TNCC - Trauma Nurse Core Curriculum Disaster Management Questions and Answers 1 — Questions and Answers
Question 1: During a mass casualty incident caused by a bus rollover, you are triaging a 30-year-old male using the START algorithm. The patient is unable to walk. He is apneic. You manually open his airway, and he begins to breathe at a rate of 22 breaths/min. What is the next immediate action and corresponding triage category?
- Assess for a radial pulse or capillary refill.
- Tag the patient as RED (Immediate) and move to the next victim. (Correct answer)
- Tag the patient as BLACK (Expectant/Deceased) and move to the next victim.
- Assess his ability to follow simple commands.
Correct answer: Tag the patient as RED (Immediate) and move to the next victim.
According to the START triage algorithm, if an apneic adult patient begins to breathe after their airway is opened, they are considered to have a compromised airway and are immediately categorized as RED (Immediate) to receive life-saving care. No further assessment (perfusion or mental status) is needed at this stage of primary triage.
Question 2: Which of the following scenarios is a recognized exception to standard mass casualty triage principles, requiring the use of "reverse triage"?
- A multi-vehicle highway collision with blunt and penetrating trauma.
- An industrial explosion with numerous burn and blast injuries.
- A multiple-victim lightning strike. (Correct answer)
- A building collapse with crush injuries.
Correct answer: A multiple-victim lightning strike.
In a multiple-victim lightning strike, reverse triage is the standard of care. Victims who are in cardiopulmonary arrest should be treated first. Lightning acts like a massive defibrillation, causing temporary paralysis of the heart and respiratory centers. These victims have a good chance of resuscitation with immediate CPR, whereas those with vital signs are more likely to survive the initial event.
Question 3: A key difference between the adult START triage system and the pediatric JumpSTART system is the management of an apneic patient. What intervention is performed in the JumpSTART algorithm for an apneic child that is NOT performed for an adult?
- Assessing for a peripheral pulse and, if present, delivering five rescue breaths. (Correct answer)
- Immediately tagging the child as BLACK (Expectant/Deceased) if they are not breathing.
- Checking capillary refill before opening the airway.
- Using the AVPU scale to determine if the apnea is neurologically-related.
Correct answer: Assessing for a peripheral pulse and, if present, delivering five rescue breaths.
The JumpSTART algorithm accounts for the fact that children are more likely to experience respiratory arrest before cardiac arrest. If an apneic child has a palpable pulse after the airway is opened, the rescuer should deliver five rescue breaths. If breathing resumes, the child is tagged RED (Immediate). This intervention is unique to the pediatric algorithm.
Question 4: You are the first nurse to arrive at a chaotic mass casualty incident. According to disaster management principles, what is your PRIMARY role during the initial response phase?
- Begin performing detailed head-to-toe assessments on the most injured victims.
- Establish a treatment area and begin providing advanced life support interventions.
- Provide emotional support and crisis intervention to the 'walking wounded'.
- Perform rapid triage to sort patients and do the greatest good for the greatest number of people. (Correct answer)
Correct answer: Perform rapid triage to sort patients and do the greatest good for the greatest number of people.
In a mass casualty incident, the primary goal shifts from doing everything possible for one patient to doing the greatest good for the greatest number of people. The first qualified provider on scene is responsible for rapidly triaging victims to identify who needs immediate transport and life-saving care, thereby maximizing survival for the entire group.
Question 5: Following a chemical spill at an industrial plant, numerous victims arrive at the hospital's emergency entrance via private vehicles. They are coughing and complaining of skin irritation. What is the absolute priority action the trauma nurse must ensure before these patients enter the treatment area?
- Administering oxygen via non-rebreather mask to all symptomatic patients.
- Establishing intravenous access for anticipated fluid and medication administration.
- Moving all patients to a designated decontamination zone for removal of clothing and showering. (Correct answer)
- Obtaining a detailed history of the specific chemical agent involved from each patient.
Correct answer: Moving all patients to a designated decontamination zone for removal of clothing and showering.
The highest priority is to prevent the spread of contamination to healthcare providers, other patients, and the facility itself. All patients exposed to a chemical agent must undergo thorough decontamination *before* entering the main treatment area. This involves removing all clothing and washing with copious amounts of water.
Question 6: A patient triaged with a YELLOW (Delayed) tag at a mass casualty incident would be best described as having which type of injuries?
- Life-threatening injuries that are readily correctable with immediate intervention.
- Minor injuries, such as abrasions and minor lacerations; they are considered the 'walking wounded'.
- Injuries that are so severe that survival is highly unlikely, even with maximal resources.
- Serious injuries that are not immediately life-threatening but require treatment. (Correct answer)
Correct answer: Serious injuries that are not immediately life-threatening but require treatment.
The YELLOW (Delayed) category is for patients who have serious injuries (e.g., long bone fractures, significant burns that do not compromise the airway) but are not in immediate danger of death. Their treatment can be delayed while RED (Immediate) patients are stabilized.
TNCC - Trauma Nurse Core Curriculum Disaster Management Questions and Answers 1
During a mass casualty incident caused by a bus rollover, you are triaging a 30-year-old male using the START algorithm.
The patient is unable to walk.
He is apneic.
You manually open his airway, and he begins to breathe at a rate of 22 breaths/min.
What is the next immediate action and corresponding triage category?