Emergency and Disaster Nursing Flashcards

During a multi-vehicle accident outside Riyadh, a field nurse applies the START triage system. A victim is breathing after repositioning the airway, has a respiratory rate of 26 breaths/min, a radial pulse present, and cannot follow commands. What is the correct triage color for this patient?

Answer: Red (Immediate)

In START triage: breathing after airway repositioning (would have been Black if not breathing), RR >30 = Red, RR 10–29 with absent radial pulse = Red, RR 10–29 with radial pulse present but altered mental status = Red (Immediate). The patient has RR 26 (within 10–29) with a radial pulse present, but cannot follow commands (altered mental status), placing them in the Red/Immediate category requiring urgent intervention.

A Saudi hospital activates its Hospital Incident Command System (HICS) during a chemical exposure mass-casualty event. What is the FIRST nursing priority in the hospital's decontamination zone?

Answer: Remove the patient's clothing and irrigate exposed skin with large amounts of water

For chemical exposure, decontamination always precedes treatment. Removing clothing eliminates up to 80% of contamination, and copious water irrigation removes residual chemical agents from the skin and eyes. Administering antidotes or transferring to ICU before decontamination endangers staff and contaminates the facility. History-taking is secondary to life-saving decontamination.

A nurse working in a Saudi hospital emergency department assesses a patient using the Manchester Triage System (MTS). The patient presents with severe chest pain radiating to the left arm, diaphoresis, and a pulse oximetry of 94%. Which triage category should be assigned?

Answer: Red — Immediate (0 minutes)

Severe chest pain with radiation, diaphoresis, and hypoxia (SpO2 94%) are classic signs of acute myocardial infarction — a life-threatening emergency. Under the Manchester Triage System used in many Saudi hospitals, such presentations are classified as Red/Immediate (0 minutes wait), triggering an immediate 12-lead ECG and activation of the cardiac catheterization team per Saudi Heart Association STEMI protocols.

During a Hajj season mass-casualty event, Saudi Civil Defense coordinates with hospitals. Under the Saudi National Disaster Management Plan, which agency has PRIMARY authority for field medical coordination during a mass-casualty incident?

Answer: Saudi Red Crescent Authority (SRCA)

The Saudi Red Crescent Authority (SRCA) is the primary agency responsible for field emergency medical services and on-scene medical coordination during mass-casualty incidents in Saudi Arabia, including Hajj-related events. SCFHS regulates health professionals; GACA oversees aviation; SFDA handles medications and food safety. SRCA's field teams work in coordination with Civil Defense and MOH hospitals.

A nurse triages a 7-year-old child who was brought in during a building collapse. The child is breathing spontaneously at 22 breaths/min, has a palpable radial pulse, but is crying inconsolably and will not follow commands. Using the JumpSTART pediatric triage system, what is the correct classification?

Answer: Red (Immediate)

JumpSTART (used for pediatric patients) parallels START but adjusts for normal pediatric physiology. For children: breathing present, RR 15–45 (22 is normal), pulse present, but AVPU score of 'P' or 'U' (not following commands = responds to pain at best) → classified as Red/Immediate. A child who is only crying and not following verbal commands cannot be classified as merely Delayed (Yellow).

During a large-scale disaster drill at a Saudi hospital, nurses are taught about the 'Reverse Triage' concept. In which specific situation is reverse triage appropriately applied?

Answer: When healthcare workers and key personnel are injured and must be treated first to restore medical capacity

Reverse triage is an ethical exception to standard mass-casualty triage, applied when the medical system's capacity has been devastated (e.g., a bombing of the hospital itself). In this scenario, treating lightly injured but medically essential personnel first — such as surgeons, nurses, and incident commanders — rapidly restores the system's ability to save the most lives overall. It is NOT a routine practice and must be authorized by incident command.