During a hospital-wide emergency drill, a nurse is assigned to the emergency response team. Which action should the nurse prioritize first when responding to a mass casualty incident?

Key Action: Implement Triage First

In a hospital-wide MCI response, the nurse's immediate priority is to activate and apply the facility's triage protocol. This systematic sorting process is the foundation for all subsequent care, ensuring that limited resources are directed to patients with the most urgent, survivable conditions. The goal shifts from individual patient care to achieving the greatest good for the greatest number.

Triage Categories and Color Codes

Standard disaster triage uses a color-coded system to rapidly classify patients:

• Immediate (Red): Life-threatening injuries requiring intervention within minutes (e.g., severe respiratory distress, uncontrolled hemorrhage). These patients have the highest priority for transport and treatment.
• Delayed (Yellow): Significant injuries that can wait a short time for treatment without risk of immediate deterioration (e.g., stable abdominal injury, major fractures).
• Minimal (Green): Minor injuries or "walking wounded" who can safely wait for extended periods or assist with their own care (e.g., minor lacerations, sprains).
• Expectant (Black): Injuries incompatible with life given available resources, or patients with no pulse. These patients receive comfort care only when resources are limited.

Nurse's Role During Triage

The triage nurse must perform a rapid assessment (often under 30 seconds per patient) focusing on airway, breathing, circulation, and disability. The nurse assigns a category tag and directs the patient to the designated treatment area. Re-triage is essential, as a patient's condition can change, requiring category reassignment. Documentation during MCI is streamlined to essential identifiers, triage category, and immediate interventions.

Avoiding Common Pitfalls

Do not begin treatment during the initial triage sweep unless providing a simple life-saving maneuver (e.g., opening an airway, applying a tourniquet). Avoid the urge to treat the first or loudest patient. Defer non-essential tasks like family notification and routine unit duties to designated support teams. Emotional attachment to a single patient must be managed to maintain focus on the overall incident command system and patient flow.