# Using the START mass-casualty triage algorithm, classify each adult victim as Immediate (red) or Not immediate in the initial START pass.

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> language: en  
> subject: Emergency Response Plan  
> category: SIPC

## Question

Using the START mass-casualty triage algorithm, classify each adult victim as Immediate (red) or Not immediate in the initial START pass.

|  | Immediate (red) | Not immediate in initial START pass |
| --- | --- | --- |
| Nonambulatory adult breathes 36/min after the airway is open. |  |  |
| Adult walks to the designated area with superficial forearm cuts. |  |  |
| Initially apneic adult begins breathing after one airway repositioning. |  |  |
| Nonambulatory adult breathes 22/min, has a palpable radial pulse, follows commands, and has a closed forearm fracture. |  |  |
| Adult remains apneic after one airway repositioning. |  |  |
| Nonambulatory adult breathes 24/min but has no palpable radial pulse. |  |  |

## Explanation

START is a rapid initial sorting method, not a complete diagnostic examination. Ambulatory victims are initially directed to the minor group for secondary assessment. A nonambulatory adult is tagged immediate when respirations exceed 30 per minute, perfusion is inadequate, or simple commands cannot be followed. An apneic adult receives one airway repositioning attempt; breathing that begins leads to immediate classification, while persistent apnea is not tagged red in the initial pass. All classifications require reassessment as conditions and resources change.

## In-depth explanation

Correct Answer
Immediate classification follows abnormal respiration, perfusion, or mental-status criteria in the START sequence.

Why It Fits
The algorithm applies a small number of observable thresholds to prioritize limited rescue resources quickly.

Clinical Picture
An injury that looks serious is not automatically red when breathing, perfusion, and command-following remain adequate during initial START triage.

Memory Link
Walk, breathe, perfuse, obey: any failed RPM check is red.

NCLEX Rule
After separating walkers, assess airway and respirations, then perfusion, then command-following; persistent apnea after repositioning is not immediate in START.

Why the Alternatives Fail
Assigning color only by visible injury, spending prolonged time on one victim, or repeatedly attempting an airway defeats rapid mass-casualty triage.

Sources
1HHS CHEMM START Adult Triage Algorithm
2NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Mass-casualty incident
Following a structural collapse, responders first direct everyone who can walk to a designated area. For nonambulatory adults, the nurse uses respirations, perfusion, and ability to follow simple commands for rapid initial triage. Only the information in each row should be used.

## Key concepts

- **START** — Simple Triage and Rapid Treatment, a rapid adult mass-casualty triage algorithm.
- **Immediate** — The red triage category for a victim who requires rapid intervention and meets the algorithm's high-priority criteria.
- **Initial triage** — The first rapid sorting pass, followed by repeated reassessment as victim condition and resource availability change.

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