Answers for Appendix F: Triage Scenarios
INTRODUCTION
The following suggested answers to the ATLS Triage Scenarios their choices rather than to arrive at a particular correct
should be on hand during the course as a reference for answer. There may be several correct answers for a particular
instructors. ATLS sites can also distribute these solutions to scenario given specific local resources and/or unique
participants at the end of the course. The most important circumstances (twists) that the faculty may introduce
aspect of the triage scenarios is to emphasize the principles and discuss.
of triage and encourage the students to reason through
647
,648 SECTION 4 ■ Student Course Resources
TRIAGE scENARIo I
Mass Shooting at a Shopping Mall
scENARIo
You are summoned to a safe triage area at a shopping mall where 6 people are injured in a mass shooting.
The shooter has killed himself. You quickly survey the situation and determine that the patients’ conditions
are as follows:
PATIENT A—A young male is screaming, ―Please help me, my leg is killing me!‖
PATIENT B—A young female has cyanosis and tachypnea and is breathing noisily.
PATIENT C—An older male is lying in a pool of blood with his left pant leg soaked in blood.
PATIENT D—A young male is lying facedown and not moving.
PATIENT E—A young male is swearing and shouting that someone should help him or he will call his lawyer.
PATIENT F—A teenage girl is lying on the ground crying and holding her abdomen.
QUEsTIoNs FoR REsPoNsE
1. For each patient, what is the primary problem requiring treatment? The student(s) should indicate that
management priorities could be based on information gleaned by surveying all of the victims from a distance.
If the student indicates that he or she needs to examine each of the patients individually before making a
decision, the group should discuss this response. The direction of the discussion should indicate that, while
information is being obtained on one patient, another patient might die from a more serious injury. Also,
the time taken to gather detailed information on all of the patients before establishing priorities based
on that information could lead to disastrous results. If there is doubt about which one of these patients
is most severely injured, based on the available information, the decision must be made to proceed with
the best information available at the time. The instructor should then provide information that could be
obtained by surveying the situation from a distance, as follows:
PATIENT A—is a young male screaming, ―Please help me, my leg is killing me!‖
Possible Injury/Problem:The patient has a probable fracture/open fracture of the lower extremity.
PATIENT B—appears to have cyanosis and tachypnea and is breathing noisily.
Possible Injury/Problem:This patient likely has a compromised airway.
PATIENT C—is an older male lying in a pool of blood with his left pant leg soaked in blood.
Possible Injury/Problem:This patient has potential blood loss from an open fracture or laceration.
PATIENT D—is lying facedown and not moving.
Possible Injury/Problem:This patient may be comatose, dead, or have a brain or spine injury.
PATIENT E—is swearing and shouting that someone should help him or he will call his lawyer.
Possible Injury/Problem:: Is this patient hemodynamically normal? This patient may be in shock, have a
psychological problem, or a personality disorder.
PATIENT F—A teenaged girl is lying on the ground crying and holding her abdomen.
Possible Injury/Problem:Does this patient have a torso gunshot injury?
The instructor should clearly explain that all of the previously outlined information could be obtained without
actually examining any of these patients in detail and that, based on this information, a triage decision could be
made. The instructor may ask, ―Suppose you are in doubt about which patient is most severely injured. How
should you respond?‖ Students should be prompted to respond that the decision must be made to proceed
on the basis of the best information available at the time.
Based on the information obtained by surveying the patients from a distance, the students are then asked
to triage the victims and give the rationale for their choices. The convergent or divergent model may be used
here to facilitate the discussions.
, PART B ■ Answers for Appendix F: Triage Scenarios 649
TRIAGE scENARIo I (coNTINUED)jf jf jf
2. Establish jfthe jfpatient jfpriorities jffor jffurther jfevaluation jfby jfplacing jfa jfnumber jf(1 jfthrough jf6, jfwhere jf1 jfis jfthe jfhighest
jfpriority jf and jf6 jfis jf the jflowest) jf in jfthe jf space jfnext jfto jfeach jfpatient jf leaer.
