# Multiple injured clients arrive after a multi-vehicle crash. The nurse applies START for adults and JumpSTART for children. Which initial triage assignments are correct? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=369324&lang=en  
> language: en  
> subject: Assignment/Delegation/Supervision  
> category: MOC

## Question

Multiple injured clients arrive after a multi-vehicle crash. The nurse applies START for adults and JumpSTART for children. Which initial triage assignments are correct? Select all that apply.

1

A 35-year-old with respirations of 8/min, a weak radial pulse, and inability to follow commands: Red, Immediate

2

A 50-year-old who can walk but has a closed femur fracture, pain rated 8/10, and respirations of 22/min: Red, Immediate

3

A nonambulatory 40-year-old with abdominal pain, respirations of 26/min, capillary refill of 1 second, and ability to follow commands: Yellow, Delayed

4

A 60-year-old who remains apneic after the airway is opened and repositioned and has no other signs assessed: Red, Immediate

5

A 28-year-old with respirations of 28/min, capillary refill of 4 seconds, and inability to follow commands: Red, Immediate

6

A 6-year-old who remains apneic after airway repositioning but has a pulse: give 5 rescue breaths; if breathing returns, assign Red, Immediate

## Explanation

START rapidly sorts adults using the ability to walk, respirations, perfusion, and mental status. A respiratory rate below 10/min, poor perfusion, or inability to follow commands leads to an Immediate assignment (Choices 1 and 5). A walking client is initially Minor even when an injury requires later reassessment (Choice 2). A nonambulatory adult whose respirations, perfusion, and command-following remain within START thresholds is initially Delayed (Choice 3). An apneic adult who does not breathe after airway repositioning is assigned the deceased/expectant category rather than Immediate (Choice 4). In JumpSTART, an apneic child with a palpable pulse receives 5 rescue breaths; return of spontaneous breathing leads to an Immediate assignment (Choice 6). All mass-casualty triage decisions require repeated reassessment as conditions and resources change.

## In-depth explanation

Clinical Judgment
The mass-casualty triage goal is the greatest good for the greatest number, not maximal care for any one patient. Use RPM — Respirations, Perfusion (radial pulse or capillary refill), Mental status (follows commands) — to sort adults in under 60 seconds each.

Memory Tip
Adult START → no breaths after airway open = Black. Pediatric JumpSTART (ages 1–8) → 5 rescue breaths after airway open; if breathing returns = Red, if not = Black.

KR vs US
US disaster systems mandate START/SALT training for ED nurses. In Korea the equivalent role usually falls to dispatch teams (DMAT) at the scene, but NCLEX-RN expects the staff nurse to know triage colors and apply them when patients arrive at the ED door.

## Clinical scenario

Clinical Practice Guide
The CDC and FEMA endorse SALT (Sort-Assess-Lifesaving-Treatment-Transport) as the national mass-casualty standard, integrating START and JumpSTART. Lifesaving interventions during SALT include opening the airway, controlling major hemorrhage, decompressing tension pneumothorax, and giving 2 rescue breaths to a child — not advanced procedures.

Caution
Common NCLEX traps: applying adult START rescue rules to a child, treating a walking fracture as Red, and forgetting that Black means expectant, not deceased — interventions still happen later if resources allow.

## Key concepts

- **START Triage** — Simple Triage And Rapid Treatment, the adult mass-casualty triage system using RPM (Respirations, Perfusion, Mental status). Outputs four categories: Red (Immediate), Yellow (Delayed), Green (Minor), Black (Expectant). Goal is under 60 seconds per patient. NCLEX exam tip: respiratory rate over 30 or under 10, capillary refill over 2 seconds, or inability to follow commands all tag Red.
- **JumpSTART Triage** — The pediatric variant of START for ages 1 to 8. Key differences: respiratory rate cutoffs are 15–45 (instead of adult 10–30); if there is no breathing after airway repositioning, give 5 rescue breaths — return of breathing tags Red, no return tags Black. NCLEX exam tip: rescue breaths are pediatric only — never apply to adults.
- **SALT Triage** — Sort-Assess-Lifesaving-Treatment-Transport — the FEMA/CDC-endorsed national mass-casualty triage method that incorporates START and JumpSTART. The Lifesaving step adds four time-limited interventions (open airway, control hemorrhage, decompress chest, give 2 rescue breaths to a child) before the final color tag. NCLEX exam tip: SALT is the umbrella; START and JumpSTART are tools inside it.

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