Disaster Management

Triage Scenario l
Gas Explosion in the Gymnasium
• You are summoned to a triage area at a constructon site where 5 w
orkers are injured in a gas explosion during the renovation of a gym
nasium ceiling. You quckly survey the situation and determine that t
he patients' conditions are as follows:
• PATIENT A - A young male is screaming. "Pease help me, my leg is ki
lling me!”
• PATIENT B - A young female has cyanosis and tachypnea and is breat
hing very noisily.
• PATIENT C - A A 50-year-old male is lying in a pool of blood with his
left trouser leg soaked in blood.
• PATIENT D - A young male is lying face down and not moving
• PATIENT E - A young male is swearing and shouting that someone sh
ould help him or he will call his lawyer.
 Questions for Response
1. For each patient, what is the primary problem requiring treatment?
• PATIENT A - is a young male screaming, "Please help me, my leg is killing me!”
Possible Injury/Problem :

• PATIENT B – appears to have cyanosis and tachypnea and breathing very noisyli.
Possible Injury/problem:

• PATIENT C - is a 50 year old male lying in a pool of blood with his left trouser leg s
oaked in blood.
Possible Injury/problem:

• PATIENT D – is lying face down and not moving.

Possible injury/Problem :

• PATIENT E - is swearing and shouting that someone should help him or he will call
his lawyer.
Possible injury/Problem:
2. Establish your patient priorities for further
evaluation by placing a number (1 through 5, with 1
being the highest priority and 5 being the lowest) in
the space next to each patient letter.

• .........................Patient A
• ……….................Patient B
• .........................Patient C
• ……….................Patient D
• .........................Patient E
3. Briefly outline your rationale for prioritizing th
ese patients in this manner.
• Priority 1- Patient.............
Rationale:

• Priority 2- Patient.............
Rationale:

• Priority 3- Patient.............
Rationale:

• Priority 4- Patient.............
Rationale:

• Priority 5- Patient.............
Rationale:
4. Briefly, describe the basic life support maneuvers or
additional assessment techniques you would use to
further evaluate the problem(s).

• Priority 1- Patient.............
Bassic life support maneuvers or additional assessment techniques:................

• Priority 2- Patient.............
Bassic life support maneuvers or additional assessment techniques:................

• Priority 3- Patient.............
Bassic life support maneuvers or additional assessment techniques:................

• Priority 4- Patient.............
Bassic life support maneuvers or additional assessment techniques:................

• Priority 5- Patient.............
Bassic life support maneuvers or additional assessment techniques:................
Characterize the patients according to who receives basic life
support(BLS) or advanced life support (ALS) care and describe
what that care would be. (Patients are listed in priority order
as identified in scenario I.)

PATIENT BLS ALS DESCRIPTION OF

CARE

E
Prioritize patient transfers and identify destinations.
Provide a brief rationale for your destina tion choice.

PRIORITY PATIENT DESTINATION RATIONALE

trauma center Nearest hospital

Trauma center Nearest hospital

Trauma center Nearest hospital

Trauma center Nearest hospital

Trauma center Nearest hospital

• In situations involving multiple patients, what criteria would you use to identify an
d prioritize the treatment of these patients?

• What cues can you elicit from any patient that could be of assistance in triage?

• Which patient injuries or symptoms should receive treatment at the scene before
prehospital personnel arrive?

• After prehospital personnel arrive, what treatment should be instituted, and wha
t principles govern the order of institation of such as treatment?

• In multiple patient situations, which patients should be transported? Which shoul

d be transported early?

• Which patients may have treatment delayed and be transported later?

 Triage scenarios II
Trailer Home Explosion and Fire
• An explosion and fire, due to a faulty gas line, has involved one trailer ho
me in a nearby trailer park. Because of the close proximity of the incident
to the hospital, the prehospital personnel transport the patients directly t
o the hospital without prior notification. the five patients. all members of
the same family, are immobilized on lang spine boards when they arrive a
t your small hospital emergency department. The injured patients are :

• PATIENT A - A 45-year-old male is coughing and expectorating carbonaceo

us material. Hairs on his face and head are singed. His voice is clear, and h
e reports pain in his hands, which have erythema and early blister formati
on. vital signs are blood pressure 120 mm Hg systolic; heart rate, 100 beat
s per minute, and respiratory rate, 10 breath per minute.

• PATIENTB-A 6 year-old female appears frightened and crying. She reports

pain from burns (erythema/blisters) over her back, buttocks, and both le
gs posteriorly. Vital signs are blood pressure, 110/70 mm Hg; heart rate, 1
00 beats per minute, and respiratory rate, 25 breaths per minute.
• PATIENT C - A 70 –year-old-male is coughing, wheezing, and expectorating carbo
naceous material, His voice is hoarse, and he reponds only to painful stimuli, Ther
e are erythema, blisters, and charred skin on the anterior chest and abdominal w
alls, and circumferential burrs of both thighs. Vital signs are blood pressure, 80/4
0 mm Hg, heart rate, 140 beats per minute, and respiratory rate, 35 breaths per
minute.

