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Lesson

SALT Mass-Casualty Triage

12 min Trauma Skip to quiz

Objective: Use SALT when there are more patients than you can treat: Sort, Assess, Lifesaving interventions, and Treatment/transport. Do not use it to delay one critical patient you can fully treat. It does not replace the local mass-casualty plan.

Why this matters

When there are more patients than rescuers, the order of work changes. SALT was built so different services would share one model. SALT means Sort, Assess, Lifesaving interventions, and Treatment/transport. It is not a second medical license, and it is not permission to ignore incident command.

First, report that ordinary care is no longer enough and start the sort. Check the still, quiet patients first. Do a few short lifesaving actions. Do not use SALT to delay one critical patient you can fully treat. Do not use it on a routine crash you can manage. The local mass-casualty plan still owns tags, destinations, and who can pronounce death.

Key points
  • Sort by asking people who can walk to move to a collection point. Ask others to wave or make a purposeful movement. Go first to the people who are still and silent.
  • Keep lifesaving interventions short. Open the airway, stop major bleeding, and decompress a chest only if you are authorized and the indication is real.
  • Your tags, transport destinations, and who can pronounce death are in the local mass-casualty plan. Learn that plan. This page does not replace it.
Verbalize
  • Say aloud / radio script. This is a mass-casualty incident. I need command. I am starting a SALT sort.
  • If you can walk, move to the collection point.
  • I will do only short lifesaving care: open an airway, stop bleeding, and decompress a chest only if I am authorized.

Clinical sequence

  1. Make the scene safe. Report that there are more patients than you can treat one by one. Ask for the mass-casualty plan and more units.
  2. Do a global sort. Direct anyone who can walk. Look for purposeful movement. The still, quiet patients are the first individual assessments.
  3. Assess one person at a time. Open the airway with a simple maneuver. If the patient breathes, control major hemorrhage. Major bleeding is still MARCH, even in a crowd.
  4. If the patient does not breathe after you open the airway, follow the local plan for expectant or dead categories. Move toward patients you can still help. Do not start a long resuscitation on one patient while others have not been sorted, unless your role that day is treatment and someone else is sorting.
  5. Priority and transport follow the plan. Single-patient field triage still matters when the system is not overwhelmed. Do not use mass-casualty rules on a routine crash you can fully treat.

Teaching points

  • SALT was proposed as a national all-hazards model after a review of existing systems, including START and JumpSTART. Knowing the letters does not make you the triage officer.
  • Expectant care, when your plan uses that category, is a command and medical-control decision in most civilian systems. Do not invent that category because you are tired.
  • Children do not sort like adults. If your plan uses JumpSTART or a pediatric modification, use that. Do not guess.

Common errors

  • Tagging for five minutes before anyone opens an airway or places a tourniquet.
  • Using mass-casualty language when you have enough rescuers for ordinary care.
  • Decompressing every quiet chest because lifesaving interventions sounded broad.

Practice

One-minute check

Eight people are hurt, and you are the first crew. Say the sort command you will give, the short lifesaving actions you will do while sorting, and the document that owns the tags.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

  • Lerner EB, et al. Mass casualty triage: an evaluation of the data and development of a proposed national guideline. Disaster Med Public Health Prep. 2008;2(Suppl 1):S25-S34. SALT is Sort, Assess, Lifesaving interventions, Treatment/transport.
  • NASEMSO National Model EMS Clinical Guidelines (2022) — MCI operations remain a local plan

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. SALT stands for:
2. Lifesaving interventions in a SALT-style sort are:
3. A patient who is not breathing after you open the airway, in a true mass-casualty incident, is:
4. This lesson replaces your agency MCI plan:
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