> Anyway, capillary refill times were just made up! Apparently when they went to do a study into CRT they found out that the figure of 2 and 4 seconds were simply plucked out of the ether. (I still use it all the time anyway, of course).

I must admit to having a 'double-take' when reading the report that revealed the arbitrary nature of the 2 second CRT standard [1]. Apparently the upper limit of normal of 2 seconds was found on closer questioning of the originators of CRT to be an arbitrary figure put forward by an experienced nurse who later became a medical student. Considering the extensive use of CRT over the past 15 years or so it seems frightening what's relied upon without real fundamental understanding of the origin(s).

How does the List feel about the inclusion of CRT as a measurement of tissue perfusion in pre-hospital triage? The triage sieve as taught on the MIMMS course [2] includes CRT based on the arbitrary 2 second value, but is this really very useful in the often cold, damp and dark conditions of the pre-hospital environment? Some certainly suggest not and the START (Simple Triage And Rapid Treatment) [3] method of triage disregards CRT in favour of checking for the presence of a radial pulse (yes or no). If present, the mental state is assessed and depending on whether the casualty follows commands or not, they are triaged as delayed or immediate as appropriate. If there's no radial pulse, bleeding is controlled and the casualty is triaged as immediate.

[2] Hodgetts, T. J. and Mackway-Jones, K. (Eds.) (1995) Chapter 16 - Triage. In Major Incident Medical Management and Support: The Practical Approach. pp 117-118. ISBN 0-7279-0928-2.

[3] Benson, M., Koenig, K. L. and Schultz, C. H. (1996) Disaster Triage: START, the SAVE - A New Method of Dynamic Triage for Victims of a Catastrophic Earthquake. Prehospital and Disaster Medicine. 11, No. 2, pp 117-124.