# A nurse is part of an emergency response team using START (Simple Triage and Rapid Treatment) at a multi-casualty bus accident. Which actions match the START principles? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=372756&lang=en > language: en > subject: Advance Directives > category: MOC ## Question A nurse is part of an emergency response team using START (Simple Triage and Rapid Treatment) at a multi-casualty bus accident. Which actions match the START principles? Select all that apply. 1 Reassess and re-triage all victims periodically because conditions change as resources arrive. 2 Spend extended time stabilizing critically injured victims one at a time before assessing remaining victims. 3 Direct any victim who can walk to a designated area and tag them green (minor) for later evaluation. 4 Tag a victim with a respiratory rate over 30, capillary refill over 2 seconds, or who cannot follow simple commands as red (immediate). 5 Open the airway of an apneic victim; if breathing resumes, tag them red (immediate); if not, tag black (deceased/expectant) and move on. ## Explanation START is a rapid mass-casualty triage system based on quick assessment in 30–60 seconds per victim using the RPM check (Respirations, Perfusion, Mental status). (1) Walking wounded → green; they can self-evacuate to a designated area. (2) Apneic victim → open airway; if breathing resumes the victim is red, otherwise black (deceased/expectant in MCI ethics, where resources are scarce and salvageable victims take priority). (3) Red criteria: respirations >30, capillary refill >2 sec or absent radial pulse, cannot follow simple commands. (5) Triage is dynamic — reassess as resources arrive and conditions change. Choice 2 is incorrect — START explicitly prohibits prolonged stabilization at the expense of assessing remaining victims; the goal is the greatest good for the greatest number, not optimal individual care. ## In-depth explanation START triage tags are color-coded: green (minor) for walking wounded with deferred care; yellow (delayed) for those who can wait without life-threatening injury; red (immediate) for salvageable life-threatening injury and the first priority; black (deceased or expectant) for victims with no respirations after airway opening or injuries so severe survival is not possible with available resources. The RPM check assigns red on respirations greater than 30 per minute or absent (after airway opening), perfusion with capillary refill greater than 2 seconds or absent radial pulse, and mental status that cannot follow simple commands; walking is green and other findings are yellow, with each assessment lasting about 30 to 60 seconds per victim. MCI ethics shift from individualized optimal care to "the greatest good for the greatest number": resources go to salvageable patients with the highest expected benefit, and survivors with severe injuries that would consume disproportionate resources may be tagged expectant. ## Clinical scenario A nurse is part of an emergency response team using **START (Simple Triage and Rapid Treatment)** at a **multi-casualty bus accident**. The nurse applies START principles. ## Key concepts - **START Triage Tags** — Green (minor): walking wounded, deferred care. Yellow (delayed): can wait, not life-threatening. Red (immediate): salvageable life-threatening injury — first priority. Black (deceased or expectant): no respirations after airway opening, or so severely injured survival is not possible with available resources. - **RPM Check** — Respirations: >30/min or absent → red (after airway opening). Perfusion: capillary refill >2 sec or absent radial pulse → red. Mental status: cannot follow simple commands → red. Walking → green. Otherwise yellow. Each assessment is approximately 30–60 seconds per victim. - **MCI Ethics — Greatest Good** — In a mass-casualty incident with limited resources, prioritization shifts from individualized optimal care to the greatest good for the greatest number. Resources go to salvageable patients with the highest expected benefit. Survivors with severe injuries who would consume disproportionate resources may be tagged expectant. ## Related questions - [A home hospice RN is leading care for a 72-year-old patient with end-stage heart failure. …](https://mymerci.kr/pages/nclex_q.php?qn_id=372731&lang=en) - [An adult who lacks decision-making capacity has an advance directive naming the spouse as …](https://mymerci.kr/pages/nclex_q.php?qn_id=393390&lang=en) - [A client's family member asks the nurse whether the client has HIV. 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