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Difficulty: MediumEmergency Response Plan

A specialized medical task force arrives at the site of a severe passenger train derailment. As part of the initial disaster response team utilizing the Simple Triage and Rapid Treatment (START) algorithm, which casualty should the nurse categorize as requiring immediate, life-saving intervention?

  1. A casualty with a large abdominal laceration who is breathing 22 times per minute, obeys commands, and has an absent radial pulse.Answer
  2. B
    A casualty trapped under debris who exhibits no spontaneous respirations after attempts to manually open the airway.
  3. C
    A casualty with a suspected spinal cord injury who is unable to move their legs, breathes 18 times per minute, has a capillary refill of 1 second, and correctly states their name.
  4. D
    A casualty who self-extricated from the wreckage, is supporting a deformed right wrist, and is visibly distressed but breathing unlabored.

Answer

The casualty with the abdominal laceration and an absent radial pulse should be categorized for immediate intervention.
The casualty with an absent radial pulse requires an Immediate (Red) tag. The START algorithm prioritizes casualties based on Respiration, Perfusion, and Mental Status (RPM). Although this casualty is breathing normally and obeys commands, the absent radial pulse indicates severe circulatory compromise and shock, meaning they require immediate life-saving intervention.

Step-by-Step Solution

1
Assess for casualties who are able to walk away from the incident.
The casualty with the deformed wrist can walk and is categorized as Minimal (Green tag).
Separating the 'walking wounded' immediately reduces the number of casualties requiring complex triage in the hot zone.
2
Evaluate the respiratory status of the remaining non-ambulatory casualties.
The casualty trapped under debris remains apneic after airway repositioning and is categorized as Expectant (Black tag).
In a mass casualty incident, extensive resources like CPR are not initiated for apneic clients in order to ensure the most good is done for the greatest number of people.
3
Assess the circulation and perfusion of the casualties who are breathing effectively.
The casualty with the abdominal laceration has an absent radial pulse, meeting criteria for Immediate (Red tag).
An absent radial pulse indicates severe systemic shock and hemodynamic instability, taking precedence over their stable respiratory rate.
4
Evaluate the mental status of casualties with intact airway, breathing, and circulation.
The casualty with the suspected spinal cord injury has stable vitals and obeys commands, making them Delayed (Yellow tag).
Although the mechanism of injury is severe, the casualty is physiologically stable enough to wait for transport while life-threatening injuries in others are addressed.

Key Concept

Disaster Triage (START Algorithm)
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Topics

Emergency Response Plan

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