Disaster Nursing Prioritization

hi everyone,

I'm confused about the concept of prioritization of disaster nursing of patients' situations outside the healthcare facility.

I'm confused which ABC to apply (Airway, Breathing, Circulation) or (Ambulatory, Bed ridden, and Critical care patients)

I want to want to emphasize that the scenario is outside the hospital. so I'm confused if triage rules will be applied here.

Here is an example from Kaplan.

My Answer was (1) because the patient can walk away from the disaster area.

So my question is why did Kaplan answer not choose the patient that can ambulate?

The home care nurse visits a client in a large apartment complex. During the visit, the area experiences a major earthquake. Which of the following clients should the

nurse see FIRST?

1. A restless client with a rigid abdomen and absent bowel sounds.

2. An unconscious client with left-sided tracheal shift from midline.

3. A client complaining of excruciating pain with an obvious deformity of the left leg.

4. A client clutching her chest and complaining of severe chest pain.

Strategy: Determine the most unstable client.

(1) likely has injuries to abdominal organs, resulting in hemorrhage and severe circulatory compromise and requires emergent evaluation; airway and breathing take priority

(2) CORRECT--first sign of a tension pneumothorax; airway and breathing take priority

(3) assess for neurovascular compromise; client with breathing difficulties takes priority

(4) circulatory problem; airway/breathing problems take priority

Your first question....

I'm confused which ABC to apply (Airway, Breathing, Circulation) or (Ambulatory, Bed ridden, and Critical care patients)

When you assess/triage patients, even in a disaster, you assess the ABC's. Airway breathing circulation. But you triage for attention/transport and treatment by whether they can walk, be carried, need immediate attention or is the injury survivable. When you are surrounded with trauma and critical injuries what is important/emergent in the standard situation can wait in this situation. The most cititcal and survivable is moved/seen first because the ambulatory can move for themselves.

In the scenario the first priority would be

2) An unconscious client with left-sided tracheal shift from midline.

A tension pneumothorax while life threatening is not necessarily a non survivable injury. They are unconscious so they Amy have trouble maintaining their airway. The "fix" for a tension pneumo can be pretty quick and yield big results (needle thoracoscopy). Their vitals are present and will benefit from immediate removal from the area.

The next priority

1) A restless client with a rigid abdomen and absent bowel sounds.

This patient is in serious trouble as well. The patient is restless indicating serious blood loss and impending shock if not already in shock. Abdominal injuries are serious and life threatening. YOu already know there is sever abd swelling and injury (abdominal compartment syndrome)by the silent bowel sounds and rigid abdomen.

The next one to be removed is debatable. It would depend on how the chest pain "looked" but

3 ) with the obvious deformity and compromise to the "circulation" they would be next seen/moved.

4) The patient walking and talking and able to complain about their chest pain......can wait.

Emergency Severity Index: Implementation Handbook

Ihope this clarifies the situation

YOU're welcome....:loveya: