The method was developed in 1983 by the staff members of Hoag Hospital and Newport Beach Fire Department located in California, and is currently widely used in the United States.
The only medical intervention used prior to declaring a patient deceased is an attempt to open the airway.
[1][2] After all patients have been evaluated, responders use the START classifications to determine priorities for treatment or evacuation to a hospital.
One early proposed modification substituted the presence of a radial pulse for capillary refill in classifying patients as immediate.
[3] The Fire Department of New York uses a modified version of START with an orange or "urgent" classification intermediate in severity between immediate and delayed.
[2] Like many other triage systems, START suffers from implementation problems such as substantial amounts of overtriage.
Since START was developed, consensus has emerged that triage should be more sophisticated, by incorporating resource limitations and capacity in determining how to prioritize patients.