The first step in responding to an incident is recognizing the event is occurring and initiating the plans that were developed in the preparedness phase. External responses may include activities such as search-and-rescue operations, firefighting, and building shelters for displaced persons. Nurses need to have a good understanding of the disaster plan, as well as a concrete awareness of the events surrounding the incident, to provide the best care for their patients. As an example, during the 2016 Fort McMurray fire, surrounding hospitals were required to be prepared to care for high numbers of patients with burns and respiratory compromise. This included not only the citizens, but also firefighters and first responders.
Efficient internal facility responses to disasters include disaster triage and casualty distribution (Saunderson Cohen, 2013). Nursing during a disaster often focuses on providing care to an influx of patients to a care centre, and it requires an understanding that these patients may have varying degrees of illness and injury as well as emotional stress from the event. Disaster triage is the process of “doing the greatest good for the greatest number of casualties” and has been characterized as the “keystone to mass casualty management” (Saunderson Cohen, 2013, p. 26).
Treatment priorities may vary according to available supplies and resources, as well as the type of disaster (Stopford, 2007).
Various disaster triage systems have been designed for use in mass casualty incidents; therefore, it is important for facilities to determine in advance which system they will use. One method of disaster triage is the simple triage and rapid transport (START) tool. This system was developed in the 1980s in Orange County, California, and has been adopted throughout many countries (Saunderson Cohen, 2013, p. 27).
When the triage nurse is using the START tool, patients are rapidly assessed (less than one minute) and determined to be either red, yellow, green, or black.
Immediate care required. These patients are in a priority treatment category with illnesses or injuries that could result in loss of life or limb.
Urgent care required. This category of patient requires urgent treatment but can wait until the red-tagged patients have been stabilized.
Minimal care required. These patients require care but are deemed stable enough to wait several hours for treatment.
End-of-life care required. Black-tagged patients are deemed to be beyond the ability of the care team to provide lifesaving care. They are in a state of impending death or already lifeless.
Essential Learning Activity 13.4.1
Mass casualty incidents involving high numbers of pediatric patients use the JumpSTART system. Read about the process of triaging pediatric patients using the JumpSTART Pediatric Triage Algorithm from the US Department of Health and Human Services.