A nurse encounters four patients after a mass casualty event. Who should be given the highest triage priority?

RRB Nsg. Superintendent-2026 (Shift -1st)

Medical & Surgical Nursing

Hard

Appeared in: RRB Nsg. Superintendent-2026 (Shift -1st)

Explanation

In a mass casualty incident (MCI), the principle is to provide the greatest good for the greatest number of people, prioritizing those with the highest chance of survival.
A patient with severe respiratory distress has a life-threatening condition (compromised airway/breathing) that is often correctable with immediate intervention.
According to the START triage system, compromised breathing is a top-priority indicator, classifying the patient as Red (Immediate).
This patient is prioritized over those with non-survivable injuries (Black tag) or less critical injuries (Yellow and Green tags).

Option A: In a mass casualty event, a patient with no pulse and no respiration is categorized as Black (Expectant/Deceased). Resources are allocated to save viable patients, so CPR is not initiated.
Option C: A patient with minor lacerations is considered 'walking wounded' and is categorized as Green (Minor). They have the lowest priority for treatment.
Option D: A patient with an isolated fractured arm has a serious but not immediately life-threatening injury. They are categorized as Yellow (Delayed) and can wait for treatment.

Visual 1: Flowchart: The START triage algorithm, detailing the assessment of Respirations, Perfusion, and Mental Status (RPM) to assign color tags.
Visual 2: Infographic: The four disaster triage color tags (Red, Yellow, Green, Black) with icons, priority levels, and clear examples of injuries for each category.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Disaster Triage and START Method in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Nurses must be able to rapidly switch from the standard 'treat the sickest first' mentality to the disaster triage principle of 'save the most salvageable lives'.
Accurate triage is a critical nursing skill during disasters that directly impacts patient survival by ensuring limited resources are used effectively.
Triage is a dynamic process. A patient's condition can change, requiring the nurse to reassess and potentially change their triage category.

How to Approach the Question

First, identify the key phrase 'mass casualty event'. This tells you to apply disaster triage rules, not standard emergency triage.
Recall the four color-coded triage categories: Red (Immediate), Yellow (Delayed), Green (Minor), and Black (Expectant).
Systematically evaluate each option and assign a triage color:
No pulse/respiration = Black (Expectant)
Severe respiratory distress = Red (Immediate)
Minor lacerations = Green (Minor)

Concept Tested & Keywords

Concept Tested: Disaster Triage and START Method
Stem keywords: mass casualty event, triage priority
Lead-in keywords: highest
Clinical cues: The phrase 'mass casualty event' is the critical cue to apply disaster triage principles instead of standard emergency room triage.

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