Triage Systems Used in Mass Casualty Incidents

Triage is the process of rapidly sorting patients according to urgency, severity, available resources, and the likelihood that treatment will improve outcomes. In mass casualty incidents, triage becomes especially important because the number of injured or critically ill patients may exceed the ability of the healthcare system to respond normally.

For respiratory therapists, triage is closely connected to airway management, oxygenation, ventilation, disaster response, and ventilator allocation.

When resources are limited, triage helps clinicians decide which patients need immediate care, which can wait, and which may not survive despite aggressive treatment.

What Is Triage?

Triage is a structured method of assigning patients to categories so that care can be delivered in an organized and clinically appropriate way. The word comes from the French verb trier, which means to separate, sift, or select. In healthcare, triage is used when clinicians must decide how to prioritize care among multiple patients.

In routine clinical practice, triage may occur in the emergency department, during rapid response calls, in telehealth monitoring, or in the ICU. During a disaster, triage becomes even more critical because patients may arrive in large numbers over a short period of time. Some patients may have minor injuries, while others may have airway obstruction, respiratory failure, shock, burns, trauma, altered mental status, chemical exposure, or life-threatening bleeding.

The purpose of triage is not to decide whose life is more valuable. All patients have equal human worth. Instead, triage helps healthcare workers make practical and ethical decisions when time, staff, space, equipment, ventilators, oxygen, medications, and monitoring resources are limited. It is based on urgency, survivability, and the best use of available resources.

In respiratory care, triage is especially important because airway and breathing problems can become fatal within minutes. A patient with severe respiratory distress, apnea, airway obstruction, or profound hypoxemia may need immediate intervention. A patient with minor injuries who can walk and speak may safely wait. Triage allows the respiratory therapist and other responders to focus first on patients with the greatest immediate need and the greatest chance of benefit.

Why Triage Matters in Mass Casualty Incidents

A mass casualty incident is any event that overwhelms the normal capacity of the healthcare system. These events may include natural disasters, terrorist attacks, explosions, chemical exposures, biological outbreaks, radiologic events, pandemics, fires, floods, earthquakes, and large transportation accidents.

In a mass casualty incident, the usual healthcare model may not work. Under normal conditions, a patient who needs a ventilator usually receives one if the equipment and staff are available. During a major disaster or pandemic, there may be more patients needing ventilatory support than there are ventilators, ICU beds, oxygen sources, circuits, humidification systems, medications, and trained clinicians.

This is why triage is part of disaster planning. It helps hospitals and respiratory care departments prepare for a sudden surge of critically ill or injured patients. A respiratory care department must think ahead about how many patients may need oxygen therapy, airway management, suctioning, bronchodilator therapy, noninvasive ventilation, invasive mechanical ventilation, and monitoring. The department must also consider staffing, call-back procedures, backup gas sources, additional ventilators, disposable supplies, and how nonrespiratory personnel may be used during a crisis.

Mass casualty incidents often create respiratory problems. Blast injuries may cause pulmonary contusion, pneumothorax, airway injury, acute lung injury, or acute respiratory distress syndrome. Chemical exposures may damage the airway and lungs or interfere with normal neuromuscular function. Nerve agents can cause seizures, paralysis, apnea, and respiratory failure. Biological events may cause pneumonia, sepsis, respiratory failure, and ARDS. Radiologic or nuclear events may involve burns, blast trauma, inhalation injury, shock, and contamination.

Because respiratory failure is common in many disaster scenarios, triage is highly relevant to respiratory therapists. RTs may be involved in initial assessment, airway support, oxygenation, ventilation, decontamination support, infection control, equipment allocation, and continued monitoring.

The Ethical Basis of Triage

Triage is both clinical and ethical. Clinically, it is based on the patient’s condition and the urgency of treatment. Ethically, it must be fair, objective, and focused on patient need rather than personal bias.

A key principle is that triage does not assign value to people. It assigns priority to medical needs under limited conditions. For example, if a respiratory therapist is needed in two places at the same time, both patients have equal worth. However, the therapist may need to decide which patient requires immediate intervention first. A patient in severe respiratory distress or cardiac arrest may require immediate attention, while a stable patient receiving routine therapy may safely wait.

Triage decisions often involve a balance between duty and outcomes. Clinicians have a duty to care for patients, but in a disaster they must also consider how to use limited resources to save the greatest number of lives. This is why triage systems use objective findings such as respiratory status, perfusion, mental status, organ failure, and likelihood of survival.

