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Difficulty: HardEmergency Response Plan

An emergency pediatric nurse is assigned to perform field triage at the scene of a severe multi-vehicle collision involving a school bus. Utilizing the JumpSTART pediatric mass casualty algorithm, the nurse assesses a 6-year-old victim who is unresponsive and not breathing. After the nurse manually opens the airway, the child remains apneic. Which action should the nurse take next?

  1. Check for a palpable pulse and, if present, administer five rescue breaths.Answer
  2. B
    Classify the victim as expectant (BLACK) and immediately move to assess the next casualty.
  3. C
    Assign an immediate (RED) triage tag and place the victim in a side-lying recovery position.
  4. D
    Begin cardiopulmonary resuscitation (CPR) cycles of 15 compressions to 2 breaths.

Answer

Check for a palpable pulse and, if present, administer five rescue breaths.
In the pediatric JumpSTART mass casualty algorithm, children who remain apneic after manual airway positioning are not immediately classified as expectant. Because pediatric cardiac arrest is usually secondary to primary respiratory failure, the nurse must next check for a palpable pulse. If a pulse is present, the nurse delivers 5 rescue breaths. If the child begins breathing, they are tagged RED (immediate); if they remain apneic, or if no pulse is present, they are tagged BLACK (expectant).

Step-by-Step Solution

1
Assess the pediatric victim's initial respiratory status.
The victim is found to be unresponsive and apneic.
Spontaneous breathing is the first physiological parameter assessed in non-ambulatory mass casualty victims.
2
Perform a manual airway maneuver (such as a jaw thrust or head tilt-chin lift).
The victim remains apneic after the airway is opened and cleared.
Positional airway obstruction must be ruled out before determining if the apnea is due to a primary physiological failure.
3
Apply the rules specific to the pediatric JumpSTART algorithm rather than the adult START algorithm.
Unlike adults, children who remain apneic after airway positioning are not immediately categorized as expectant (unsalvageable).
Children often experience primary respiratory arrest that can rapidly respond to brief ventilatory support, whereas adults in trauma-induced cardiac arrest are generally considered unsalvageable in an MCI.
4
Palpate for a peripheral or central pulse to determine the next intervention.
If a pulse is felt, the nurse delivers 5 rescue breaths. If the child begins breathing, they are tagged RED. If they remain apneic after the breaths, or if no pulse was present initially, they are tagged BLACK.
This critical step maximizes pediatric survival rates without committing to full, resource-draining CPR.

Key Concept

Pediatric Mass Casualty Triage (JumpSTART Algorithm)
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Topics

Emergency Response Plan

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