DISASTER NURSING - RLE

Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

Lesson title: Emergency and Disaster Management: Disaster Materials:

Triage Part 1 Activity Sheets, Improvised Materials

Learning Targets: References:

At the end of the module, students will be able to: 1. Veneema, Tener Goodwin., Disaster
1. Describe the differences among daily hospital triage, mass Nursing and Emergency Preparedness for
casualty incident, disaster triage, tactical – military triage, Chemical, Biological, and Radiological
and special conditions (hazmat) triage. Terrorism and Other Hazards.,11 West 42nd
2. Understand the situations in which each model of disaster Street New York, Springer Publishing
triage is used. Company, 2007
3. List and describe the features of field triage tag. 2. https://riverview.org/downloads/pdfs/rvh-
ems-start-and-jump-start-mci-triage-tools.pdf

A. SUBJECT ORIENTATION

The instructor will start by introducing herself to the class and the assigned subject, Disaster Nursing – RLE. The course
outline will be distributed and discussed accordingly. Listed below are the additional information vital in orientation:

1. Classroom rules and regulations.

2. The calendar of activities (major examinations).
3. Computation of grades specific for this subject.
4. Election for block officers.

B. MAIN LESSON

Disaster triage is employed when local emergency services are overwhelmed to the point that immediate care cannot be
provided to everyone who needs it. During disaster triage where there are many casualties, patients are usually sorted
into one of the following categories: (a) critical, (b) urgent, (c) minor, or (d) catastrophic.
a) Critical - critical casualties are those that are life threatening, but likely to be amenable to rapid intervention that
does not require an inordinate amount of resources.
b) Urgent - Urgent casualties are those conditions that are serious and, if not treated in a timely manner, are likely to
deteriorate to become critical. Urgent cases are referred to a hospital setting, but these cases will be treated after
the critical cases are attended to.
c) Minor - Casualties are classified as minor when the care required can be provided in a low-tech setting and a
delay in treatment would unlikely contribute to a significant deterioration in the victims' condition.
d) Catastrophic - This classification is used for conditions that have either a very grave prognosis or would require
an amount of resources that are so large they would divert care from others with a much better prognosis. During
a disaster situation, catastrophic casualties will not be treated until the critical and urgent cases are attended to.

DISASTER TRIAGE SYSTEMS

 Simple Triage and Rapid Treatment (START) system (for triaging adults)
 Jump START system (for triaging pediatric patients)
 Start/Save (when triage process must be over an extended period of time)

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 DISASTER NURSING - RLE
Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

Simple Triage and Rapid Treatment (START) System

1. All patients who can walk (walking wounded) are categorized as Delayed (GREEN) and are asked to move away
from the incident area to a specific location.
2. The next group of patients is assessed quickly (30-60 seconds per patient) by evaluating RPM:
o Respiration (position upper airway or determine respiratory rate)
o Perfusion/blood circulation (check capillary refill time)
o Mental status (determine patient's ability to obey commands)
CATEGORY RPM INDICATORS
R= Respiratory rate >30;
Critical (RED) P= Capillary Refill >2 seconds;
M= Doesn’t obey commands
R <30
Urgent (YELLOW) P <20 seconds
M= Obeys command
Expectant: dead or dying (BLACK) R= no breathing
Table 1.1 Using RPM to Classify Patients

COLOR DESCRIPTOR AND ORDER OF TRANSPORT

Critical: Unstable, with acute problems for immediate
Red intervention is likely to save life or limb. Transport
immediately.
Urgent: Acute problem and stable, but may deteriorate.
Yellow
Transport after Red cases.
Delayed: Injured or ill, but stable and not likely to
Green deteriorate if treatment is delayed. (Referred to as the
walking wounded). Transport after Red and Yellow.
Expectant: Dead or nonsalvageable given the available
Black
resources. Lowest transport priority.
Table 1.2. Color-Coding for Prehospital Disaster Triage System

JumpSTART
- The JumpSTART system was originally created to meet the unique needs of assessing children less than 8 years
of age (Romig, 2002b).

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 DISASTER NURSING - RLE
Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

Figure 1.1 JumpSTART triage algorithm

- In this triage system a child's respiratory rate is assessed as "good" if it is between 15 and 45 (one breath every
2-4 seconds). A child with a rate <15 or >45 would be classified as Critical (RED).
- A child's perfusion is checked by palpating the distal pulses. A child with a weak or nonexistent distal pulse gets
classified as Critical (RED).
- Assess for mental status using the AVPU system (Alert, responds to Vocal stimuli, responds to Painful stimuli,
Unresponsive). A child who is unresponsive or has an inappropriate response to pain would be classified as
Critical (RED).
- In addition, unlike the START system, in the JumpSTART system, a young child who is not breathing on initial
assessment should still be checked for a pulse. If a pulse is found, the child receives a brief (5 breaths) ventilatory
trial, which, if not successful results in assigning the patient as Expectant (BLACK).

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 DISASTER NURSING - RLE
Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

Figure 1.2. Combined START/JumpSTART triage algorithm.

