CHALLENGES FACED BY NURSES IN PRE-HOSPITAL CARE IN IMPLEMENTING THE START PROTOCOL IN MULTIPLE CASUALTY INCIDENTS

Abstract

Introduction: The increase in mass casualty incidents has amplified the need for organized responses in pre-hospital care, especially given the high complexity involved in the initial triage of victims. In this context, the START protocol stands out as a strategic tool for rapid classification and clinical prioritization, favoring the organization of the care flow and the optimization of available resources. However, its implementation by nurses still faces challenges related to the structural, organizational, and operational conditions of emergency services. Objective: To analyze the challenges faced by nurses in pre-hospital care in the implementation of the START protocol in mass casualty incidents. Methodology: This is a descriptive literature review with a qualitative approach, carried out through the analysis of scientific publications published between 2021 and 2026. Analysis and discussion of results: The studies demonstrated that the application of START contributes to greater agility in triage, better organization of care, and optimization of healthcare resources. However, factors such as insufficient technical training, lack of institutional standardization, structural limitations, professional overload, and chaotic scenarios directly interfere with the effectiveness of the protocol. Evidence also indicated that continuous training, realistic simulations, and institutional strengthening favor greater classification accuracy and patient safety. Conclusion: It is concluded that the effectiveness of the START protocol depends directly on professional qualification, the organization of services, and the strengthening of institutional policies focused on emergencies. The nurse occupies a strategic position in this process, making continuous investments in training, infrastructure, and evidence-based practices indispensable for strengthening pre-hospital care in incidents with multiple victims.