It's good to be back on the list! I signed off before a long trip quite some time
ago and neglected to sign back on.
As Debra Mulligan mentioned, I'm the developer of JumpSTART (JS), which is
currently considered the gold standard for pediatric MCI triage in the field in
the US and also used in numerous EDs. JS is also taught in a number of areas
around the world.
The paper from Israel that Debra made available to the list is from 2006. In it,
a national-level consensus group recommended that JumpSTART be used by
the national EMS service (Magan David Adom) for pediatric MCI triage. What
the paper doesn't say is that very little triage is done in the field in Israel,
primarily due to the risk of secondary blasts following primary suicide
bombings. The paper's recommendation was great news for me, but I have no
indication that the recommendation has been implemented.
From the beginning, I've been up-front about the fact that neither JS nor
START (the precursor adult tool) have been clinically validated. In fact, the
little research there is on START and START-based tools suggests that they
are of questionable validity and have poor interrater reliability and
reproducibility. The only study comparing pediatric applications (in a decent
number of pediatric ED patients but under very limited parameters) showed
START and JS to be inferior to the SMART Tape and the CareFlight tool in
sensitivity. Research in the MCI triage field is very limited in that such
incidents are relatively infrequent and documentation is usually poor during
even smaller disasters. No existing adult or pediatric tool has been validated
under true MCI-style triage conditions.
I've stated in the past that I would support other tools that had evidence
backing their use for children in the (conventional trauma) disaster setting.
Although I will continue teaching JumpSTART and supporting those who
choose to use it, I have thrown my support behind the Sacco Triage Method
(STM). You can read my rationale for supporting the STM on my JumpSTART
Everything I have on JumpSTART and MCI triage (including the STM) is
available for download at no charge from my website at
www.jumpstarttriage.com. Feel free to use the presentations, scenarios and
other files as you like. I don't require that you obtain further permission to use
the materials as long as they're used for educational and/or protocol purposes
and not for profit.
If anyone has specific questions, I'd be delighted to field them. You can email
me via the JumpSTART website or directly at [log in to unmask]
Lou Romig MD, FAAP, FACEP
Miami Children's Hospital (FL)
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: