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Difficulty: HardEmergency Response Plan

A rapid response medical team is deployed to the site of a structural collapse at a large indoor transit hub. The nurse is performing rapid mass casualty triage using the START (Simple Triage and Rapid Treatment) algorithm. Which client should the nurse classify with a red tag (Immediate)?

  1. A client with a respiratory rate of 22 breaths/min, a palpable radial pulse, and who makes no purposeful movement when asked to squeeze the nurse's hand.Answer
  2. B
    A client with obvious bilateral femur deformities, a respiratory rate of 28 breaths/min, a capillary refill time of 1.5 seconds, and who is alert and crying for help.
  3. C
    A client who is apneic and pulseless, and who exhibits no spontaneous breathing after the nurse uses the jaw-thrust maneuver to open the airway.
  4. D
    A client with a profusely bleeding scalp laceration and a deformed wrist who successfully relocated to the designated safe zone when instructed.

Answer

The client with normal respirations and perfusion but an altered mental status (unable to follow simple commands) requires an immediate (red) tag.
In the START triage algorithm, clients are assessed sequentially for Respirations, Perfusion, and Mental Status (RPM). If respirations are under 30 breaths/minute and perfusion is adequate (indicated by a palpable radial pulse or capillary refill under 2 seconds), the nurse must assess mental status. A client who cannot follow simple commands (such as squeezing a hand) is exhibiting an altered mental status. This classifies them as "Immediate" (red tag) because it indicates a potential severe head injury, severe hypoxia, or profound shock requiring immediate life-saving intervention.

Step-by-Step Solution

1
Recall the parameters of the START triage algorithm used for adult clients in mass casualty incidents.
The START method assesses Respirations, Perfusion, and Mental status (RPM) sequentially to determine triage category.
Mass casualty triage prioritizes resource allocation based on physiological stability rather than visual severity of individual injuries.
2
Evaluate the client who cannot follow commands against the RPM criteria.
Respirations are normal (< 30 breaths/min) and perfusion is adequate (palpable radial pulse), but the mental status assessment is failed.
According to the START algorithm, an inability to follow simple commands indicates significant neurological compromise or impending shock, necessitating an immediate (red) classification.
3
Analyze the remaining clients to ensure they do not take higher priority.
The walking client is minor (green), the client who remains apneic after airway repositioning is expectant (black), and the alert client with femur fractures but stable RPM parameters is delayed (yellow).
Applying the strict criteria of the START algorithm prevents the misallocation of life-saving resources to clients who are physiologically stable or unsalvageable.

Key Concept

Disaster Triage Principles (START Algorithm)
Estimated Time:1m 30s
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Topics

Emergency Response Plan

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