j f j f5 j f j f jf Patient jfA
j f j f1 j f j f jf Patient jfB
j f j f3 j f j f jfPatient jfC
j f j f2 j f j f jfPatient jfD
j f j f6 j f j f jfPatient jfE
j f j f4 j f j f jfPatient jfF
3. Briefly jfoutline jfyour jfrationale jffor jfprioritizing jfthe jfpatients jfin jfthis jfmanner. jfThe jfinstructor jfleads jfthe
jfdiscussion jfby jf asking jf the jfstudents jf to jf give jf the jfrationale jffor jf their jfpriority jfchoices, jfand jf these jf answers
jfare jfdiscussed jf among jf the jf students. jf At jfthe jf end jfof jfthe jfdiscussion, jfthe jfstudents jfshould jf arrive jfat jf the
jffollowing jf priorities: jfNOTE: jfPatients jfB jfand jfD jfmay jfbe jfinterchanged jfas jfPriorities jf1 jfand jf2, jfand jfboth jfmay jfbe
jfconsidered jfhigh jfpriority. jfHowever, jfthe jfrationale jfmust jfbe jfgiven jfby jfthe jfstudent—for jfexample, jfPatient jfD
jfmay jfhave jfa jfmajor jfairway jfproblem jfas jfwell. jfThe jfreason jffor jfdetermining jfthat jfpatients jfB jfand jfD jfare
jfhigher jfpriorities jfthan jfpatient jfC jfis jfthat jfthey jfappear jfto jfhave jfairway jfand jfbreathing jfproblems, jfwhereas
jfpatient jfC jfappears jfto jfhave jfcirculatory jfproblems jfrelated jfto jfhemorrhage. jfAlso, jfPatients jfA jfand jfE jfmay jfbe
jfconsidered jflow jfpriority.
pRIORITT pATIENT RATIONALE
1 B jf– jfAirway The jfpatient jfapparently jfis jfnot jftalking. jfHer jfrespiratory jfelorts jfare jfrapid, jfand
jfcompromise jfthere jfis jfevidence jfof jfan jfobstructed jfairway jf(breathing jfnoisily). jfThe jfcyanosis jfis
jfadditional jfinformation jfsupporting jfrespiratory jfcompromise.
2 D jf– jfComa/brain/ With jfthe jfpatient jflying jffacedown jfand jfnot jfmoving, jfit jfmust jfbe jfassumed jfthat
jfspine jfinjury/ jfhe jfor jfshe jfis jfcomatose, jfhas jfa jfspine jfinjury, jfor jfis jfdead. jfHad jfthe jfpatient jfbeen
jfdead? jfawake jfand jfcapable jfof jfmoving, jf he jfor jfshe jflikely jfwould jfnot jfbe jflying
jffacedown. jfThe jfABCDEs jfmust jfbe jfassessed jfwith jfthe jfconcern jffor jfaltered jflevel jfof
jfconsciousness jfand jfspinal jfinjury.
3 C jf– jfBlood jfloss Based jfon jfthe jfinformation jfprovided, jfthere jfis jfclear jfevidence jfthat jfthe jfpatient
jfhas j f blood j f loss. j f The j f extent j f of j f the j f blood j f loss j f and j f whether j f it j f is
j f continuing j f are jfnot j f known. j f The j f patient’s j f ABCDEs j f must j f be j f assessed
j f to j f determine j f the j f extent jfof jfthe jfproblem.
4 F jf– jfPossible Given jfthe jfmechanism jfof jfpossible jfinjuries—gunshot jfwounds, jfand jfthat jfthe
jftorso jfgunshot jfpatient jfis jfclutching jfher jfabdomen—responders jfmust jfsuspect jfa jftorso
jfwound jfgunshot jfinjury. jfA jfpatient jfwith jfa jftorso jfgunshot jfwound jfneeds jfrapid
jfassessment jfby jfa jfsurgeon, jfeven jfwithout jfobvious jfsigns jfof jfblood jfloss.
5 A jf– jfProbable The jfpatient’s jfABCDEs jfwould jfappear jfto jfbe jfgrossly jfnormal. jfHis jfchief jfsymptom
jffracture/open jfappears jfto jfbe jfpain jfin jfhis jflower jflimb, jfwhich jfshould jfbe jfviewed jfinitially jfas
jffracture jfof jflower jfa jfbony/soft-tissue jfinjury jfor jfproblem.
jfextremity
6 E jf– jfHemodyna- If jfthe jfpatient jfwere jfjust jfcursing, jfthe jfresponder jfcould jfbe jfconcerned jfabout
jfmically jf normal jfhypoxia jfversus jfa jfperfectly jfstable jfpatient jfwith jfa jflitigious jfpersonality. jfThe
jfpatient jfis jfmaking jfjudgments jfthat jfare jfrational jfand jfprotective, jfif jfargumentative
jfand jfirritating.
