In the emergency department, 20 victims arrive after an accident. Using START triage, identify which patient should be classified as Red (immediate priority):

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

The START triage system prioritizes patients with life-threatening but treatable conditions.
The algorithm follows the RPM mnemonic: Respirations, Perfusion, and Mental Status.
Breathing difficulty (abnormal respirations) is the first critical vital sign assessed after identifying non-walking victims.
A patient with compromised breathing (e.g., respiratory rate > 30/min or < 10/min) is immediately tagged as Red (Immediate) because they require urgent intervention to survive.
The presence of pinpoint pupils, while clinically significant, is secondary to the immediate life threat posed by breathing difficulty in this triage context.

Option A: In a mass casualty incident, a patient with 80% TBSA burns has an extremely low chance of survival. The principle of MCI triage is to allocate limited resources to save the most lives. This patient would be triaged as Black (Expectant).
Option C: This option is an identical duplicate of the correct answer (Option B). It also describes a patient who would be correctly triaged as Red (Immediate). The question format is flawed by having two correct options.
Option D: The first step in START triage is to identify the 'walking wounded.' Any victim who can walk, regardless of their specific injury like a fracture, is initially classified as Green (Minor).

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Application of START Triage in a Mass Casualty Incident (MCI) in acute care settings.
Nurses play a critical role in disaster response and must be proficient in MCI triage to rapidly assess and prioritize a large number of casualties.
Accurate triage ensures that limited medical resources are used effectively to save the maximum number of lives.
MCI triage involves difficult ethical decisions. The goal shifts from doing everything possible for one patient to doing the most good for the largest number of people.

How to Approach the Question

First, identify that the question describes a Mass Casualty Incident (MCI), which requires a specific triage system (START) different from routine ED triage.
Recall the four color categories of START triage: Red, Yellow, Green, and Black.
Systematically apply the START algorithm to each patient described in the options.
Step 1: Identify the 'walking wounded.' The patient who is walking is immediately classified as Green.
Step 2: For the remaining patients, assess RPM (Respirations, Perfusion, Mental Status) in that order.
A patient with abnormal respirations (e.g., >30/min or difficulty breathing) is immediately Red. This is the highest priority among the non-walking victims.

Concept Tested & Keywords

Concept Tested: Application of START Triage in a Mass Casualty Incident (MCI)
Stem keywords: START triage, emergency department, accident, mass casualty, Red, immediate priority
Lead-in keywords: identify which patient
Clinical cues: 20 victims arrive after an accident, indicating a mass casualty incident where resources are strained.

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 114-116

Practise the full NORCET 3 - 2022 (Shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.