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 (Simple Triage and Rapid Treatment) algorithm prioritizes patients based on Respirations, Perfusion, and Mental Status (RPM).
A patient with breathing difficulty has a compromised airway or breathing, which is the highest priority (after controlling catastrophic hemorrhage).
According to the algorithm, any patient with a respiratory rate greater than 30 breaths per minute or who requires assistance to maintain an open airway is tagged as Red (Immediate).
The presence of pinpoint pupils could indicate a cause like opioid overdose or nerve agent exposure, further highlighting the need for urgent medical intervention.

Option A: In a mass casualty incident, a patient with 80% TBSA burns has an extremely low chance of survival, even with extensive resources. Triage aims to do the most good for the most people.
Option C: This option is an identical duplicate of the correct answer. In an exam, if two options are identical, it's usually a question error, but the underlying principle remains that breathing difficulty is the top priority.
Option D: The first step of the START algorithm is to identify the 'walking wounded.' Any patient who can walk is immediately classified as Green (Minor), regardless of their injuries.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Application of the START triage system in a mass casualty incident in acute care settings.
Nurses are crucial in implementing triage during mass casualty incidents, making rapid, life-or-death decisions to allocate limited resources effectively.
Understanding triage principles like START is a core competency for emergency and disaster nursing, ensuring that patients with the highest chance of survival receive care first.
What if? If the patient with breathing difficulty was also found to be apneic (not breathing), the nurse's first action would be to open the airway. If breathing starts, they are tagged Red. If breathing does not start, they are tagged Black.

How to Approach the Question

First, identify the core concept: The question asks to apply the START triage system to prioritize patients in a mass casualty incident.
Recall the START algorithm's steps and color codes: Green (walking wounded), Red (immediate), Yellow (delayed), Black (expectant).
Analyze each option against the algorithm's criteria (Respirations, Perfusion, Mental Status - RPM).
Option D: 'walking' -> immediately classify as Green.
Option A: '80% TBSA burns' -> recognize this as an injury with very low survivability in a mass casualty setting -> classify as Black.
Option B/C: 'breathing difficulty' -> this is a compromise of the 'B' in ABCs and a primary criterion for a Red tag in the START algorithm.

Concept Tested & Keywords

Concept Tested: Application of the START triage system in a mass casualty incident.
Stem keywords: emergency department, accident, START triage, Red, immediate priority
Lead-in keywords: identify which patient
Clinical cues: Mass casualty scenario with 20 victims, requiring prioritization of care.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 585-587

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 113-115

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.