Utilizing the simple triage and rapid transport (START) system, in what order should the nurse prioritize the following patients?

Question

Choice 1. A 67-year-old male complaining of chest pain. His heart rate is 120 beats/minute, his blood pressure is 100/68 mmHg, and his respiratory rate is 20 breaths/min.
Choice 2. A 27-year-old woman presenting with a respiratory rate of 36 breaths/min and capillary refill of 4 seconds.
Choice 3. A 58-year-old woman who is able to walk on her own and states over and over, "I don't know what happened."
Choice 4. A 30-year-old male with a collapsed airway and multiple chest trauma. He does not have a palpable carotid pulse and the nurse is unable to assess respiratory movement.

Answer 1

Correct Answer: 2,1,3,4

Triage means sorting. A very basic triage system is to categorize or label patients requiring the most support and emergency care as red. Patients whose respiratory rate is above 30 and capillary refill is greater than 2 seconds should be tagged red and have first priority of care. Those patients who are in less critical condition but still need to be transported to emergency centers for care are classified as yellow. These patients will require some medical attention but will not die if care is delayed. Their respiratory status is stable and they can follow simple commands. Patients who have minor injuries and do not warrant transport to an emergency center are categorized as green. They can walk and take care of themselves. Patients who are least likely to survive or are already deceased are color coded as black. This category would include patients who are not breathing and remain apneic even after the airway is manually opened.