Thirty people are injured in a train derailment. Which client should be transported to hospital first?

NHM MP Staff Nurse-2022

Medical Surgical Nursing

Hard

Appeared in: NHM MP Staff Nurse-2022

Explanation

In a mass casualty incident (MCI), the guiding principle is to provide the greatest good for the greatest number of people, which differs from standard emergency care.
The client with a sucking chest wound has a life-threatening but highly treatable injury that compromises breathing (an 'ABC' issue). This patient is triaged as RED (Immediate).
Rapid intervention, such as applying a three-sided occlusive dressing, can stabilize this patient, giving them a high chance of survival. Therefore, they are the highest priority for transport.

Option A: An unresponsive client with a high spinal cord injury has a very poor prognosis and requires extensive, immediate resources (like mechanical ventilation) that are limited in an MCI. This patient would be triaged as BLACK (Expectant).
Option B: A compound arm fracture is a serious injury but is not immediately life-threatening. The client is hemodynamically stable and can wait for surgical intervention. This patient is triaged as YELLOW (Delayed).
Option C: A leg laceration is a minor injury. This client is considered 'walking wounded' and is the lowest priority for transport. This patient is triaged as GREEN (Minor).

Clinical Relevance

Nursing practice connection: Use the key finding related to Mass Casualty Incident (MCI) Triage and Prioritization to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role in an MCI is to perform rapid triage (ideally in less than 60 seconds per patient) to correctly categorize victims and ensure limited resources are used to save the maximum number of lives.
The START (Simple Triage and Rapid Treatment) method is a common pre-hospital triage system focusing on assessing Respiration, Perfusion, and Mental Status (RPM) to quickly categorize patients.
What if? If the 25-year-old was also unresponsive and not breathing even after opening the airway, their triage category would change from RED (Immediate) to BLACK (Expectant), as they would be considered unsalvageable in an MCI context.

How to Approach the Question

First, identify the question type. This is a priority question set within a Mass Casualty Incident (MCI).
Recall the core principle of MCI triage: 'Do the greatest good for the greatest number of people.' This is fundamentally different from daily hospital triage where the most critically ill person is always treated first.
Apply a standard triage system like START. Mentally categorize each patient based on injury severity and their likelihood of survival with immediate care.
Analyze the options: A sucking chest wound is a life-threatening breathing problem that is fixable (RED). A high spinal injury with unresponsiveness has a poor prognosis (BLACK). A compound fracture is serious but can wait (YELLOW). A laceration is minor (GREEN).
Select the patient in the highest priority category, which is RED (Immediate), as they have the best chance of survival if transported and treated first.

Concept Tested & Keywords

Concept Tested: Mass Casualty Incident (MCI) Triage and Prioritization
Stem keywords: train derailment, thirty people injured, transported to hospital first
Lead-in keywords: Which client, first
Clinical cues: Mass casualty scenario (30 injured) - indicates standard triage rules are suspended in favor of MCI protocols.

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