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 DISASTER NURSING - RLE
Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

Figure 1.3. Sample Triage Tag.

M START Triage System

Since the capillary filling criterion in the dark and cold environments in emergencies and disasters is not an appropriate
reflection of the circulatory system, this criterion has been omitted in the modified model of the triage system (MSTART).
The only therapeutic measures allowed in this method are opening the airway of the patient and controlling the bleeding
by direct pressure on the site of the bleeding.

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 DISASTER NURSING - RLE
Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

Sieve Triage
Similar to the START method, this method, which is used in parts of Europe, Australia, and the United Kingdom, first uses
the walking filter to examine the injured individual, and uses four tags encompassing red, yellow, green and black tags to
classify the injured patients.

CareFlight Triage

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 DISASTER NURSING - RLE
Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

This method is a tool for rapid triage in mass casualty incidents, in which such criteria as walking ability, obeying the
commands, palpable radial pulses, and airway respiration are evaluated. The injured people are placed in four urgent
(red), emergency (yellow), delayed (green) and non-salvageable (black) classes.

Careflight Triage Algorithm

The noteworthy point is that in this method the criterion of obeying the commands is examined before the evaluation of
breathing and pulse rate. This method is one of the fastest triage methods, which takes only 15 seconds to test each
patient.

Reverse Triage
Reverse triage is a method that is commonly used during emergencies and disasters. In reverse triage, injured people
with fewer damages and minor injuries are at the priority of receiving services. This is also used in cases, where the
treatment team or soldiers, during the war, are injured. This is used in the disaster and emergencies, where medical
resources are limited, with the aim of returning people as quickly as possible and helping other people. Reverse triage is
also a way to increase the capacity of the emergency unit of the hospital during disasters. Accordingly, those patients with
mild injuries and those supposed to be without any medical complications for at least 96 hours after discharge are at the
top of the discharge list.
Telephone triage
In telephone triage, decision makers over the phone must effectively assess the patient's symptoms and provide
directives based on the urgency. This should be done in a timely fashion while meeting standard guidelines in order to
prevent symptoms from worsening.

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.

Multiple Choice
1. You're working as a triage nurse during a disaster situation. Based on the triage color code tags placed on each
of the wounded, which tag color represents the wounded who have the highest priority of being treated first?
A. Green

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 DISASTER NURSING - RLE
Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

B. Yellow
C. Red
D. Black
ANSWER: ________
RATIO:_______________________________________________________________________________________________
_______________________________________________________________________________

2. A catastrophic disaster has occurred 5 miles from the hospital you are working in. The hospital's disaster plan is
activated and the wounded are brought to the hospital. You're helping triage the survivors. One of the wounded is
able to walk around and has minor lacerations on the arms, hands, chest, and legs. You would place what color
tag on this survivor?
A. Red
B. Yellow
C. Green
D. Black
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

3. While triaging the wounded from a disaster, you note that one of the wounded is not breathing, radial pulse is
absent, capillary refill >2 seconds, and does not respond to your commands. What color tag is assigned?
A. Green
B. Red
C. Yellow
D. Black
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

4. The wounded victim is unable to walk, has respiratory rate of 12, capillary refill is 8 seconds, and is unresponsive.
The wounded victim is assigned what tag color?
A. Green
B. Red
C. Yellow
D. Black
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

5. The wounded victim is unable to walk, has respiratory rate of 19, capillary refill of one second, and is able to obey
your commands. The wounded victim is assigned what tag color?
A. Green
B. Red
C. Yellow
D. Black

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 DISASTER NURSING - RLE
Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

6. The wounded victim is unable to walk, respiratory rate is absent but when airway is repositioned breathing is
noted. The wounded victim is assigned what tag color?
A. Green
B. Red
C. Yellow
D. Black
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

7. The wounded victim is unable to walk, respiratory rate is absent and when airway is repositioned breathing is still
absent. The wounded victim is assigned what tag color?
A. Green
B. Red
C. Yellow
D. Black
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

8. The wounded victim is able to walk and obey commands. The wounded victim is assigned what tag color?
A. Green
B. Red
C. Yellow
D. Black
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

9. The following personnel can be involved in the care during disaster and emergency, select all that apply (SATA):
A. Nursing Medic
B. Health care practitioner
C. First Aid responder
D. Caregiver
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

10. When a major wave of patients arrive to a hospital, such as immediately after a natural disaster, a similar process
can be applied to discharging patients early when the medical system is stressed. This is a triage system known
as:

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 DISASTER NURSING - RLE
Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

A. Telephone Triage
B. Reverse Triage
C. SALT Triage
D.SMART Triage
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
____________________________________________________________________________________________
5. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________
6. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________
7. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________
8. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________
9. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________
10. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________

C. LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you

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 DISASTER NURSING - RLE
Module #1 Student Activity Sheet

Name: ________________________________________________________ Class number: ______

Section: ____________ Schedule: _________________________________ Date: _____________

track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2) What question(s) do you have as we end this session?

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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