During extreme resource shortages, crisis standards of care may be used. This means the goal shifts from providing the usual level of care to each individual patient toward providing the greatest possible benefit to the largest number of patients. This does not mean patients are abandoned. Even patients who are unlikely to survive should receive comfort measures, pain relief, dignity, and appropriate supportive care.

Disaster Triage Categories

Many disaster triage systems use color-coded categories to identify patient priority. The four major categories are green, yellow, red, and black.

Green: Minor

Green patients have minor injuries and can usually wait for treatment. They are often called the “walking wounded” because they can move on their own and may be able to follow instructions. These patients may have minor cuts, sprains, mild symptoms, or injuries that are not immediately life-threatening.

In a disaster, green patients may be directed to a waiting area, outpatient treatment area, or discharge area after appropriate screening. They should not take priority over patients with airway, breathing, or circulation compromise.

For exam purposes, a patient who is able to walk, talk, follow commands, and has only minor injuries is usually placed in the green category.

Yellow: Delayed

Yellow patients have serious injuries or illnesses, but their condition is not expected to deteriorate significantly within the next few hours. They need medical care, but they can wait while red patients are treated first.

Examples may include stable fractures, moderate injuries, controlled bleeding, or respiratory symptoms that are concerning but not immediately life-threatening. These patients should be monitored because their status can change. A yellow patient may become red if respiratory distress worsens, perfusion declines, or mental status changes.

For respiratory therapists, yellow patients may include those who need oxygen therapy, bronchodilator treatment, or further assessment but do not show severe hypoxemia, apnea, shock, or airway compromise.

Red: Immediate

Red patients have life-threatening but potentially treatable conditions that require rapid medical attention. This group has the highest treatment priority.

The most important clue is compromise of the airway, breathing, or circulation. A patient with airway obstruction, severe respiratory distress, apnea, severe hypoxemia, shock, uncontrolled bleeding, altered mental status from hypoxia, or signs of impending respiratory failure should be considered red.

For respiratory therapists, the red category is especially important. These patients may require airway opening, suctioning, oxygen therapy, bag-mask ventilation, noninvasive ventilation, intubation, mechanical ventilation, chest decompression, or rapid transport to a higher level of care.

A red patient is not simply “very sick.” The injury or illness must be serious, time-sensitive, and potentially survivable with immediate intervention.

Black: Expectant or Deceased

Black patients are either deceased or unlikely to survive under the available conditions. This category may include patients with injuries incompatible with life, absent respirations after airway repositioning, devastating trauma, or severe illness with extremely poor survival probability during a resource-limited event.

The black category can be difficult emotionally and ethically. It does not mean that care is withheld completely. Patients who are expectant should receive comfort care, pain relief, and dignity when possible. Deceased patients may be moved to the morgue or a designated area according to the disaster plan.

In extreme surge conditions, some patients who might receive aggressive treatment during normal conditions may be classified as expectant because the resources required are unavailable or because the likelihood of survival is extremely low.

START Triage

START stands for Simple Triage and Rapid Treatment. It is one of the most widely used prehospital triage systems for mass casualty incidents. It was designed to be simple enough for first responders to apply quickly in the field.

START uses three major physiologic parameters: respiration, perfusion, and mental status. These are often remembered as RPM.

Respiration refers to whether the patient is breathing and whether the respiratory rate is adequate. If the patient is not breathing, the airway may be opened. If breathing does not resume, the patient may be classified as deceased or expectant. If respirations are present but severely abnormal, the patient may be classified as immediate.

Perfusion refers to circulation. This may be assessed by capillary refill or radial pulse, depending on the version of the system being used. Poor perfusion suggests shock or severe circulatory compromise and may place the patient in the red category.

Mental status refers to the patient’s ability to follow commands. A patient who cannot follow simple commands may have severe neurologic impairment, shock, hypoxia, head injury, intoxication, or other serious problems. In START, inability to follow commands suggests a higher triage priority.

START is useful because it is fast and does not require complex equipment. It helps responders identify patients who can walk, patients who need immediate treatment, patients whose care can be delayed, and patients who are deceased or expectant.

However, START is not perfect. It simplifies decision-making during chaotic events, but triage categories may change as patients deteriorate or improve. Ongoing reassessment remains essential.

JumpSTART Triage

JumpSTART is the pediatric version of START. It is designed for children because pediatric patients differ from adults in respiratory rate, physiology, airway size, compensatory ability, and response to illness or injury.

Children may experience respiratory failure more quickly than adults because they have smaller airways, higher oxygen consumption, and less physiologic reserve. A child may also have difficulty following commands due to age, fear, developmental level, or injury. JumpSTART adjusts triage decision-making to account for these differences.