INTRODUCTION
The following suggested answers to the ATLS Triage Scenarios their choices rather than to arrive at a particular correct
should be on hand during the course as a reference for answer. There may be several correct answers for a particular
instructors. ATLS sites can also distribute these solutions to scenario given specific local resources and/or unique
participants at the end of the course. The most important circumstances (twists) that the faculty may introduce
aspect of the triage scenarios is to emphasize the principles and discuss.
of triage and encourage the students to reason through
647
,648 SECTION 4 ■ Student Course Resources
TRIAGE scENARIo I
Mass Shooting at a Shopping Mall
scENARIo
You are summoned to a safe triage area at a shopping mall where 6 people are injured in a mass shooting.
The shooter has killed himself. You quickly survey the situation and determine that the patients’ conditions
are as follows:
PATIENT A—A young male is screaming, ―Please help me, my leg is killing me!‖
PATIENT B—A young female has cyanosis and tachypnea and is breathing noisily.
PATIENT C—An older male is lying in a pool of blood with his left pant leg soaked in blood.
PATIENT D—A young male is lying facedown and not moving.
PATIENT E—A young male is swearing and shouting that someone should help him or he will call his lawyer.
PATIENT F—A teenage girl is lying on the ground crying and holding her abdomen.
QUEsTIoNs FoR REsPoNsE
1. For each patient, what is the primary problem requiring treatment? The student(s) should indicate that
management priorities could be based on information gleaned by surveying all of the victims from a distance.
If the student indicates that he or she needs to examine each of the patients individually before making a
decision, the group should discuss this response. The direction of the discussion should indicate that, while
information is being obtained on one patient, another patient might die from a more serious injury. Also,
the time taken to gather detailed information on all of the patients before establishing priorities based
on that information could lead to disastrous results. If there is doubt about which one of these patients
is most severely injured, based on the available information, the decision must be made to proceed with
the best information available at the time. The instructor should then provide information that could be
obtained by surveying the situation from a distance, as follows:
PATIENT A—is a young male screaming, ―Please help me, my leg is killing me!‖
Possible Injury/Problem:The patient has a probable fracture/open fracture of the lower extremity.
PATIENT B—appears to have cyanosis and tachypnea and is breathing noisily.
Possible Injury/Problem:This patient likely has a compromised airway.
PATIENT C—is an older male lying in a pool of blood with his left pant leg soaked in blood.
Possible Injury/Problem:This patient has potential blood loss from an open fracture or laceration.
PATIENT D—is lying facedown and not moving.
Possible Injury/Problem:This patient may be comatose, dead, or have a brain or spine injury.
PATIENT E—is swearing and shouting that someone should help him or he will call his lawyer.
Possible Injury/Problem:: Is this patient hemodynamically normal? This patient may be in shock, have a
psychological problem, or a personality disorder.
PATIENT F—A teenaged girl is lying on the ground crying and holding her abdomen.
Possible Injury/Problem:Does this patient have a torso gunshot injury?
The instructor should clearly explain that all of the previously outlined information could be obtained without
actually examining any of these patients in detail and that, based on this information, a triage decision could be
made. The instructor may ask, ―Suppose you are in doubt about which patient is most severely injured. How
should you respond?‖ Students should be prompted to respond that the decision must be made to proceed
on the basis of the best information available at the time.
Based on the information obtained by surveying the patients from a distance, the students are then asked
to triage the victims and give the rationale for their choices. The convergent or divergent model may be used
here to facilitate the discussions.
, PART B ■ Answers for Appendix F: Triage Scenarios 649
TRIAGE scENARIo I (coNTINUED)jf jf jf
2. Establish jfthe jfpatient jfpriorities jffor jffurther jfevaluation jfby jfplacing jfa jfnumber jf(1 jfthrough jf6, jfwhere jf1 jfis jfthe jfhighest
jfpriority jf and jf6 jfis jf the jflowest) jf in jfthe jf space jfnext jfto jfeach jfpatient jf leaer.
