Disaster Preparedness & Emergency Response

When a mass casualty event hits, normal priorities flip — you stop trying to save the sickest patient first. Knowing who to walk past is what saves the most lives.

In a mass casualty incident (MCI), the nurse shifts from individual-focused care to population-focused care. The goal becomes doing the greatest good for the greatest number, which means triage drives every decision. The START triage system assigns color-coded tags: GREEN (minor — can walk, "walking wounded"), YELLOW (delayed — serious but can wait hours for treatment), RED (immediate — life-threatening but survivable with rapid intervention), and BLACK (expectant — dead or injuries incompatible with survival given available resources). Triage flows in a specific order: first assess ability to walk, then respirations — if absent, reposition the airway once; if respirations resume, tag RED; if not, tag BLACK. If respirations are present but >30/min = RED. Next assess perfusion (capillary refill >2 seconds or absent radial pulse = RED), then mental status (unable to follow commands = RED). The nurse's role includes activating the facility's emergency operations plan, following the chain of command (incident command system, or ICS), maintaining documentation even under pressure, and knowing their assigned role before an event occurs. Decontamination happens BEFORE the patient enters the facility to prevent secondary exposure. Nurses do not freelance — they follow the institutional plan and report to their designated area.

Key Distinctions

Don't confuse MCI triage with ER triage — in the ER, the sickest patient is seen first; in an MCI, the most salvageable patient is prioritized. BLACK tag does not mean dead on arrival — it includes victims who would normally receive aggressive care but cannot given current resources. Students mix up decontamination timing: it occurs outside, before entry, not in the ED.

Clinical Pearl

RPM — Respirations, Perfusion, Mental status. That's your START triage sequence after you sort out the walkers. RPM saves time when seconds decide who lives.