For respiratory therapists, pediatric triage is especially important because children may require airway positioning, ventilation support, oxygen therapy, and close monitoring. A child who is apneic, has poor perfusion, or has altered mental status requires rapid evaluation.

Note: JumpSTART helps prevent children from being undertriaged or overtriaged by applying a system that is more appropriate for pediatric physiology.

SALT Triage

SALT stands for Sort, Assess, Life-saving interventions, Treatment/Transport. It is another field triage system used during mass casualty incidents.

SALT differs from START because it includes life-saving interventions as part of the triage process. These interventions may include controlling major hemorrhage, opening the airway, chest decompression, and giving auto-injector antidotes when appropriate.

This feature is important because some immediate actions can change the patient’s outcome before full treatment is available. For example, opening the airway may restore breathing. Chest decompression may relieve a tension pneumothorax and improve ventilation and circulation. Control of major bleeding may prevent death from hemorrhagic shock. Auto-injector antidotes may be lifesaving during nerve agent exposure.

In respiratory care, SALT is especially relevant because airway opening and chest decompression are directly related to oxygenation and ventilation. A patient who cannot breathe due to airway obstruction may die quickly without intervention. A patient with tension pneumothorax may develop severe respiratory distress, hypotension, and obstructive shock. SALT recognizes that certain immediate interventions should not be delayed until later transport or hospital care.

Note: SALT also emphasizes sorting patients first, then assessing them individually. This helps responders organize the scene before moving into more detailed evaluation and treatment.

SOFA and Hospital-Based Triage

SOFA stands for Sequential Organ Failure Assessment. Unlike START, JumpSTART, and SALT, which are mainly used in the field, SOFA is used for hospitalized critically ill patients. It helps evaluate the function of major organ systems and may be used to estimate prognosis.

SOFA is relevant during pandemics and large-scale disasters because many patients may require ICU care at the same time. When ICU beds, ventilators, medications, and staff are limited, hospitals may need an objective way to prioritize critical care resources.

SOFA evaluates organ dysfunction and can help predict outcomes in critically ill patients. It may be especially useful in patients with sepsis, shock, hypoperfusion, or multiple-organ failure. A high SOFA score suggests more severe organ dysfunction and a higher risk of death.

In extreme surge conditions, SOFA may be used as part of exclusion criteria for critical care. For example, a score suggesting a very high mortality risk may indicate that the patient is unlikely to benefit from scarce ICU resources. This is difficult, but it may become necessary when the demand for ventilators and ICU care exceeds supply.

For respiratory therapists, SOFA connects directly to ventilator allocation. A patient may need mechanical ventilation, but if the patient also has severe multi-organ failure and a very low chance of survival, the care team may need to consider whether the ventilator should be allocated to another patient with a better chance of recovery.

Note: SOFA should not be used as the only factor in decision-making. It is one tool within a larger clinical and ethical process. Patient reassessment, institutional policy, disaster protocols, and multidisciplinary review are also important.

Ventilator Allocation During Disasters

Ventilator allocation is one of the most challenging parts of disaster triage. Mechanical ventilators are limited resources. They also require trained staff, oxygen supply, circuits, filters, humidification, alarms, monitoring, suction, medications, and ongoing assessment.

During a severe pandemic or mass casualty incident, the number of patients needing mechanical ventilation may be much greater than the number of ventilators available. This creates a crisis in which usual standards of care may not be possible.

Ventilator triage is not just about asking, “Who needs a ventilator?” Many patients may need one. The harder question is, “Who is most likely to benefit from a ventilator when there are not enough for everyone?”

Exclusion criteria may be developed to guide these decisions. These criteria should be objective and based on clinical conditions rather than judgments about a person’s social worth, disability, or quality of life. Examples may include severe irreversible organ failure, metastatic malignancy, unresponsive cardiac arrest, severe burns with very low survival probability, devastating neurologic injury, or end-stage disease.

During extreme conditions, patients may also need to be reassessed after ventilator support is started. If a patient continues to deteriorate despite treatment and another patient has a better chance of survival, policies may allow reallocation of ventilatory support. These decisions are ethically difficult and should follow institutional protocols, crisis standards of care, and multidisciplinary review whenever possible.

Note: Respiratory therapists may play an important role in ventilator triage by providing accurate assessment data, monitoring patient response, managing ventilator settings, identifying equipment needs, and communicating changes in patient status.

Triage in Chemical, Biological, Radiological, and Nuclear Events

Triage changes when a disaster involves chemical, biological, radiological, or nuclear exposure. These events are often grouped under the abbreviation CBRN.

