NCM 121 Disaster Nursing

Name: ________________ Score:________

Year and Section: _________ Date: _________

Mass Casualty Triage System

Mass casualty scenes are chaotic. Overwhelmingly, complicated triage systems are
difficult to put into practice by the cognitively overloaded responder. Hence, the
objective of this exercise is to help student nurse to be oriented to the triage
protocols use in mass casualty scenes.

Case Scenario : A prolific bomb maker has been terrorizing the City of Binan. He
has detonated several devices recently and sources indicate he plans for more. He has
a pregnant wife and young child. All reside in the city.

Once the bomb maker detonated his device, law enforcement, neighbors, and his own
family were wounded.

Evaluate the casualties using the triage systems:

A. In the first group of casualties, three SWAT officers are wounded, one with an
isolated head injury, one with an abdominal injury, and one with massive hemorrhage
secondary to an amputated leg.

1. The head-injured officer: is not moving, doesn’t follow commands, has a

respiratory rate of 20, and has a palpable radial pulse.
2. The officer with a penetrating abdominal injury: is walking, follows commands,
has a respiratory rate of 26, and a palpable radial pulse.
3. The officer with a leg amputated: is crawling, follows commands, has a
respiratory rate of 28, and a palpable radial pulse.

How do you triage these casualties under each of the triage systems?

Paul Manaig,MD
1. The head-injured officer:

Triage System Condition Triage Priority Color

/Indicator Category
START not able to IMMEDIATE 1st RED
walk, RR <30,
radial pulse
present,
doesn’t follow
commands
SALT

RAMP

2. The officer with a penetrating abdominal injury:

Triage System Condition Triage Priority Color

/Indicator Category
START

SALT

RAMP

Paul Manaig,MD 2023

2. The head-injured officer:

3.The officer with a leg amputated:

Triage System Condition Triage Priority Color
/Indicator Category
START

SALT

RAMP

B. In the second group of casualties, a SWAT officer suffered blast lung from over
pressure, a passerby was wounded by shrapnel, and a law enforcement K9 suffered an
amputated rear limb.

1. Officer: crawling and following commands, respiratory rate of 40, a palpable radial
pulse.
2. Passerby: walking, following commands, respiratory rate 14, with a palpable radial
pulse

1. Officer
with blast lung
Triage System Condition Triage Priority Color
/Indicator Category
START

SALT

RAMP

Paul Manaig,MD 2023

2. Passerby:
Triage System Condition Triage Priority Color
/Indicator Category
START

SALT

RAMP

C. In the third group of wounded casualty, a SWAT officer has massive hemorrhage
from an amputated arm; a neighbor who came out to see what the ruckus was about
suffered burns over his arm, leg, and torso; and another SWAT officer is unresponsive
with no signs of life.

1. Officer with amputated arm: still, not following commands, respiratory rate 36,
no radial pulse.
2. Passerby with burns: 20% partial thickness body surface area burns; walking,
following commands, respiratory rate 14, with a palpable pulse.
3, Unresponsive SWAT Officer: still, not following commands, no spontaneous
breathing, no pulse.

1. Officer
with amputated arm:
Triage System Condition Triage Priority Color
/Indicator Category
START

SALT

RAMP

Paul Manaig,MD 2023

2. Passerby with burns:
Triage System Condition Triage Priority Color
/Indicator Category
START

SALT

RAMP

3. Unresponsive officer:
Triage System Condition Triage Priority Color
/Indicator Category
START

SALT

RAMP

D. In the home, the disgruntled bomber blew himself up, wounded his pregnant wife,
who suffered a penetrating chest injury, and killed his young son. The next-door
neighbor was decapitated in the blast and landed in the back yard. The bomb maker’s
body is found scattered across the crime scene. His injuries are incompatible with life;
therefore he does not get triaged.

1. Pregnant wife: penetrating chest injury, walking, following commands, respiratory

rate of 26, palpable radial pulse.
2. Bomber’s son: still, not following commands, no spontaneous breathing, no
palpable radial pulse.
3. Neighbor: still, not following commands, no spontaneous breathing, no palpable
radial pulse.
Paul Manaig,MD 2023
3. The head-injured officer:
1. Pregnant wife:
Triage System Condition Triage Priority Color
/Indicator Category
START

SALT

RAMP

2. Bomber’s son:
Triage System Condition Triage Priority Color
/Indicator Category
START

SALT

RAMP

3. Neighbor:
Triage System Condition Triage Priority Color
/Indicator Category
START

SALT

RAMP

Paul Manaig,MD 2023