Question

1.The local community hospital routinely practices activation of its Emergency Preparedness Plans. One key aspect of the emergency preparedness exercise is to provide all staff with opportunities to practice their various roles during an actual emergency. Registered nurses from the emergency department frequently have key roles in patient triage and emergency management.(Learning Objective2)


a. How is triage different in a disaster from triage on a routine day in the emergency department?

b. What are the triage categories during a mass casualty incident?

c. During the disaster exercise, a simulated patient with a penetrating head injury who does not respond to painful stimuli and has a Glasgow Coma Scale of 5 is brought to the emergency department. In what category should the patient be placed?


2.The nursing staff in the emergency department are placed on alert for a Level I disaster at a local mall. A bomb exploded, and there were multiple causalities as a result. A field disaster triage was set up, and the hospital was notified of a bus load of patients who would arrive at the emergency department for needed care. The ambulance will bring patients needing emergent care. (Learning Objective 5)


a. What physical injuries may occur after the primary blast event, and what management is needed?

b. What physical injuries may occur after the secondary blast phase, and what management is needed?

Answer 1

1. a. Triage is the process by which patients are classified according to the type and urgency of their conditions to get the right patient to the right place at the right time with the right care provider.

In a routine emergency department, the triage is used to assess patients severity of injury or illness within a short time after their arrival, thereby assign priorities and transfer each patient to the appropriate place for treatment.

But in disaster, the priority of triage is to prioritize patient care based on need and available resources. Here importance is given to awareness to the situation and also Planning is done for surge capacity while simultaneously attending to patients who require immediate action.

b.Triage categories

• Non disaster
• Multicasuality/ disaster

Triage level commonly used

1. Resuscitation
2. Emergent
3. Urgent
4. Less urgent
5. Non urgent

Triage in mass casuality

Priority 1 - Red : critical

Priority 2 - yellow : Serious

Priority 3 - Green : Minor injuries

                  Blue - Dead

c. The patient is categorized under Red / immediate category because he needs a surgical intervention and other life saving interventions and should br transported to advanced facilities. The person is likely to survive with immediate intervention

2. a. Primary blast injury occurs when the blast wave hits the body. The common injuries are burns, angina, crush injury, asthma or COPD exacerbations due to dust, smoke, or toxic fumes

Management - In primary blast injury treatment is focussed on the systematic management

b. Secondary blast injury asre caused when the debris that is displaced by the wind of explosion penetrates or interact with the body surface. They include penetrating trauma with visible bleeding, concussion, contusion , loss of sensorium or concussion, contusion, head injury.

Management - resuscitation, penicillin, anti tetanus, debridement, wash, pack. Surgery if needed.