• PATIENT D - A 19-year-old female is obtunded but responds to pain when her righ
t humerus and leg are moved. There is no obvious deformity of the arm, and the t
high is swollen while in a traction splint.Vital signs are blood pressure, 140/90 mm
Hg, heart rate, 110 beats per minute, and respiratory rate, 32 breaths per minut
e.

• PATIENTE - A 45.year-old male is pale and reports pain in his pelvis.There is clinical
evidence of fracture with abdominal distention and tenderness to palpation. Ther
e is erythema and blistering of the anterior chest and abdominal walls and thighs.
He also has a laceration to the forehead. Vital signs are blood pressure, 130/90 m
m Hg; heart rate, 90 beats per minute, and respiratory rate, 25 breaths per minut
e.
• Management priorities in this scenario can be
based on information obtained by surveying
the injured patients at a distance. Although
there may be doubt as to which patient is
more severely injured, based on the avaiable
information, a decison must be made to
proceed with the best information available at
the time.
1. Identify which patients(s) has associated trauma
and/or inhalation injury in addition to bodysurface
burns.
 Patient A
 Patient B
 Patient C
 Patient D
 Patient E
2. Using the table provided below:

a. Establish priorities of care in your hospital emergency department

by placing a number (1 through 5, with 1 being the highest priorit
y and 5 being the lowest) in the space next to each patient letter i
n the column “Treatment Prority”
b. Identify which patient has associated trauma and/or an airway inj
ury and place a mark in the appropriate column under"Assocated”
c. Estimate the percent of body surface are (BSA) burn for each pati
ent and enter the percent for each a patient letter in the column”
% BSA”.
d. Identify which patient(s) should be transferred to a burn center a
nd/or a trauma center and place a mark in the appropriate column
under “Transfer”
e. Establish your priorities for transfer and enter the priority number
under “Transfer Priority”
PATIENT ASSOCIATED TREATME %BSA TRANSFER TRANSFE
NT R
PRIORITY PRIORITY
TRAUMA AIRWAY BURN TRAUMA
INJURY
TRIAGE SCENARIO III
Car Crash
• You are the only doctor available in a 100-bed
community emergency departement. One
nurse and nurse assistant are available to
assist you. Ten minutes ago you were notified
by radio that ambulances would be arriving
with patients from a single motor vehicle
crash. No further report is received. Two
ambulances arrive with five patients who
were occupants is an automobile traveling at
60 mph (96 kph) before it crashed.
The injured patients are :
• Patient A- A 45 year old male was the driver of the car. He
apparently was not wearing a seat belt. Upon impact, he
has thrown against the windshield. On admission, he is
notabily in severe respiratory distress. The prehospital
personnel provide the following information to you after
preliminary assessment: injuries include (1) severe
maxillofacial trauma with bleeding from the nose and
mouth, (2) an angulated deformity of the left forearm, and
(3) multiple abrasions over the anterior chest wall. The
vital signs are blood pressure, 150/80 mm Hg, heart rate,
120 beats per minute, respiratory rate, 40 breaths per
minute, and Glasgow Coma Scale(GCS) score, 8.
• PATIENT B-A 38-year-old female passenger was
apparently thrown from the front seat and found
30 feet (9 meters) from the car. On admission
she is awake, alert, and reports abdominal and
chest pain The report you are given indicates
that, on palpating her hips. she reports pain,
and fracture- related crepitus is felt. The vtal
signs are blood pressure, 110/90 mm Hg, heart
rate, 140 beats per minute, and respiratory rate,
25 breaths per minute.
• PATIENT C-A 48-year-old male passenger was
found under the car. You are told that on
admission he was confused and responded slowly
to verbal stimuli. lnjuries include multiple
abrasions to his face, chest, and abdomen.
Breath sounds are absent on the lett, and his
abdomen is tender to palpation. The vital signs
are blood pressure, 90/50 mm Hg, heart rate
140 beats per minute. respiratory 35 breaths per
minute, and GCS score, 10
• PATIENT D- A 25-year-old female was extricated
from the back seat of the vehicle. she is 8
months to pregnant, behaving hysterically, and
reporting abdominal pain. Injuries include
multiple abrasions to her face and anterior
abdominal wall. You are told that her abdomen
tender to palpation. She in active labor. The vital
signs are blood pressure, 120/80 mmHg heart
rate, 100 beats per minutes. and respiratory
rate, 25 breaths per minute .
• PATIENTE-A 6-year-old male was extricated
from the floor of the rear seat. At the scene he
was alert and talking. He now responds to
painful stimuli only by crying out. Injures
include multiple abrasions and an angulated
deformity of the right lower leg. There is dried
blood around his nose and mouth. The vital
signs are blood pressure, 110/70 mm Hg,
heart rate. 180 beats per minute, 35 breaths
per minute.
Questions and Response Key for
Students' Response
• Outline the steps you would take to triage
these five patients.
• Establish your patient priorities by placing a
number(1 through 5, with 1 being the highest
a Priority and 5 being the lo in the space next
to each lettered patient. Then, in the space
provided, briefly outline your rationale for
prioritizing these patients in this manner.
 Triage Scenario IV
Train Crash Disaster
• Two trains collide head-on at 1800 hours. one
train is a commercial tanker carrying eight
tanker cars and is driven by an engineer and
fireman. No other personnel are board The
tanks are filled with a highly flammable liquid.
the other train is a passenger train traveling
on the same track. weather conditions are
mild, and the ambient temperature is 20 ˚C
(72 P).
 Upon arrival at the scene, EMTs and
paramedics find :
• DECEASED-Two engineers and one fireman
Five passengers, including one infant with a fatal head injury