j f j f5 j f j f jf Patient jfA
j f j f1 j f j f jf Patient jfB
j f j f3 j f j f jfPatient jfC
j f j f2 j f j f jfPatient jfD
j f j f6 j f j f jfPatient jfE
j f j f4 j f j f jfPatient jfF
3. Briefly jfoutline jfyour jfrationale jffor jfprioritizing jfthe jfpatients jfin jfthis jfmanner. jfThe jfinstructor jfleads jfthe
jfdiscussion jfby jf asking jf the jfstudents jf to jf give jf the jfrationale jffor jf their jfpriority jfchoices, jfand jf these jf answers
jfare jfdiscussed jf among jf the jf students. jf At jfthe jf end jfof jfthe jfdiscussion, jfthe jfstudents jfshould jf arrive jfat jf the
jffollowing jf priorities: jfNOTE: jfPatients jfB jfand jfD jfmay jfbe jfinterchanged jfas jfPriorities jf1 jfand jf2, jfand jfboth jfmay jfbe
jfconsidered jfhigh jfpriority. jfHowever, jfthe jfrationale jfmust jfbe jfgiven jfby jfthe jfstudent—for jfexample, jfPatient jfD
jfmay jfhave jfa jfmajor jfairway jfproblem jfas jfwell. jfThe jfreason jffor jfdetermining jfthat jfpatients jfB jfand jfD jfare
jfhigher jfpriorities jfthan jfpatient jfC jfis jfthat jfthey jfappear jfto jfhave jfairway jfand jfbreathing jfproblems, jfwhereas
jfpatient jfC jfappears jfto jfhave jfcirculatory jfproblems jfrelated jfto jfhemorrhage. jfAlso, jfPatients jfA jfand jfE jfmay jfbe
jfconsidered jflow jfpriority.
pRIORITT pATIENT RATIONALE
1 B jf– jfAirway The jfpatient jfapparently jfis jfnot jftalking. jfHer jfrespiratory jfelorts jfare jfrapid, jfand
jfcompromise jfthere jfis jfevidence jfof jfan jfobstructed jfairway jf(breathing jfnoisily). jfThe jfcyanosis jfis
jfadditional jfinformation jfsupporting jfrespiratory jfcompromise.
2 D jf– jfComa/brain/ With jfthe jfpatient jflying jffacedown jfand jfnot jfmoving, jfit jfmust jfbe jfassumed jfthat
jfspine jfinjury/ jfhe jfor jfshe jfis jfcomatose, jfhas jfa jfspine jfinjury, jfor jfis jfdead. jfHad jfthe jfpatient jfbeen
jfdead? jfawake jfand jfcapable jfof jfmoving, jf he jfor jfshe jflikely jfwould jfnot jfbe jflying
jffacedown. jfThe jfABCDEs jfmust jfbe jfassessed jfwith jfthe jfconcern jffor jfaltered jflevel jfof
jfconsciousness jfand jfspinal jfinjury.
3 C jf– jfBlood jfloss Based jfon jfthe jfinformation jfprovided, jfthere jfis jfclear jfevidence jfthat jfthe jfpatient
jfhas j f blood j f loss. j f The j f extent j f of j f the j f blood j f loss j f and j f whether j f it j f is
j f continuing j f are jfnot j f known. j f The j f patient’s j f ABCDEs j f must j f be j f assessed
j f to j f determine j f the j f extent jfof jfthe jfproblem.
4 F jf– jfPossible Given jfthe jfmechanism jfof jfpossible jfinjuries—gunshot jfwounds, jfand jfthat jfthe
jftorso jfgunshot jfpatient jfis jfclutching jfher jfabdomen—responders jfmust jfsuspect jfa jftorso
jfwound jfgunshot jfinjury. jfA jfpatient jfwith jfa jftorso jfgunshot jfwound jfneeds jfrapid
jfassessment jfby jfa jfsurgeon, jfeven jfwithout jfobvious jfsigns jfof jfblood jfloss.
5 A jf– jfProbable The jfpatient’s jfABCDEs jfwould jfappear jfto jfbe jfgrossly jfnormal. jfHis jfchief jfsymptom
jffracture/open jfappears jfto jfbe jfpain jfin jfhis jflower jflimb, jfwhich jfshould jfbe jfviewed jfinitially jfas
jffracture jfof jflower jfa jfbony/soft-tissue jfinjury jfor jfproblem.
jfextremity
6 E jf– jfHemodyna- If jfthe jfpatient jfwere jfjust jfcursing, jfthe jfresponder jfcould jfbe jfconcerned jfabout
jfmically jf normal jfhypoxia jfversus jfa jfperfectly jfstable jfpatient jfwith jfa jflitigious jfpersonality. jfThe
jfpatient jfis jfmaking jfjudgments jfthat jfare jfrational jfand jfprotective, jfif jfargumentative
jfand jfirritating.
