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
Triage is the process of quickly assessing and prioritizing patients based on the severity of their injuries or illnesses. The three-tiered system of triage typically includes:
- Immediate: Patients with life-threatening injuries or conditions that require immediate medical attention.
- Delayed: Patients with non-life-threatening injuries who can wait for treatment.
- Minor: Patients with minor injuries or illnesses that require minimal medical attention and can often be treated later.
In contrast, Mass Casualty Incident (MCI) triage philosophy is designed for situations where there are a large number of casualties and limited resources. It often employs a more simplified system, such as the “START” (Simple Triage and Rapid Treatment) system, which categorizes patients into:
- Immediate: Patients with life-threatening injuries who require immediate treatment and have a high chance of survival if treated promptly.
- Delayed: Patients with significant injuries that are not immediately life-threatening but may become so if not treated soon.
- Minimal: Patients with minor injuries or those who require minimal medical attention.
- Expectant: Patients with severe injuries that are unlikely to survive even with treatment. In MCI situations, these patients may not receive immediate care in order to prioritize resources for those with better chances of survival.
Now, let’s categorize the patients you mentioned using the MCI triage philosophy:
- 10-year-old boy with a massive head injury, no spontaneous breathing, BP 60 palp: This patient would be categorized as “Immediate.” His head injury is life-threatening, and he requires immediate attention to maintain airway, breathing, and circulation.
- 22-year-old female with a closed fracture of the left arm: This patient would typically be categorized as “Delayed.” While her injury is painful and needs treatment, it is not immediately life-threatening.
- 60-year-old male with a laceration in the leg complaining of shortness of breath: This patient would also be categorized as “Delayed.” The leg laceration, while requiring treatment, is not immediately life-threatening. However, the complaint of shortness of breath should be further assessed to ensure it’s not indicative of a more severe underlying condition.
- 15-year-old girl with glass embedded in the eyes: This patient would be categorized as “Immediate.” Eye injuries can be vision-threatening, and immediate attention is needed to assess and address the situation.
- 52-year-old male with a pulse of 30 and a blood pressure of 70/30: This patient would be categorized as “Immediate.” His extremely low pulse and blood pressure indicate a life-threatening condition, and he requires immediate intervention.
Regarding ethical issues, in an MCI situation, the primary ethical principle is to do the greatest good for the greatest number of people with the available resources. This means making difficult decisions about resource allocation and prioritizing patients based on their likelihood of survival. It may be ethically challenging to categorize patients as “Expectant” when their chances of survival are very low, but doing so is often necessary to allocate resources where they can have the most significant impact. Ethical considerations also include ensuring transparency in the triage process, minimizing bias, and providing the best possible care under challenging circumstances.