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
Full Answer Section
3. Delayed (Green):
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22-year-old female with a close fracture of the left arm: This patient's injury, although painful, is not immediately life-threatening and can wait for treatment after the critically injured are stabilized.
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15-year-old girl with glass embedded in the eyes: While painful and potentially debilitating, this injury doesn't pose an immediate threat to life and can be addressed after more critical patients are attended to.
Ethical Considerations:
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Justice: The triage system, by nature, prioritizes those with the highest chance of survival and benefitting from immediate treatment. This can raise ethical concerns about fairness, especially when younger or seemingly "less productive" individuals are categorized as delayed despite significant suffering.
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Resource allocation: During MCIs, resources are often limited. Balancing the needs of multiple patients with varying degrees of injury while ensuring efficient resource allocation poses ethical challenges.
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Uncertainty: Rapid assessment in chaotic situations can lead to misdiagnosis or underestimation of injury severity. It's crucial to be mindful of such uncertainties and constantly re-evaluate patients' conditions when possible.
My Role as Triage Nurse:
As the Triage Nurse, my primary responsibility is to swiftly assess and categorize patients based on the severity of their injuries and their potential to survive with immediate intervention. This involves:
- Conducting rapid physical examinations with minimal resource usage.
- Applying the MCI triage criteria while remaining aware of potential uncertainties.
- Communicating effectively with medical personnel to ensure appropriate and timely care for each patient.
- Adapting to changing situations and re-evaluating patients as needed.
Remember, MCI triage is a dynamic process, and ethical considerations remain paramount. The goal is to maximize the number of lives saved with the resources available while providing the best possible care to every patient within the constraints of the situation.