PHTLS Triage and Mass Casualty Incident (MCI) Management

Question 1

In the START triage system, after directing all walking wounded away from the immediate scene, what is the FIRST physiologic parameter assessed in remaining victims?

Accepted Answer

Respirations — presence and rate

Answer

START (Simple Triage And Rapid Treatment) assesses three parameters in sequence: (1) Respirations — if absent, one attempt to reposition the airway; (2) Perfusion — radial pulse or capillary refill; (3) Mental status — ability to follow a simple command. Respiratory assessment is always the first step after the walking-wounded sort.

Question 2

In START triage, a victim does not breathe after a single attempt to reposition the airway. What triage tag should be applied?

Accepted Answer

Black — Expectant

Answer

A victim who does not breathe after one airway repositioning attempt is classified Black (Expectant) in START triage. Resources cannot be expended on airway management for a single patient when many others are waiting. This is one of the most difficult MCI decisions but is essential to saving the greatest number of lives.

Question 3

Using START triage, a victim has a respiratory rate of 34 breaths per minute. What triage category is assigned?

Accepted Answer

Red — Immediate, based on respiratory rate alone

Answer

In START, a respiratory rate greater than 30 breaths per minute immediately classifies the patient as Red (Immediate). No further assessment steps are needed once this threshold is crossed. A rate below 10 is also classified as Immediate (Red). Only rates of 10–29 prompt advancing to the perfusion and mental status steps.

Question 4

A mass casualty incident (MCI) is best defined as any event in which:

Accepted Answer

The number or severity of patients exceeds available local EMS resources

Answer

An MCI is defined by the relationship between patient load and available resources — not by a fixed patient count. Two critically injured patients can constitute an MCI for a single-unit rural system, while a major urban trauma center may manage 20 patients without declaring an MCI. The threshold is resource-relative, not numerically absolute.

Question 5

JumpSTART modifies the adult START system for pediatric patients primarily by adding which intervention for apneic children who have a palpable pulse?

Accepted Answer

Five rescue breaths before assigning the Expectant category if still apneic

Answer

JumpSTART adds a critical rescue breath step: if a child is apneic but has a palpable pulse, give 5 rescue breaths. If breathing resumes, classify as Red (Immediate). If the child remains apneic, classify as Black (Expectant). This modification reflects that pediatric arrest more commonly begins with primary respiratory failure rather than primary cardiac failure.

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS Triage and Mass Casualty Incident (MCI) Management