In CBRN events, contaminated patients can create danger for healthcare workers, other patients, and the hospital itself. For that reason, triage may need to occur outside the healthcare facility. Decontamination may be required before patients enter the treatment area.

The basic sequence is triage, decontaminate if needed, and then treat according to priority. This helps prevent the hospital from becoming contaminated and protects staff from exposure.

In chemical events, respiratory therapists may encounter patients with airway irritation, bronchospasm, pulmonary edema, respiratory failure, chemical burns, or apnea. Chlorine gas, for example, can cause airway and lung injury. Nerve agents can cause excessive secretions, bronchoconstriction, paralysis, seizures, and apnea. These patients may require airway support, suctioning, oxygen therapy, ventilation, and antidote therapy.

In biological events, patients may present with infectious respiratory disease, pneumonia, sepsis, ARDS, or ventilatory failure. Triage must include infection control, isolation, PPE use, and decisions about which patients need hospitalization or ventilatory support.

In radiologic or nuclear events, patients may have trauma, burns, inhalation injury, radiation sickness, shock, or contamination. Triage must include both medical urgency and contamination control.

Note: Respiratory therapists must understand the importance of PPE, isolation, decontamination zones, and respiratory protection. Entering a contaminated area without proper protection can place the therapist at risk and reduce the healthcare team’s ability to respond.

Disaster Response Zones

Disaster scenes may be divided into zones based on contamination risk. These zones help organize triage, decontamination, and treatment.

The hot zone is the area with the highest risk of contamination. This is often where initial triage occurs. Personnel in this area may need high-level respiratory protection, such as a self-contained breathing apparatus, depending on the hazard.

The warm zone is where decontamination usually occurs. Patients move from the hot zone into the warm zone so contaminants can be removed before they enter the treatment area. Personnel may use powered air-purifying respirators or other protective equipment depending on the event.

The cold zone is the treatment area after decontamination. Standard PPE may be sufficient in this zone, depending on the situation. Patients are treated and transported according to triage priority.

Note: For exam purposes, the sequence is important: initial triage, decontamination if required, and treatment or transport based on priority.

The Respiratory Therapist’s Role in Triage

Respiratory therapists are essential members of the disaster response team because many mass casualty patients have airway, breathing, or oxygenation problems.

The RT may help assess respiratory rate, work of breathing, breath sounds, oxygen saturation, mental status, airway patency, chest movement, and signs of shock. The therapist may identify patients who need oxygen, suctioning, airway positioning, bag-mask ventilation, intubation, noninvasive ventilation, mechanical ventilation, or chest decompression.

In the emergency department or ICU, the RT may help manage ventilator setup, patient-ventilator monitoring, oxygen delivery devices, aerosol therapy, airway clearance, arterial blood gas sampling, transport ventilation, and infection control procedures.

RTs may also assist with planning before a disaster occurs. This may include checking ventilator inventory, identifying backup oxygen sources, preparing emergency equipment, reviewing call-back procedures, training staff, and participating in disaster drills.

During a surge, the RT must think beyond one patient at a time. Equipment may need to be prioritized. Oxygen supplies may need to be conserved. Ventilator circuits, masks, filters, humidifiers, suction devices, and medication delivery systems may become limited. The therapist must work with the healthcare team to provide the safest care possible under the circumstances.

Triage and Telehealth

Triage is not limited to disaster scenes and emergency departments. It can also occur through telehealth and remote monitoring.

In respiratory care, telehealth may be used for patients with COPD, asthma, neuromuscular disease, home oxygen therapy, or home mechanical ventilation. Through remote monitoring, clinicians may review symptoms, oxygen saturation, respiratory rate, ventilator data, pulmonary function measurements, and visual assessment.

Telehealth triage helps determine whether a patient can remain at home, needs medication adjustment, requires an office visit, should go to urgent care, or must be sent to the emergency department. This can be especially helpful for patients who live far from care, have limited mobility, or depend on home ventilatory support.

Remote triage is still based on urgency, severity, and likely benefit. A patient with mild symptoms may be managed at home with follow-up. A patient with worsening dyspnea, falling oxygen saturation, confusion, chest pain, or signs of respiratory failure needs immediate in-person care.

Triage and Neurologic Assessment

Triage may also involve neurologic assessment. The Glasgow Coma Scale, or GCS, is commonly used to evaluate eye opening, verbal response, and motor response. Scores range from 3 to 15.

A patient with a low GCS may be unable to protect the airway. This creates a respiratory concern because loss of airway protection can lead to aspiration, hypoventilation, obstruction, and respiratory failure.

