Disaster Triage and Emergency Response

Mass casualty incidents (MCIs) require a fundamental shift in nursing practice. Instead of focusing all resources on one critically ill patient, disaster triage prioritizes treating the greatest number of patients who can survive.

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The Paradigm Shift

Everyday Nursing vs. Disaster Nursing

The Core Principle

"The greatest good for the greatest number" - This means some patients who would receive full treatment in normal circumstances may receive minimal or no treatment during disasters.

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Disaster Triage Categories

The START triage system (Simple Triage and Rapid Treatment) uses a color-coded system:

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RED - Immediate (Highest Priority)

Patients with life-threatening conditions that are treatable with available resources.

Examples of RED Tag Patients

Key Concept

RED patients will die without immediate intervention but can survive if treated promptly. These patients receive resources first because the investment yields survival.

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YELLOW - Delayed (Second Priority)

Patients with significant injuries who are stable enough to wait 30-60 minutes without deteriorating.

Examples of YELLOW Tag Patients

Key Concept

YELLOW patients need treatment but can tolerate a wait while RED patients are addressed. Continuous reassessment is needed because YELLOW can become RED.

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GREEN - Minor (Third Priority)

The "walking wounded" - patients with minor injuries who can wait hours for treatment.

Examples of GREEN Tag Patients

Key Concept

GREEN patients can often help themselves and others. They may assist with transporting supplies or providing comfort to other victims.

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BLACK - Expectant (Not Treated)

Patients who are deceased or have injuries so severe that survival is unlikely with available resources.

Examples of BLACK Tag Patients

Critical Understanding

This is NOT abandonment - it is ethical allocation of limited resources to save the most lives. In normal situations, all of these patients would receive treatment.

The Ethical Framework

During a disaster:

• Treating one BLACK patient with CPR for 30 minutes
• Means 10 RED patients do not receive life-saving interventions
• Those 10 patients die while you try to save one who likely will not survive
• The ethical choice is to save the 10

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Triage Process

START Method Steps

1. Voice Command: "Everyone who can walk, move to this area!"

   • Those who can walk = GREEN (minor)

2. Check Respirations:

   • Not breathing → Open airway → Still not breathing = BLACK
   • Not breathing → Open airway → Starts breathing = RED
   • Breathing >30/min = RED
   • Breathing <30/min = Continue to next step

3. Check Perfusion (Capillary Refill):

   • 2 seconds = RED

   • <2 seconds = Continue to next step

4. Check Mental Status:

   • Cannot follow simple commands = RED
   • Can follow commands = YELLOW

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Special Populations

Pediatric Considerations (JumpSTART)

• Different respiratory rate cutoffs
• Different mental status assessment
• Modified approach for infants

Geriatric Considerations

• May have baseline cognitive impairment
• Vital sign parameters may be different
• Consider medications that affect presentation

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Nurse's Role in Disaster Response

Immediate Actions

Psychological First Aid

• Remain calm and confident
• Provide clear instructions
• Offer reassurance when possible
• Refer to mental health resources after immediate crisis

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Reassessment

Triage is dynamic - patient conditions change:

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Common Disaster Scenarios

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On the NCLEX

Common testing points:

• Understanding the color-coded triage categories
• Recognizing that BLACK does not mean abandonment
• Knowing that disaster triage differs from ER triage
• Prioritizing RED patients first in treatment
• Understanding the "greatest good" principle

Exam Strategy: In disaster questions, look for the patient who will die without immediate intervention BUT can survive if treated. That is the RED patient and should be treated first.