Disaster Triage And Mass Casualty Principles
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NCLEX-RN › Disaster Triage And Mass Casualty Principles
Following a bombing in a public area, the nurse is performing START triage at the scene. Using START triage, how should the nurse categorize this victim: a 45-year-old with respirations 36/min, weak radial pulse, and unable to follow simple commands after you tell him to squeeze your hand?
Red tag (immediate)
Green tag (minor)
Black tag (expectant/deceased)
Yellow tag (delayed)
Explanation
This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer C reflects the most appropriate triage decision because the victim has a respiratory rate of 36/min (greater than 30), weak radial pulse indicating poor perfusion, and inability to follow commands, all criteria for immediate (red tag) categorization. The distractors are less appropriate: A (green) is for minor injuries with ability to walk and stable parameters; B (yellow) is for delayed care with stable vital signs but inability to walk; D (black) is for deceased or expectant victims with no respirations even after intervention. In triage prioritization, red-tag victims with threats to airway, breathing, or circulation are treated first to maximize survivability. Decision-making principles involve quick sequential assessments to categorize based on urgency in resource-limited settings. A transferable strategy for triage in mass casualty events is to use color-coded tags to organize transport and treatment priorities efficiently.
After a bombing, the nurse is triaging multiple victims using START. Which victim should the nurse attend to FIRST? (1) 36-year-old with respirations 18/min, capillary refill 2 seconds, follows commands, severe arm pain with deformity; (2) 50-year-old with respirations 22/min, capillary refill 2 seconds, follows commands, soot around mouth and hoarse voice; (3) 29-year-old walking, respirations 20/min, alert, minor abrasions; (4) 61-year-old with respirations 24/min, capillary refill 2 seconds, alert, nausea and headache.
61-year-old with respirations 24/min, capillary refill 2 seconds, alert, nausea and headache
29-year-old walking, respirations 20/min, alert, minor abrasions
36-year-old with respirations 18/min, capillary refill 2 seconds, follows commands, severe arm pain with deformity
50-year-old with respirations 22/min, capillary refill 2 seconds, follows commands, soot around mouth and hoarse voice
Explanation
This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer B reflects the most appropriate triage decision because the 50-year-old has normal parameters but signs of inhalation injury (soot, hoarseness), indicating potential airway compromise and need for immediate (red tag) priority despite START criteria. The distractors are less appropriate: A is delayed (yellow) with deformity; C is minor (green); D is minor (green) with symptoms but stable. In triage prioritization, impending threats like airway burns are escalated even if current vitals normal. Decision-making principles incorporate clinical judgment beyond algorithm for deteriorating risks. A transferable strategy for triage in mass casualty events is to flag potential complications like inhalation for rapid evaluation.
After a bombing, the nurse is using START triage. What is the nurse's PRIORITY action when an adult victim has respirations 0/min and does not start breathing after the nurse opens the airway?
Apply a red tag and request immediate transport
Tag the victim black (expectant/deceased) and move to the next victim
Begin rescue breathing for 1 minute and reassess
Assess pupils and obtain a full neurologic assessment
Explanation
This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer A reflects the most appropriate triage decision because the victim has no respirations even after airway opening, classifying as expectant (black tag) in resource-limited settings. The distractors are less appropriate: B and C attempt resuscitation against START principles; D delays full assessment inappropriately. In triage prioritization, black tags allow focus on viable victims to maximize overall survival. Decision-making principles accept that not all can be saved in mass casualties. A transferable strategy for triage in mass casualty events is to maintain emotional resilience when making tough tagging decisions.
During hurricane response, the nurse is triaging with START. What is the nurse's PRIORITY action for a victim with respirations 32/min and an obvious penetrating chest wound with bubbling at the site?
Tag yellow and reassess after other victims are triaged
Administer oral analgesics and have the victim sit upright
Apply an occlusive dressing to the chest wound and reassess breathing
Obtain a 12-lead electrocardiogram and notify the provider
Explanation
This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer A reflects the most appropriate triage decision because the victim has a high respiratory rate and bubbling chest wound indicating sucking pneumothorax, requiring immediate occlusive dressing to stabilize breathing. The distractors are less appropriate: B delays with diagnostics; C is supportive but not priority; D tags incorrectly without intervention. In triage prioritization, open chest wounds threaten breathing and need prompt sealing. Decision-making principles include simple fixes like dressings before tagging. A transferable strategy for triage in mass casualty events is to carry essential supplies like occlusive materials for rapid use.
During hurricane aftermath response, the nurse is triaging at a community shelter using START. Which victim should the nurse attend to FIRST? (1) 63-year-old with history of diabetes, confused, respirations 20/min, capillary refill 2 seconds, blood glucose not available; (2) 37-year-old with respirations 34/min after near-drowning, coughing pink frothy sputum; (3) 12-year-old walking with minor abrasions, respirations 18/min, alert; (4) 46-year-old with rib pain, respirations 22/min, capillary refill 2 seconds, follows commands.
63-year-old with diabetes, confused, respirations 20/min, capillary refill 2 seconds
37-year-old with respirations 34/min after near-drowning, coughing pink frothy sputum
12-year-old walking with minor abrasions, respirations 18/min, alert
46-year-old with rib pain, respirations 22/min, capillary refill 2 seconds, follows commands
Explanation
This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer B reflects the most appropriate triage decision because the 37-year-old has a respiratory rate of 34/min (greater than 30) and pink frothy sputum suggesting pulmonary edema, classifying as immediate (red tag). The distractors are less appropriate: A is immediate (red) due to confusion but less acute than B's respiratory distress; C is minor (green); D is delayed (yellow) with pain but stable. In triage prioritization, respiratory rates over 30 indicate urgent breathing issues to address first. Decision-making principles weigh immediate threats like airway compromise over stable alterations. A transferable strategy for triage in mass casualty events is to prioritize based on ABCs while considering potential deterioration.
