Triage involves the rapid assessment and prioritization of patients. Compare the three-tiered system of triage to the Mass Casualty Incident (MCI) triage philosophy. Imagine that you are the Triage Nurse during an MCI. How will you categorize the following patients using the MCI triage philosophy? Explain your answer. Are there any ethical issues that should be considered?
10-year-old boy with massive head injury, no spontaneous breathing, BP 60 palp
22-year-old female with a close fracture of the left arm
60-year-old male with a laceration in the leg complaining of shortness of breath
15-year-old girl with glass embedded in the eyes
52-year-old male with a pulse of 30 and a blood pressure of 70/30
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The three-tiered system of triage, commonly referred to as "traditional triage," categorizes patients into three levels: immediate, delayed, and minimal. Immediate category refers to patients who require immediate intervention to save their lives, delayed category refers to patients who require medical intervention urgently but not immediately life-saving, and minimal category refers to patients who have minor injuries and can wait longer for medical attention.
On the other hand, Mass Casualty Incident (MCI) triage philosophy is an approach used in situations with a large number of casualties that overwhelms the healthcare system. The MCI triage philosophy uses the START (Simple Triage and Rapid Treatment) system which categorizes patients as immediate, delayed, or expectant. Immediate patients require immediate treatment and have a high chance of survival, delayed patients require treatment but can wait up to an hour, and expectant patients have severe injuries and poor chances of survival, so their treatment is given low priority.
As the Triage Nurse during an MCI, I would categorize the following patients as per the MCI triage philosophy:
1. 10-year-old boy with a massive head injury, no spontaneous breathing, BP 60 palp: This patient would be categorized as immediate as he has a life-threatening condition and requires immediate intervention to save his life.
2. 22-year-old female with a close fracture of the left arm: This patient would be categorized as delayed since a close fracture of the arm, while painful, is not life-threatening and can wait for medical attention.
3. 60-year-old male with a laceration in the leg complaining of shortness of breath: This patient would also be categorized as immediate since he has a laceration along with complaints of shortness of breath, which indicates potential internal bleeding or other serious underlying conditions requiring prompt treatment.
4. 15-year-old girl with glass embedded in the eyes: This patient would be categorized as immediate since an injury to the eyes can lead to permanent damage if not addressed promptly.
5. 52-year-old male with a pulse of 30 and a blood pressure of 70/30: This patient would be categorized as immediate as he has a significantly low pulse and blood pressure, indicating a life-threatening condition that requires immediate intervention.
Ethical issues that should be considered in this scenario include the principle of justice, which involves allocating resources fairly among patients, and the principle of beneficence, which is the duty to do good and maximize patient outcomes. Triage decisions during an MCI may involve making difficult choices regarding the allocation of limited resources, prioritizing treatment, and may result in some patients receiving less immediate care due to their condition. It is essential to prioritize patients based on their chance of survival and the severity of their injuries. Communication, transparency, and clear ethical guidelines are crucial in managing these ethical dilemmas.
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