• INJURED-The fireman from the commercial train, ejected 30 feet,

with 40% BSA second- and third- degree burns.
Forty-seven passengers from the passenger train:
– 12 category Red patients, 8 with extensive(20-50% BSA) second- and
third-degree burn.
– 8 category Yellow patients, 3 with focal (<10% BSA) second-degree
burns.
– 22 category Green patients, 10 with painful hand and forearm
deformities.
– 5 category Blue patients, 3 with catastrophic (>75% BSA) second- and
third-degree burns.
• Two fire companies and two additional
ambulances have been called. The local
community hospital has 26 beds, 5 primary
care providers, and 2 surgeons, 1 of whom is
on vacation. The nearest trauma center is 75
miles(120 kilometers) away, and the nearest
designated burn center is over 200 miles(320
kilometers) away.
1. Should community disaster plans be invoked?
Why, or why not?
2. If a mass casualty event is declared, who
should be the medical incident commander?
3. What is the first concideration of the medical
incident commander at the scene?
4. What considerations should be taken into
account in medical operations at the scene?
5. What is the second consideration of the medical
incident commander at the scene?
6. What is the meaning of the red, yellow, green,
blue, and black triage categories?
7. Given the categories in Question 6, which
patients should be evacuated to the hospital, by
what transport methods, and in what order?
8. What efforts should be taken by the medical
incident commander to assist with response and
recovery?
 TRIAGE SCENARIO V
SUICIDAL BOMB BLAST AT A POLITICAL
RALLY
A suicidal bomb blast has been reported at an
evening political rally. The area is 30 minutes
away from your level II trauma center. You are
summoned to the scene as one of the triage
officers. Initial report reveals 12 mortalities
and 40 injured. Many rescue teams are busy in
evacuation.
You arrive at an area where you find 3 dead
bodies and 6 injured patients.
The condition of the 6 injured patients
is as follows:
• Patient A- A young male, concious and alert, has a
small penetrating wound in the lower neck just to the
left side of the trachea, with mild neck swelling, hoarse
voice, no active bleeding.
• Patient B- A young male is soaked in blood, pale and
lethargic, yet responding to verbal commands. Both leg
are deformed and attached only by thin muscular
tissue and skin below the knees bilaterally.
• Patient C – A young male is complaining of
breathlessness, with tachypnea, cyanosis, and multiple,
small, penetrating wounds to the left side of her chest.
• Patient D – A middle aged male has multiple
penetrating wounds to the left side of the abdomen
and left flank, pale looking and complaining of severe
abdominal pain. Second- and third-degree burns visible
over the lower abdomen.
• Patient E – An elderly male, breathless and coughing
up bloodstained sputum, is disorientated and has
multiple bruises and lacerations over his upper torso.
• Patient F- A young male, has a large wound on the
anterior aspect of the right lower leg with visible bone
ends projecting from wound, and is complaining of
severe pain. There is no active bleeding.
 Question of response
• Based on the information, describe the
potential A, B, C problems for each patient :
• What initial life support maneuvers can be
offered before transport to a trauma center
(assuming that typical pre-hospital eqiupment
is available at this time)?
• What other considerations do you keep in
mind during triage at the scene of this
incident?
• Describe the transfer to trauma center of each
patient in order of priority with your rationale
(1 being the highest and 6 being the lowest)
• What should be your main management
considerations upon arrival of the patients at
the trauma center?
Thanks