Patients with a GCS of 8 or less often require close monitoring and may need intubation and mechanical ventilation. Patients with higher scores may still need observation, especially if there are other signs of deterioration.

For respiratory therapists, neurologic triage is important because mental status is closely connected to airway protection and ventilatory drive. A patient who becomes increasingly confused, unresponsive, or unable to follow commands may need urgent airway and ventilatory support.

Triage in Acute Heart Failure

Triage is also important in acute heart failure. Patients with acute heart failure may deteriorate quickly during the first hours after arrival in the emergency department. Early diagnosis, triage, and treatment can reduce complications and improve outcomes.

The triage process involves identifying the severity of illness, oxygenation status, perfusion, blood pressure, mental status, urine output, signs of pulmonary congestion, and possible precipitating causes. Some patients may have acute coronary syndrome, pulmonary embolism, cardiac tamponade, arrhythmias, hypertensive crisis, cardiogenic shock, or severe hypoperfusion.

Respiratory therapists may be involved in oxygen therapy, noninvasive ventilation, mechanical ventilation, ABG analysis, monitoring, and assessment of respiratory distress. A patient with severe pulmonary edema, hypoxemia, altered mental status, or fatigue may need immediate ventilatory support.

In this setting, triage helps determine whether the patient needs routine treatment, close monitoring, ICU admission, noninvasive ventilation, intubation, vasopressor support, or urgent cardiac evaluation.

Key Exam Points About Triage

For board exam preparation, the most important triage concept is that patients are prioritized based on urgency, severity, and available resources.

A patient with airway, breathing, or circulation compromise is usually red/immediate. A patient who can walk and has minor injuries is usually green/minor. A patient with serious but stable injuries is yellow/delayed. A patient who is deceased or unlikely to survive under available conditions is black/expectant.

START uses respiration, perfusion, and mental status. JumpSTART is the pediatric version of START. SALT includes life-saving interventions such as hemorrhage control, airway opening, chest decompression, and auto-injector antidotes. SOFA is used in hospitalized critically ill patients to assess organ dysfunction and estimate prognosis.

In CBRN events, triage may occur outside the facility, and decontamination must occur before treatment inside the hospital. The hot zone is the contaminated area, the warm zone is the decontamination area, and the cold zone is the treatment area.

Note: For respiratory care, always focus on airway, breathing, oxygenation, ventilation, perfusion, mental status, and the availability of ventilators and trained personnel.

Triage Practice Questions

1. What is triage?
Triage is the process of rapidly sorting patients into priority categories based on urgency, severity, available resources, and the likelihood that treatment will improve outcomes.

2. Why is triage important during a mass casualty incident?
Triage is important because many patients may need care at the same time, while staff, equipment, ventilators, oxygen, ICU beds, and supplies may be limited.

3. What does the word triage come from?
The word triage comes from the French verb trier, which means to separate, sift, or select.

4. What is the main purpose of triage in disaster management?
The main purpose is to prioritize patient care so that limited resources are used where they are most likely to save lives.

5. Why is triage especially important for respiratory therapists?
It is important because respiratory therapists often manage airway, breathing, oxygenation, ventilation, and ventilator needs during emergencies and disasters.

6. What type of patient is usually assigned to the green triage category?
A green patient has minor injuries, can usually walk, and can safely wait for treatment.

7. What are green patients often called in disaster triage?
Green patients are often called the walking wounded.

8. What type of patient is usually assigned to the yellow triage category?
A yellow patient has serious injuries or illness but is stable enough that treatment can be delayed for a limited time.

9. What type of patient is usually assigned to the red triage category?
A red patient has a life-threatening but treatable condition that requires immediate medical attention.

10. What is the most important respiratory clue for a red triage category?
Airway compromise, severe respiratory distress, apnea, severe hypoxemia, or signs of impending respiratory failure suggest a red category.

11. What type of patient is usually assigned to the black triage category?
A black patient is deceased or unlikely to survive despite aggressive treatment under the available conditions.

12. Should expectant patients still receive care?
Yes. Expectant patients should receive comfort care, pain relief, dignity, and appropriate supportive measures when possible.

13. What does START stand for?
START stands for Simple Triage and Rapid Treatment.

14. What are the three physiologic parameters used in START?
START uses respiration, perfusion, and mental status.

15. What acronym is often used to remember the START parameters?
RPM is used to remember respiration, perfusion, and mental status.

