Triage Systems: ED Triage vs Disaster Triage (START) — Different Rules for Different Situations
Your nursing instinct says treat the sickest patient first — and in the ED, that's correct. In a mass casualty, that instinct kills people. The NCLEX will hand you a disaster scenario and tempt you to pick the most critical patient; the correct answer is the most salvageable one.
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Practice 31 NCLEX-style questions
Practice nowComparison
- Sickest first, by acuity
- ★Greatest good for the greatest number
- 5 levels (ESI 1–5) by acuity + resources
- 4 tags: RED, YELLOW, GREEN, BLACK
- ESI 1: needs lifesaving care now
- RED: life threat but survivable
- ESI 5: non-urgent, no resources
- ★BLACK: expectant or dead
- CPR not performed
- Unlimited resources
- Everyone eventually treated
- Scarce resources → most salvageable
- Experienced, ESI-trained ED RN
- Any trained responder at the scene
- Continuous re-triage in the waiting area
- Rapid 30–60 sec/victim
- Reassess once all are tagged
ED Triage (ESI)
- Sickest first, by acuity
Disaster (START)
- ★Greatest good for the greatest number
ED Triage (ESI)
- 5 levels (ESI 1–5) by acuity + resources
Disaster (START)
- 4 tags: RED, YELLOW, GREEN, BLACK
ED Triage (ESI)
- ESI 1: needs lifesaving care now
Disaster (START)
- RED: life threat but survivable
ED Triage (ESI)
- ESI 5: non-urgent, no resources
Disaster (START)
- ★BLACK: expectant or dead
- CPR not performed
ED Triage (ESI)
- Unlimited resources
- Everyone eventually treated
Disaster (START)
- Scarce resources → most salvageable
ED Triage (ESI)
- Experienced, ESI-trained ED RN
Disaster (START)
- Any trained responder at the scene
ED Triage (ESI)
- Continuous re-triage in the waiting area
Disaster (START)
- Rapid 30–60 sec/victim
- Reassess once all are tagged
★ marks the fact that sets a column apart.
Tap the column each item belongs to — jump in and play, or just watch it run.
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ED = sickest first. Disaster = most salvageable first. BLACK tag means no CPR — save who you can save.
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