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Question

Difficulty: EasyEstablishing Priorities

A triage nurse is responding to a mass casualty incident following a structural collapse at a local warehouse. Based on standard disaster triage principles, which of the following victims should the nurse classify as requiring immediate intervention (red tag)? Select all that apply.

  1. A
    An unresponsive victim with an open head injury, exposed brain tissue, and no spontaneous respirations after airway repositioning
  2. A conscious victim who is breathing at 34 breaths per minute and has a weak, rapid radial pulseAnswer
  3. A victim with an active, spurting arterial hemorrhage from a mid-thigh lacerationAnswer
  4. D
    A victim with a visibly deformed lower leg who is alert, oriented, and screaming in pain
  5. E
    A victim who is walking around the perimeter of the incident with superficial cuts on both arms

Answer

The victims requiring immediate intervention (red tag) are the conscious victim breathing at 34 breaths per minute and the victim with an active, spurting arterial hemorrhage.
In disaster triage, the 'immediate' (red tag) category is reserved for clients with life-threatening injuries who have a high probability of survival with rapid, simple interventions. Victims with a respiratory rate over 30 breaths per minute or those with active, severe hemorrhage meet the criteria for immediate lifesaving care.

Step-by-Step Solution

1
Assess the victims using the Simple Triage and Rapid Treatment (START) algorithm, focusing first on the ability to walk.
The victim walking around the perimeter is classified as minor (green tag).
Ambulatory clients in a mass casualty event are considered the 'walking wounded' and require delayed or minimal care.
2
Evaluate the respiratory status of the remaining victims.
The victim breathing at 34 breaths per minute is immediately classified as immediate (red tag). The unresponsive victim with no spontaneous respirations after airway repositioning is classified as expectant (black tag).
A respiratory rate greater than 30 indicates critical compromise. Lack of respirations after airway opening in a mass casualty incident indicates non-survivable injuries, preserving resources for those who can be saved.
3
Evaluate perfusion and severe bleeding in the remaining victims.
The victim with an active, spurting arterial hemorrhage is classified as immediate (red tag). The victim with the deformed leg is alert and oriented without critical airway or perfusion issues, so they are classified as delayed (yellow tag).
Active arterial bleeding is rapidly fatal without immediate tourniquet application or pressure, meeting red tag criteria.

Key Concept

Disaster Triage Principles (START Algorithm)
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Establishing Priorities

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