16. What is the pediatric version of START called?
The pediatric version of START is called JumpSTART.

17. Why is JumpSTART used for children instead of regular START?
JumpSTART is used because children have different respiratory rates, airway characteristics, physiologic reserves, and responses to injury or illness.

18. What does SALT stand for?
SALT stands for Sort, Assess, Life-saving interventions, Treatment/Transport.

19. What makes SALT different from START?
SALT includes immediate life-saving interventions as part of the triage process.

20. Which triage system includes life-saving interventions such as airway opening and chest decompression?
SALT includes life-saving interventions such as airway opening, hemorrhage control, chest decompression, and auto-injector antidotes.

21. Why is airway opening important in SALT triage?
Airway opening is important because airway obstruction can quickly lead to hypoxia, respiratory arrest, and death.

22. Why might chest decompression be included as a life-saving intervention during triage?
Chest decompression may be needed for tension pneumothorax, which can impair ventilation and circulation.

23. What does SOFA stand for?
SOFA stands for Sequential Organ Failure Assessment.

24. Where is SOFA most commonly used?
SOFA is most commonly used in hospitalized critically ill patients, especially in ICU or crisis-resource settings.

25. What does the SOFA score help evaluate?
SOFA helps evaluate major organ dysfunction and can help estimate prognosis in critically ill patients.

26. Why may ventilator triage become necessary during a severe pandemic?
Ventilator triage may become necessary because the number of patients with respiratory failure may exceed the available supply of ventilators, ICU beds, oxygen, and trained staff.

27. What is a mass casualty incident?
A mass casualty incident is an event that overwhelms the normal capacity of the healthcare system to care for all patients using routine resources.

28. What types of disasters may require triage?
Triage may be required during pandemics, explosions, chemical exposures, biological events, radiologic events, nuclear events, natural disasters, and terrorist attacks.

29. What is the main goal of modern disaster triage?
The main goal is to prioritize patients who are most likely to survive if they receive prompt treatment.

30. How did older military triage differ from modern triage?
Older military triage often prioritized less wounded soldiers who could return to battle, while modern triage prioritizes severely ill or injured patients who are most likely to benefit from immediate care.

31. Why is triage not considered “first come, first served”?
Triage is not first come, first served because patients are prioritized based on urgency, severity, survivability, and available resources.

32. What does ABC compromise mean in triage?
ABC compromise refers to problems with airway, breathing, or circulation that may require immediate intervention.

33. Which triage category is most appropriate for a patient with airway obstruction?
A patient with airway obstruction should usually be placed in the red/immediate category.

34. Which triage category is most appropriate for a patient with minor injuries who can walk?
A patient with minor injuries who can walk should usually be placed in the green/minor category.

35. Which triage category is most appropriate for a stable patient with serious injuries that can wait?
A stable patient with serious injuries that can wait should usually be placed in the yellow/delayed category.

36. Which triage category is most appropriate for a deceased patient?
A deceased patient should be placed in the black/expectant category.

37. What is the role of reassessment in triage?
Reassessment is important because a patient’s condition may improve or deteriorate, requiring a change in triage priority.

38. Why are objective criteria important in triage?
Objective criteria help make triage decisions more consistent, fair, and based on clinical findings rather than personal bias.

39. What does CBRN stand for?
CBRN stands for chemical, biological, radiological, and nuclear.

40. Why may triage occur outside the hospital during a CBRN event?
Triage may occur outside the hospital to prevent contaminated patients from bringing hazardous substances into the facility.

41. What should happen before contaminated patients enter the treatment area?
Contaminated patients should be decontaminated before entering the treatment area.

42. What is the correct sequence for managing patients in a CBRN event?
The correct sequence is triage first, decontaminate if needed, and then treat according to priority.

43. What is the hot zone in disaster response?
The hot zone is the contaminated or highest-risk area where initial triage may occur.

44. What type of respiratory protection may be needed in the hot zone?
A self-contained breathing apparatus may be needed in the hot zone when there is high risk of hazardous contamination.

45. What is the warm zone in disaster response?
The warm zone is the area where decontamination is performed.

46. What is the cold zone in disaster response?
The cold zone is the treatment area after decontamination, where standard PPE may be sufficient depending on the situation.

47. Why are respiratory therapists important during chemical disasters?
Respiratory therapists are important because chemical exposures can cause airway injury, bronchospasm, apnea, pulmonary edema, and respiratory failure.

48. How can nerve agents affect breathing?
Nerve agents can cause seizures, loss of consciousness, flaccid paralysis, apnea, excessive secretions, and respiratory failure.

