Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX F n Triage Scenarios
Triage Is Continuous
Triage should be continuous and repetitive at each
level or site where it is required. Constant vigilance and
reassessment will identify patients whose circumstances
have changed with alterations in either physiological
status or resource availability. As the mass-casualty
event continues to unfold, the need for retriage becomes
apparent. The physiology of injured patients is not
constant or predictable, especially considering the
limited rapid assessment required during triage. Some
patients will unexpectedly deteriorate and require an
“upgrade” in their triage category, perhaps from yellow
to red. In others, an open fracture may be discovered
after initial triage has been completed, mandating an
“upgrade” in triage category from green to yellow.
An important group that requires retriage is
the expectant category. Although an initial triage
categorization decision may label a patient as having
nonsurvivable injuries, this decision may change
after all red (or perhaps red and some yellow) patients
have been cared for or evacuated or if additional
resources become available. For example, a young
patient with 90% burns may survive if burn center care
becomes available.
Triage Scenario I
Mass Shooting at a Shopping Mall
SCENARIO
You are summoned to a safe triage area at a shopping mall where 6 people are injured in a mass shooting.
The shooter has killed himself. You quickly survey the situation and determine that the patients’ conditions
are as follows:
PATIENT A—A young male is screaming, “Please help me, my leg is killing me!”
PATIENT B—A young female has cyanosis and tachypnea and is breathing noisily.
PATIENT C—An older male is lying in a pool of blood with his left pant leg soaked in blood.
PATIENT D—A young male is lying facedown and not moving.
PATIENT E—A young male is swearing and shouting that someone should help him or he will call his lawyer.
PATIENT F—A teenage girl is lying on the ground crying and holding her abdomen.
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 is breathing noisily.
Possible Injury/Problem:
PATIENT C—is an older male lying in a pool of blood with his left pant leg soaked in blood.
Possible Injury/Problem:
PATIENT D—is lying facedown 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:
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