Triage involves the rapid assessment and prioritization of patients. Compare the three-tiered system of triage to the Mass Casualty Incident (MCI) triage philosophy. Imagine that you are the Triage Nurse during an MCI.

How will you categorize the following patients using the MCI triage philosophy? Explain your answer. Are there any ethical issues that should be considered?

10-year-old boy with massive head injury, no spontaneous breathing, BP 60 palp 22-year-old female with a close fracture of the left arm 60-year-old

male with a laceration in the leg complaining of shortness of breath 15-year-old girl with glass embedded in the eyes 52-year-old male with a pulse of 30 and a blood pressure of 70/30

 

SOLUTIONS 

The three-tiered system of triage categorizes patients into three groups based on the severity of their injuries or medical conditions: 1) those who require immediate attention, 2) those who can wait a short time for attention, and 3) those who can wait longer for attention. The Mass Casualty Incident (MCI) triage philosophy, on the other hand, is a more complex system that prioritizes patients based on their likelihood of survival with or without immediate medical intervention. This system categorizes patients into four groups: 1) those who require immediate life-saving intervention, 2) those who require urgent medical intervention, 3) those who require medical intervention within a defined time frame, and 4) those who have minor injuries or medical conditions and can wait for attention.

As the triage nurse during an MCI, I would categorize the patients as follows:

1. 10-year-old boy with massive head injury, no spontaneous breathing, BP 60 palp – This patient requires immediate life-saving intervention, as they have a severe head injury and are not breathing spontaneously. They should be prioritized for immediate medical attention.

2. 22-year-old female with a close fracture of the left arm – This patient has a non-life-threatening injury and can wait for attention. They should be categorized as "delayed" or "minimal" priority, depending on the severity of their fracture.

3. 60-year-old male with a laceration in the leg complaining of shortness of breath – This patient requires urgent medical intervention, as they are experiencing shortness of breath. They should be prioritized as "urgent" and receive medical attention as soon as possible.

4. 15-year-old girl with glass embedded in the eyes – This patient requires medical intervention within a defined time frame, as their condition could result in permanent vision loss if not addressed promptly. They should be prioritized as "urgent" and receive medical attention as soon as possible.

5. 52-year-old male with a pulse of 30 and a blood pressure of 70/30 – This patient requires immediate life-saving intervention, as their vital signs indicate a critical medical emergency. They should be prioritized for immediate medical attention.

When categorizing patients during an MCI, it is important to consider the severity of their injuries or medical conditions and prioritize them based on their likelihood of survival. Ethical issues may arise if there are not enough medical resources available to treat all patients in need, or if certain patients are prioritized over others based on factors such as age, race, or socioeconomic status. It is important for healthcare providers to prioritize patients based on their medical needs and to treat all patients with dignity and respect.