49. Why can blast injuries create a need for mechanical ventilation?
Blast injuries can cause lung injury, pneumothorax, pulmonary contusion, acute lung injury, or ARDS, which may require ventilatory support.

50. What is surge capacity?
Surge capacity is the ability of a hospital or healthcare system to expand resources and care for a sudden increase in critically ill or injured patients.

51. Why must respiratory care departments plan for disasters?
Respiratory care departments must plan because disasters can create a sudden increase in patients needing oxygen therapy, suction, airway support, and mechanical ventilation.

52. What resources may become limited during a mass casualty incident?
Ventilators, ICU beds, oxygen supplies, suction equipment, medications, circuits, humidification devices, monitoring equipment, and trained personnel may become limited.

53. Why is ventilator allocation difficult during a disaster?
Ventilator allocation is difficult because many patients may need mechanical ventilation at the same time, but there may not be enough ventilators or trained staff for everyone.

54. What is the Strategic National Stockpile?
The Strategic National Stockpile is a national reserve of medical supplies and equipment intended to support emergency response during large-scale disasters.

55. Why might the Strategic National Stockpile be insufficient during a severe pandemic?
It may be insufficient because the projected number of patients needing mechanical ventilation could greatly exceed the number of ventilators available.

56. What does ventilator triage focus on?
Ventilator triage focuses on determining which patients are most likely to benefit from mechanical ventilation when ventilators are scarce.

57. Why should ventilator exclusion criteria be objective?
Exclusion criteria should be objective so decisions are based on clinical conditions and likelihood of survival rather than personal bias or social worth.

58. What is one example of a condition that may be used as an exclusion criterion during ventilator triage?
Severe irreversible organ failure may be used as an exclusion criterion when resources are extremely limited.

59. Why may metastatic malignancy affect ventilator allocation during a crisis?
Metastatic malignancy may indicate a poor prognosis, which may reduce the likelihood that scarce ventilator support will result in survival.

60. How may severe burns affect triage priority during a mass casualty incident?
Severe burns with a very low probability of survival may place a patient in an expectant category during extreme resource shortages.

61. Why might an unresponsive cardiac arrest be excluded from critical care during a crisis?
An unresponsive cardiac arrest may have a very low chance of survival, especially when critical care resources are severely limited.

62. What is meant by crisis standards of care?
Crisis standards of care are altered care standards used during extreme emergencies when resources are insufficient to provide usual care to every patient.

63. What is the main goal of crisis standards of care?
The main goal is to provide the greatest possible benefit to the greatest number of patients with the resources available.

64. How does triage relate to ethics?
Triage relates to ethics because it requires fair, consistent decisions about patient priority when not everyone can receive immediate care.

65. Why does triage not measure a patient’s personal worth?
Triage does not measure personal worth because all patients have equal human value; it only assigns care priority based on medical urgency and likely benefit.

66. What is the role of clinical judgment in triage?
Clinical judgment is needed to apply triage systems correctly, recognize changes in patient condition, and make decisions when the situation does not fit neatly into an algorithm.

67. Why are triage algorithms useful during chaotic events?
Triage algorithms provide a structured method for making rapid decisions when many patients need help at the same time.

68. Why are triage algorithms not perfect?
They are not perfect because patient conditions can change, disaster scenes are complex, and simplified systems may not capture every clinical detail.

69. What is the respiratory therapist’s role in initial disaster assessment?
The respiratory therapist may assess airway patency, breathing pattern, oxygenation, ventilation, work of breathing, breath sounds, and signs of respiratory failure.

70. What respiratory finding would suggest immediate priority during triage?
Severe hypoxemia with respiratory distress would suggest immediate priority.

71. Why is altered mental status important during respiratory triage?
Altered mental status may indicate hypoxia, shock, neurologic injury, or inability to protect the airway.

72. How can the Glasgow Coma Scale help with triage?
The Glasgow Coma Scale helps assess neurologic status and can help identify patients who may need close monitoring, airway protection, or mechanical ventilation.

73. What GCS score is often associated with the need for close monitoring and possible intubation?
A GCS score of 8 or less is often associated with the need for close monitoring and possible intubation.

74. Why is low GCS a respiratory concern?
A low GCS is a respiratory concern because the patient may lose airway protective reflexes and develop aspiration, hypoventilation, or airway obstruction.

75. How can acute heart failure require triage?
Acute heart failure may require triage because some patients rapidly develop pulmonary edema, hypoxemia, shock, or respiratory failure and need immediate intervention.

76. What is the main triage concern in a patient with acute pulmonary edema?
The main concern is whether the patient has severe hypoxemia, respiratory distress, fatigue, or impending respiratory failure requiring immediate support.

