RR 36x/menit
CRT 1,5 detik
Sadar dan orientasi
IMMEDIATE (RED)

Skenario Pasien #3
Simple
Triage
And
Rapid
Treatment

Pasien mengalami lecet pada kepala

RR 16x/menit
CRT 1 detik
Sangat lambat menyebut nama dan dimana dia berada
Bagaimana anda men triase pasien ini ?

Skenario Pasien #3
Simple
Triage
And
Rapid
Treatment

Pasien mengalami lecet pada kepala

RR 16x/menit
CRT 1 detik
Sangat lambat menyebut nama dan dimana dia berada
IMMEDIATE (RED)

Skenario Pasien #4
Simple
Triage
And
Rapid
Treatment

Pasien tampak tidak mengalami cidera

RR 20x/menit
CRT 1 detik
Tidak sadar
Bagaimana anda men triase pasien ini ?

Skenario Pasien #4
Simple
Triage
And
Rapid
Treatment

Pasien tampak tidak mengalami cidera

RR 20x/menit
CRT 1 detik
Tidak sadar
IMMEDIATE (RED)

Skenario Pasien #5
Simple
Triage
And
Rapid
Treatment

Pasien terlentang di lantai

Tidak bernapas
CRT 3 detik
Tidak sadar
Bagaimana anda men triase pasien ini ?

Skenario Pasien #5
Simple
Triage
And
Rapid
Treatment

Pasien terlentang di lantai

Tidak bernapas
CRT 3 detik
Tidak sadar
REPOSITION THE AIRWAY!

Skenario Pasien #5
Simple
Triage
And
Rapid
Treatment

Pasien ngorok beberapa kali saat anda mencoba

mereposisi jalan napasnya beberapa waktu, namun
kemudian pasien tidak bernapas.
CRT 3 detik
Tidak sadar
Bagaimana anda men triase pasien ini ?

Skenario Pasien #5
Simple
Triage
And
Rapid
Treatment

Pasien ngorok beberapa kali saat anda mencoba

mereposisi jalan napasnya beberapa waktu, namun
kemudian pasien tidak bernapas.
CRT 3 detik
Tidak sadar
DECEASED (BLACK)

Triage
Exercises

Triage Exercise 1
Your victim has a
compound facture, of the
left femur.
Respirations are over
30/min.
Radial pulse absent.
Awake
R-Respirations 30
P-Radial pulse
M-Mental status

[] Deceased
[] Immediate
[] Delayed
[] Minor

Triage Exercise 1
Your victim has a
compound facture, of the
left femur.
Respirations are over
30/min.
Radial pulse absent.
Awake
R-Respirations 30
P-Radial pulse
M-Mental status

[] Immediate

Triage Exercise 2
A woman with sudden
onset of chest pain with
shortness of breath
Respirations are under
30/min.
Radial pulse present.
Awake
R-Respirations 30
P-Radial pulse
M-Mental status

[] Deceased
[] Immediate
[] Delayed
[] Minor

Triage Exercise 2
A woman with sudden
onset of chest pain with
shortness of breath
Respirations are under
30/min.
Radial pulse present.
Awake
R-Respirations 30
P-Radial pulse
M-Mental status

[] Minor

Triage Exercise 3
A man with 90% of his
body with second degree
burns
Respirations none
Radial pulse present.
Unconscious

R-Respirations 30
P-Radial pulse
M-Mental status

[] Deceased
[] Immediate
[] Delayed
[] Minor

Triage Exercise 3
A man with 90% of his
body with second degree
burns
Respirations none
Radial pulse present.
Unconscious

R-Respirations 30
P-Radial pulse
M-Mental status

[] Deceased

Triage Exercise 4
A student has a bruise on
their forehead, blood in the
ears and nose
Respirations are under 30
Radial pulse present.
Unconscious

R-Respirations 30
P-Radial pulse
M-Mental status

[] Deceased
[] Immediate
[] Delayed
[] Minor

Triage Exercise 4
A student has a bruise on
their forehead, blood in the
ears and nose
Respirations are under 30
Radial pulse present.
Unconscious

R-Respirations 30
P-Radial pulse
M-Mental status

[] Immediate

Triage Exercise 5
Impaled, 1 foot piece of
shrapnel in right eye
Respirations are under 30
Radial pulse present.
Awake, alert and
orientated

R-Respirations 30
P-Radial pulse
M-Mental status

[] Deceased
[] Immediate
[] Delayed
[] Minor

Triage Exercise 5
Impaled, 1 foot piece of
shrapnel in right eye
Respirations are under 30
Radial pulse present.
Awake, alert and
orientated

R-Respirations 30
P-Radial pulse
M-Mental status

[] Delayed

Triage Exercise 6
A child with server
difficulty breathing, chest
sinks in on inspiration
Respirations over 30
Radial pulse present.
Awake

R-Respirations 30
P-Radial pulse
M-Mental status

[] Deceased
[] Immediate
[] Delayed
[] Minor

Triage Exercise 6
A child with server
difficulty breathing, chest
sinks in on inspiration
Respirations over 30
Radial pulse present.
Awake

R-Respirations 30
P-Radial pulse
M-Mental status

[] Immediate

Triage Exercise 7
A girl who is saying the
same words over and over,
What happened?
Respirations under 30
Radial pulse present.
Awake, but not orientated

R-Respirations 30
P-Radial pulse
M-Mental status

[] Deceased
[] Immediate
[] Delayed
[] Minor

Triage Exercise 7
A girl who is saying the
same words over and over,
What happened?
Respirations under 30
Radial pulse present.
Awake, but not orientated

R-Respirations 30
P-Radial pulse
M-Mental status

[] Immediate

Triage Exercise 8
Bruising over abdomen,
complaining of abdominal
pain
Respirations over 30
Radial pulse present.
Awake

R-Respirations 30
P-Radial pulse
M-Mental status

[] Deceased
[] Immediate
[] Delayed
[] Minor

Triage Exercise 8
Bruising over abdomen,
complaining of abdominal
pain
Respirations over 30
Radial pulse present.
Awake

R-Respirations 30
P-Radial pulse
M-Mental status

[] Immediate

KACEPOT GHULENA MERA