SALT Triage: Prioritizing Treatment in Mass Casualty Events

SALT triage Mass casualty events such as natural disasters or terror attacks involve several (and sometimes even hundreds of) victims who require urgent medical attention. In such situations, it is crucial for first responders and medical professionals to prioritize how they treat the victims.

Employing SALT triage makes first aid more effective and efficient while enhancing patient outcomes. It is relevant in situations where there are five or more victims. Its application entails categorizing incoming patients according to the severity of their injuries so care standards and paramedic accuracy are higher.

Join us as we take a closer look at the SALT triage system and how it compares to other systems of categorization.

What Is SALT Triage?

SALT triage refers to “Sort, Assess, Lifesaving Interventions, Treatment/Transport.” It provides standardized criteria for first responders, allowing them to classify victims of mass casualty events that have five victims or more.

It is relevant in situations where the local healthcare system is overwhelmed, and the number of casualties exceeds the facility’s short-term capabilities and resources.

The SALT triage system requires first responders to promptly and systematically assess patients to determine those who need urgent treatment. They can use the system to determine the order in which patients will be treated and alert the hospital staff who will receive the patient.

By following its guidelines, responders classify victims into five categories based on their needs:

  • Green (minimal)
  • Yellow (delayed)
  • Red (immediate)
  • Gray (expected to die)
  • Black (dead)

The inclusion of the gray category is unique to SALT. It helps eliminate confusion regarding patients who are about to die but are not yet deceased. This helps address previous issues where living patients were labeled black (dead) even if they were still alive because they were expected to succumb to their injuries. As expected, it led to confusion and a waste of resources.

By having a gray tag, responders can convey that there is little hope for certain victims, enabling them to focus efforts and resources elsewhere. This makes SALT safe and quick with a low undertriage rate, though it does have a significant overtriage effect which requires further refinement.

Salt vs Start Triage. What Are the Differences?

START refers to “Simple Triage and Rapid Treatment.” Previously, it was the triage system that was used to categorize victims of mass casualty events.

The primary difference between SALT and START triage is the latter does not have a gray category. Therefore, patients who have no hope of survival are categorized as dead and under the black category. Other than this, the two triages are in alignment, specifically in their definitions for the green and black categories. However, there are some differences in the red and yellow categories. 

It’s also worth noting that START revealed higher undertriage rates than SALT when investigators tested them in a simulated mass casualty incident.

Moreover, START places greater emphasis on the patient’s mental status, breathing, and circulation. Meanwhile, it doesn’t sufficiently consider the severity of the injuries that a patient has sustained. 

Generally, medical students prefer SALT due to its consistency with traditional medical care, logic, and comprehensibility. It is easy to grasp and relatively straightforward. On the other hand, START has certain gaps that may require patients with a life-threatening injury to be categorized as only minimally injured.

This is because START mainly focuses on a patient’s ability to walk and their responsiveness. Both criteria leave much room for error in how patients are categorized. For example, those with gunshot wounds to the chest could meet the criteria for a green tag even if their prognosis is poor.

What Does SALT Entail?

SALT is designed to be easily incorporated into current medical interventions for mass casualties, with a few simple modifications.

It entails the following steps:

1. Sort

Patients are sorted and prioritized based on criteria such as their ability to make purposeful movements and follow commands.

2. Assess

Limited rapid lifesaving interventions are performed as part of the assessment for each patient and within the responder’s scope of practice.

3. Treatment and Transport

Once patients have been sorted and assessed, treatment and transportation are immediately provided for the most urgent cases. Once they are on their way to receive medical care, delayed and minimally classified patients are next in line for treatment and transportation.

The categorization of patients is divided into immediate, expectant, delayed, minimal, or dead. Care is provided in this order to ensure that patients who need urgent life-saving care are given attention and resources first.

SALT Triage Accuracy and What It Means for Trauma Practitioners

SALT triage is considered a highly accurate triage technique. It’s thus crucial for enhanced management of services and the optimization of limited resources. It can accurately and effectively identify patients who need urgent care and provide them with prompt access to diagnostic and therapeutic measures.

As far as trauma centers are concerned, SALT enables pre-hospitalists to conduct a more accurate assessment of a victim’s status. This can provide better direction to hospital providers and improve the efficiency of treatment.

Hospitals can also use SALT triage during mass casualty events when a large number of patients are able to walk to the hospital without the assistance or accompaniment of first responders.

Final Thoughts

Knowledge of the SALT triage is crucial for situations that require the quick, accurate, and efficient treatment of many patients. It allows first responders and medical professionals to prioritize their care based on their classifications.

If you’re looking to enhance your skills and knowledge of effective triage techniques, our courses at Hospital Procedures Consultants are designed to help you respond to emergency situations like mass casualty events while delivering the best possible patient care.


Bazyar, J. Farrokhi, M. Salari, A. Safarpour, H. Reza Khankeh, H.  Accuracy of Triage Systems in Disasters and Mass CasualtyIncidents; a Systematic Review. Arch Acad Emerg Med. 2022 Apr 30;10(1):e32
McKee, C. Heffernan, R. Willenbring, Willenbring, B. Schwartz, R. Liu, J. Colella, M. Lerner, E. Comparing the Accuracy of Mass Casualty Triage Systems When Used in an Adult Population. Prehosp Emerg Care. 2020 Jul-Aug;24(4):515-524
Deluhery, M. Lerner, E. Pirrallo, R. Schwartz, R. Paramedic accuracy using SALT triage after a brief initial training. Prehosp Emerg Care. 2011 Oct-Dec;15(4):526-32
Jones, N. Lee White, M. Tofil, N. Pickens, M. Youngblood, A. Zinkan, L. Baker, M. Randomized trial comparing two mass casualty triage systems (JumpSTART versus SALT) in a pediatric simulated mass casualty event. Prehosp Emerg Care. 2014 Jul-Sep;18(3):417-23
Cone, D. Serra, J. Burns, K. MacMillan, D. Kurland, L. Van Gelder, C. Pilot test of the SALT mass casualty triage system. Prehosp Emerg Care. 2009  Oct-Dec;13(4):536-40. doi

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