During hospital emergency overflow after a city-wide disaster, the nurse is assigned to triage with START principles at the entrance. Using START triage, how should the nurse categorize this victim: a 58-year-old with respirations 8/min, cyanotic lips, strong radial pulse, and confusion after falling debris struck his head?
Red tag (immediate)
Black tag (expectant/deceased)
Yellow tag (delayed)
Green tag (minor)
Explanation
This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer C reflects the most appropriate triage decision because the victim has a low respiratory rate of 8/min, cyanosis, and confusion, meeting criteria for immediate (red tag) due to respiratory compromise and altered mental status. The distractors are less appropriate: A (green) for minor walking wounded; B (yellow) for stable non-walkers; D (black) for non-responsive to airway opening. In triage prioritization, abnormal breathing rates and mental changes are flagged for immediate intervention. Decision-making principles prioritize ABCs (airway, breathing, circulation) in rapid assessments. A transferable strategy for triage in mass casualty events is to integrate scene safety and personal protective equipment use.
A rural clinic is overwhelmed after a bus accident. What is the nurse's PRIORITY action when a victim is shouting for help, walking, and has a bleeding nose but stable respirations and mentation?
Direct the victim to the designated minor-injury area (green) for later evaluation
Start an intravenous line and administer a fluid bolus
Apply a red tag and request immediate transport to a trauma center
Stop to obtain a full set of vital signs and complete a head-to-toe assessment
Explanation
This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer A reflects the most appropriate triage decision because the walking victim with minor bleeding and stable parameters is minor (green tag), directing them to a designated area for later care. The distractors are less appropriate: B delays triage with full assessment; C over-triages to red; D initiates advanced care prematurely. In triage prioritization, green victims are low urgency to free resources for others. Decision-making principles promote rapid sorting over detailed exams. A transferable strategy for triage in mass casualty events is to empower green victims with basic first aid instructions.
A bus accident has produced multiple casualties. Using START triage, how should the nurse categorize this victim: a 60-year-old who is not able to walk, respirations 20/min, capillary refill 2 seconds, follows commands, and reports severe abdominal pain with a rigid abdomen?
Green tag (minor)
Black tag (expectant/deceased)
Red tag (immediate)
Yellow tag (delayed)
Explanation
This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer B reflects the most appropriate triage decision because the victim cannot walk, has severe abdominal pain with rigidity suggesting internal injury, but normal vital signs and mental status, classifying as delayed (yellow tag). The distractors are less appropriate: A (green) for stable walkers; C (red) for abnormal parameters; D (black) for deceased. In triage prioritization, potential internal bleeding is monitored but deferred if stable. Decision-making principles use palpation for clues but rely on algorithm. A transferable strategy for triage in mass casualty events is to position yellow victims for comfort while awaiting care.
A bus crash has produced multiple pediatric victims at a rural clinic, and the nurse is using JumpSTART triage for children. Using JumpSTART, how should the nurse categorize this victim: a 4-year-old who is not breathing, has a palpable pulse, and begins breathing after the airway is repositioned; respirations are now 18/min, capillary refill 2 seconds, withdraws from pain but does not follow commands?
Black tag (expectant/deceased)
Red tag (immediate)
Yellow tag (delayed)
Green tag (minor)
Explanation
This question tests disaster triage and mass casualty principles using the JumpSTART protocol for pediatric victims. JumpSTART is the pediatric adaptation of START triage, with special considerations for children's physiological differences. The correct answer is C (Red tag/immediate) because in JumpSTART, a child who was initially apneic but begins breathing after airway positioning, even with abnormal mental status (withdraws from pain only), receives RED tag priority. The child would not be GREEN (minor) due to altered mental status, not YELLOW (delayed) because of the initial apnea requiring intervention, and not BLACK (expectant) because breathing resumed with simple airway maneuver. In JumpSTART, children who respond to airway positioning or rescue breaths are given a chance at survival with immediate priority. The key strategy is remembering that JumpSTART includes rescue breaths for apneic children with a pulse, unlike adult START triage.
Following a bombing, the nurse is caring for a RED-tagged victim in the immediate treatment area. Which intervention should the nurse implement IMMEDIATELY for a 36-year-old with a partial leg amputation and uncontrolled arterial bleeding, respirations 28/min, skin cool and pale, and weak carotid pulse?
Reassess vital signs and document findings before intervening
Apply a tourniquet proximal to the wound and tighten until bleeding stops
Clean the wound with sterile saline and apply a dry sterile dressing
Start an intravenous line and wait for a provider order to give fluids
Explanation
This question tests disaster triage and mass casualty principles, specifically immediate life-saving interventions for RED-tagged victims. In mass casualty events, simple interventions that can quickly save lives take priority. The correct answer is A because applying a tourniquet for uncontrolled arterial bleeding from a partial amputation is the most immediate life-saving intervention - this can be done quickly and prevents exsanguination. Choice B (wound cleaning) is not priority with active bleeding, Choice C (IV access) delays critical bleeding control, and Choice D (reassessment) wastes time when immediate action is needed. The principle is that in the immediate treatment area, interventions focus on the ABCs with emphasis on controlling life-threatening bleeding first. The transferable strategy is to perform the quickest intervention that addresses the most immediate threat to life - in this case, stopping arterial bleeding takes seconds with a tourniquet.