77. Why might noninvasive ventilation be needed during triage of acute heart failure?
Noninvasive ventilation may be needed to improve oxygenation, reduce work of breathing, and support ventilation in patients with severe pulmonary edema.

78. How can telehealth be used for triage in respiratory care?
Telehealth can help determine whether a patient can remain at home, needs medication adjustment, requires an office visit, or should go to urgent care or the emergency department.

79. What type of respiratory patients may benefit from telehealth triage?
Patients with COPD, asthma, neuromuscular disease, home oxygen therapy, or home mechanical ventilation may benefit from telehealth triage.

80. What remote data may help with respiratory triage?
Oxygen saturation, respiratory rate, symptoms, ventilator data, pulmonary function values, and visual assessment may help guide remote triage.

81. What telehealth finding may indicate the need for emergency care?
Worsening dyspnea, falling oxygen saturation, confusion, chest pain, or signs of respiratory failure may indicate the need for emergency care.

82. Why is oxygen supply planning important during disaster response?
Oxygen supply planning is important because many patients may require oxygen therapy or mechanical ventilation at the same time.

83. Why must suction equipment be considered during disaster planning?
Suction equipment is needed to clear secretions, blood, vomitus, or debris from the airway, especially in patients with airway compromise.

84. Why are trained personnel as important as ventilators during a disaster?
Ventilators require skilled clinicians to set up, monitor, adjust, troubleshoot, and assess patient response.

85. What could happen if a facility has ventilators but not enough trained staff?
Patients may not receive safe ventilator management, monitoring, troubleshooting, or timely intervention during deterioration.

86. Why is infection control important during biological mass casualty incidents?
Infection control helps prevent spread of disease to healthcare workers, other patients, and the community.

87. What respiratory complications may occur after a biological disaster?
Patients may develop pneumonia, sepsis, acute respiratory distress syndrome, respiratory failure, or the need for mechanical ventilation.

88. Why is decontamination important after chemical exposure?
Decontamination removes hazardous substances and helps protect healthcare workers, other patients, and the facility.

89. What respiratory problems can chlorine gas exposure cause?
Chlorine gas exposure can cause airway irritation, bronchospasm, inhalation injury, pulmonary edema, and respiratory failure.

90. Why may a radiologic or nuclear event require both triage and decontamination?
Patients may have traumatic injuries and radioactive contamination, so responders must prioritize medical care while preventing spread of contamination.

91. What is the purpose of assigning patients to disaster response zones?
Disaster response zones help separate contaminated areas, decontamination areas, and treatment areas to improve safety and organization.

92. Why should green patients usually not be treated before red patients?
Green patients have minor injuries and can wait, while red patients have life-threatening but treatable conditions requiring immediate care.

93. Why can a yellow patient later become a red patient?
A yellow patient can become red if respiratory status worsens, perfusion declines, mental status changes, or another life-threatening problem develops.

94. What is the role of pain relief in expectant patients?
Pain relief helps provide comfort, dignity, and humane care even when survival is unlikely under the available conditions.

95. Why is mental status included in START triage?
Mental status helps identify patients with possible hypoxia, shock, neurologic injury, or severe physiologic compromise.

96. Why is perfusion included in START triage?
Perfusion helps identify patients with shock, poor circulation, or severe blood loss who may need immediate treatment.

97. Why is respiratory rate included in START triage?
Respiratory rate helps identify patients with inadequate breathing, respiratory distress, or impending respiratory failure.

98. What is the purpose of auto-injector antidotes in SALT triage?
Auto-injector antidotes may provide immediate treatment during chemical nerve agent exposure and improve survival before hospital care.

99. Why is triage considered an organized response to scarcity?
Triage is an organized response to scarcity because it helps clinicians prioritize care when patients, equipment needs, and staffing demands exceed available resources.

100. What is the key takeaway about triage systems for mass casualty incidents?
The key takeaway is that triage systems help responders rapidly sort patients, identify immediate priorities, perform critical interventions, and allocate limited resources fairly.

Final Thoughts

Triage is an organized process for making rapid, fair, and clinically focused decisions when patient needs exceed available resources. In mass casualty incidents, it helps responders identify patients who need immediate treatment, those who can wait, those with minor injuries, and those who are unlikely to survive despite aggressive care.

For respiratory therapists, triage is especially important because airway compromise, respiratory failure, severe hypoxemia, and ventilator shortages are common concerns during disasters. Systems such as START, JumpSTART, SALT, and SOFA provide structure, but ongoing reassessment and sound clinical judgment remain essential.