Study guide
3.6 Disaster Triage and Emergency Response
NCLEX-RN Registered Nurse
Track your progress as you read
Finished sections get a check mark.
1 Introduction
About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course
2 Chapter 2: Management of Care
2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles
3 Chapter 3: Safety and Infection Prevention and Control
3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response
4 Chapter 4: Health Promotion and Maintenance
4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules
5 Chapter 5: Psychosocial Integrity
5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care
6 Chapter 6: Basic Care and Comfort
6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care
7 Chapter 7: Pharmacological and Parenteral Therapies
7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)
8 Chapter 8: Reduction of Risk Potential
8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures
9 Chapter 9: Physiological Adaptation
9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)
3.6 Disaster Triage and Emergency Response
Key Takeaways Explain This Topic AI
Disaster triage prioritizes "the greatest good for the greatest number" - a shift from individual patient focus to population focus
RED (Immediate/Emergent): Life-threatening but treatable injuries requiring immediate intervention - treated first
YELLOW (Delayed/Urgent): Significant injuries that can wait 30-60 minutes without deterioration
GREEN (Minor/Non-Urgent): "Walking wounded" with minor injuries who can wait hours for treatment
BLACK (Expectant/Deceased): Dead or injuries so severe that survival is unlikely - not prioritized for treatment
Last updated: January 2026
Mass casualty incidents (MCIs) require a fundamental shift in nursing practice. Instead of focusing all resources on one critically ill patient, disaster triage prioritizes treating the greatest number of patients who can survive.
- The Paradigm Shift
- Everyday Nursing vs. Disaster Nursing
- Everyday Practice Disaster Practice
- Individual patient focus Population focus
- Treat the sickest first Treat those who can survive first
- Use all available resources Ration limited resources
- Goal: Save this patient Goal: Save the most patients
- The Core Principle
"The greatest good for the greatest number" - This means some patients who would receive full treatment in normal circumstances may receive minimal or no treatment during disasters.
Disaster Triage Categories
The START triage system (Simple Triage and Rapid Treatment) uses a color-coded system:
- Color Category Description Treatment Priority
- RED Immediate/Emergent Life-threatening but TREATABLE First priority
- YELLOW Delayed/Urgent Serious but can wait 30-60 min Second priority
- GREEN Minor/Non-urgent "Walking wounded" Third priority
- BLACK Expectant/Deceased Dead or unsurvivable injuries Not treated
- RED - Immediate (Highest Priority)
Patients with life-threatening conditions that are treatable with available resources .
Examples of RED Tag Patients
- Condition Rationale
- Airway obstruction Correctable with simple intervention
- Tension pneumothorax Treatable with needle decompression
- Severe hemorrhage (controllable) Tourniquet or pressure can save life
- Open chest wound Can be sealed
- Shock (early stages) Reversible with fluids
- Key Concept
RED patients will die without immediate intervention but can survive if treated promptly . These patients receive resources first because the investment yields survival.
YELLOW - Delayed (Second Priority)
Patients with significant injuries who are stable enough to wait 30-60 minutes without deteriorating.
Examples of YELLOW Tag Patients
- Condition Rationale
- Open fractures with pulse Serious but not immediately life-threatening
- Burns (10-30% BSA) Need treatment but can wait briefly
- Moderate blood loss Controlled, patient stable
- Spinal cord injury (stable) Cannot reverse injury; can wait for transport
- Stable abdominal wounds Need surgery but can tolerate delay
- Key Concept
YELLOW patients need treatment but can tolerate a wait while RED patients are addressed. Continuous reassessment is needed because YELLOW can become RED.
GREEN - Minor (Third Priority)
The "walking wounded" - patients with minor injuries who can wait hours for treatment.
Examples of GREEN Tag Patients
- Condition Rationale
- Minor lacerations Can wait; may self-treat
- Sprains and strains Painful but not dangerous
- Minor burns (<10% BSA) Not life-threatening
- Psychological trauma Distressing but not physical injury
- Walking, talking, following commands Demonstrates adequate perfusion
- Key Concept
GREEN patients can often help themselves and others. They may assist with transporting supplies or providing comfort to other victims.
BLACK - Expectant (Not Treated)
Patients who are deceased or have injuries so severe that survival is unlikely with available resources .
Examples of BLACK Tag Patients
- Condition Rationale
- Cardiac arrest (MCI) In MCI, CPR for one patient means others die
- Massive head trauma (open skull, brain visible) Unsurvivable
- Severe burns (>90% BSA) Resource-intensive, low survival
- Unsurvivable blast injuries Limited survival even with all resources
- Already deceased No intervention can help
- Critical Understanding
This is NOT abandonment - it is ethical allocation of limited resources to save the most lives. In normal situations, all of these patients would receive treatment.
The Ethical Framework
During a disaster:
- Treating one BLACK patient with CPR for 30 minutes
- Means 10 RED patients do not receive life-saving interventions
- Those 10 patients die while you try to save one who likely will not survive
- The ethical choice is to save the 10
- Triage Process
- START Method Steps
- Voice Command: "Everyone who can walk, move to this area!"
- Those who can walk = GREEN (minor)
Check Respirations:
- Not breathing → Open airway → Still not breathing = BLACK
- Not breathing → Open airway → Starts breathing = RED
- Breathing >30/min = RED
- Breathing <30/min = Continue to next step
Check Perfusion (Capillary Refill):
- 2 seconds = RED
- <2 seconds = Continue to next step
Check Mental Status:
- Cannot follow simple commands = RED
- Can follow commands = YELLOW
- Special Populations
- Pediatric Considerations (JumpSTART)
- Different respiratory rate cutoffs
- Different mental status assessment
- Modified approach for infants
- Geriatric Considerations
- May have baseline cognitive impairment
- Vital sign parameters may be different
- Consider medications that affect presentation
- Nurse's Role in Disaster Response
- Immediate Actions
- Phase Actions
- Initial Triage arriving patients; tag appropriately
- Treatment Address RED patients first, then YELLOW
- Ongoing Continuously reassess; categories can change
- Documentation Track patient numbers, status, disposition
- Psychological First Aid
- Remain calm and confident
- Provide clear instructions
- Offer reassurance when possible
- Refer to mental health resources after immediate crisis
- Reassessment
Triage is dynamic - patient conditions change:
- Change Action
- YELLOW deteriorating Re-tag as RED
- RED stabilizing Re-tag as YELLOW
- GREEN worsening Re-tag as YELLOW or RED
- Patient dies Re-tag as BLACK
- Common Disaster Scenarios
- Scenario Common Injuries
- Building collapse Crush injuries, respiratory failure, fractures
- Mass shooting Gunshot wounds, hemorrhage
- Chemical exposure Respiratory distress, burns, decontamination needs
- Pandemic Respiratory failure, dehydration, secondary infections
- Natural disaster Fractures, lacerations, hypothermia/hyperthermia
- On the NCLEX
Common testing points:
- Understanding the color-coded triage categories
- Recognizing that BLACK does not mean abandonment
- Knowing that disaster triage differs from ER triage
- Prioritizing RED patients first in treatment
- Understanding the "greatest good" principle
Exam Strategy: In disaster questions, look for the patient who will die without immediate intervention BUT can survive if treated. That is the RED patient and should be treated first.