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Emergency & Disaster Triage (START system 등)

NCLEX Review Guide: Leadership Management, Prioritization & Emergency Triage

Leadership & Management Principles

Delegation & Supervision

  • Five Rights of Delegation: Right task, right person, right circumstances, right direction/communication, right supervision
  • RNs can delegate to UAPs (Unlicensed Assistive Personnel): stable patients, routine tasks, standardized procedures
  • Never delegate: assessment, nursing judgment, teaching, medication administration, unstable patients

Memory Aid: "STABLE"

S - Standardized procedures
T - Tasks that are routine
A - Activities of daily living
B - Basic care measures
L - Low-risk situations
E - Established protocols

Key Points

  • RN retains accountability even when delegating tasks
  • Match task complexity to staff competency level

Prioritization & Clinical Judgment

ABC Priority Framework

  • Airway takes highest priority - compromised airway is life-threatening emergency
  • Breathing second priority - assess respiratory rate, effort, oxygen saturation
  • Circulation third priority - check pulse, blood pressure, perfusion signs

Priority Levels Comparison

Level 1 (Highest)Level 2 (Moderate)Level 3 (Lowest)
Life-threatening conditionsUrgent but stableRoutine care needs
ABC compromisedPain managementTeaching/discharge planning
Unstable vital signsMedication schedulesComfort measures

Clinical Scenario

Four patients need attention: Patient A has chest pain, Patient B needs pain medication, Patient C requires discharge teaching, Patient D has difficulty breathing. Priority order: D (breathing), A (circulation), B (comfort), C (routine)

Emergency & Disaster Triage

START Triage System

  • START = Simple Triage And Rapid Treatment - used in mass casualty incidents
  • Four color-coded categories based on survivability and resource needs
  • Assessment completed in 60 seconds or less per patient
  1. Step 1: Check if patient can walk - if yes, assign GREEN (minor)
  2. Step 2: Assess respirations - if absent after airway positioning, assign BLACK (deceased)
  3. Step 3: If breathing >30/min or <10/min, assign RED (immediate)
  4. Step 4: Check perfusion - capillary refill >2 seconds or no radial pulse = RED
  5. Step 5: Assess mental status - cannot follow commands = RED, otherwise YELLOW (delayed)

START Triage Categories

ColorPriorityCharacteristicsExamples
REDImmediateLife-threatening, high survival chanceAirway obstruction, severe bleeding
YELLOWDelayedSerious but stableFractures, moderate burns
GREENMinorWalking woundedMinor cuts, sprains
BLACKDeceased/ExpectantDead or unsurvivable injuriesNo pulse, extensive burns >80%

Memory Aid: "30-2-Can Do"

30 - Respirations >30 or <10 = RED
2 - Capillary refill >2 seconds = RED
Can Do - Can't follow commands = RED

Commonly Confused Concepts

Delegation vs Assignment

DelegationAssignment
Transferring authority to UAPDistributing work among licensed staff
RN retains accountabilityEach person accountable for own work
Requires supervisionPeer-to-peer distribution

Triage vs Prioritization

TriagePrioritization
Sorting patients by urgencyOrganizing nursing tasks
Used in emergency/disasterUsed in daily nursing practice
Based on survivabilityBased on ABC framework

Study Tips & Quick Checks

NCLEX Success Strategy

  • Always choose the most life-threatening option first
  • Remember: Assessment before intervention (except emergencies)
  • When in doubt, use ABC priority framework
  • Consider both physical and psychological safety

Common Pitfalls

  • Don't confuse urgent with emergent - emergent = life-threatening
  • Remember: GREEN patients in START can walk, not just minor injuries
  • Delegation requires ongoing supervision, not just initial instruction

Self-Assessment Checklist

  • ☐ Can I identify the 5 rights of delegation?
  • ☐ Do I understand ABC prioritization framework?
  • ☐ Can I correctly apply START triage categories?
  • ☐ Do I know what tasks can/cannot be delegated?
  • ☐ Can I distinguish between emergency priorities?

Remember: You've got this! Master these leadership and triage concepts through practice, and trust your clinical judgment. Every nurse started where you are now - keep pushing forward toward your NCLEX success! 🌟

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