Ethics in Triage Scenario

cenario:

You are the nurse manager of a small, four-bed emergency department. Your department received seven patients involved in a mass casualty shooting at a local grocery store two days ago. A brief overview of each client is provided below.

Brief Client Overviews

1. Pregnant female: 32-years-old, 36 weeks gestation. Presentation to the ED: alert and oriented x 3, respiratory rate at 25 breaths/minute, radial pulses palpable, complaining of abdominal pain after being trampled during the event. Triaged as green. The course of treatment in the ED: Extensive resources (human and non-human) were used to assess the fetus. Both the patient and fetus survived and were discharged 24 hours later.
2. Caucasian female: 45-year-old suspected shooter. Presentation to the ED: gunshot wound to the right chest, unconscious, shallow breathing at eight breaths/minute, thready radial pulse. Triaged as red. The course of treatment in the ED: Patient was aggressively treated, but an argument ensued between staff members upon discovering that she was the suspected perpetrator. No further care was provided to this patient once the other patients arrived. She did not survive.
3. Caucasian female: 52-years-old, HIV positive. Presentation to the ED: gunshot wound to the right leg, confused, respirations shallow at 40 breaths/minute, no palpable radial pulse. Triaged as red. The course of treatment in the ED: Aggressive treatment of the individual, including first access to the OR. She is stable and recovering in the ICU. Upon realization that this patient was HIV positive, there is much anxiety amongst the ED staff related to potential exposure with the substantial blood loss the patient experienced.
4. African American male: 45-year-old Iraqi war veteran, history of PTSD, allegedly shot the perpetrator. Presentation to the ED: No visible physical injuries, hyperventilating at 45 breaths/minute, light-headed, palpable pulse. Triaged as green. The course of treatment in the ED: Patient was observed by ED nursing staff for several hours and released to police for questioning regarding the event.
5. Hispanic male child: 6 years-old. Presentation to the ED: gunshot wound to the abdomen, unconscious, no spontaneous respirations, radial pulse not palpable. Triaged as red. The course of treatment in the ED: Extensive treatment was provided, including bag-mask ventilation, intubation, wound care, cardiac monitoring, and blood transfusions. The patient did not survive.
6. Hispanic female: 29-years-old, mother to the six-year-old patient. Presentation to the ED: open fracture to the left leg, hysterically screaming for her child, climbing out of gurney, palpable radial pulse, respirations at 40 breaths per minute. Triaged as yellow. The course of treatment in the ED: Wound care and stabilization of fractured leg after administration of a sedative. She was the second patient to the OR. The client was kept separated from her child during the incident and not informed of his death until the following day. She is stable and recovering on the medical/surgical unit.
7. Migrant Spanish-speaking male: age unknown, appears to be in his 50s. Presentation to the ED: lethargic, unable to communicate verbally due to the language barrier, was pointing to and holding his head, laceration noted to the forehead, respirations at 30 breaths/minutes, palpable radial pulse. He was triaged as green. The course of treatment in the ED: wound care to the laceration and monitored by nursing staff for several hours, at which time he suddenly became unresponsive. A CT scan revealed a subdural hematoma, and he is in a vegetative state. No attempts were made to find a Spanish-speaking individual to assist in assessing the confusion or pain when he was still conscious.

Instructions:

The Chief Nursing Administrator of your facility has requested a post-action report focusing on the triaging and outcomes of these seven patients. The post-action report should include:

1. An evaluation of the triaging of each patient
2. Was the triaging appropriate or not, and what was the associated rationale? Use evidence/resources to support your assessment.
3. Was there evidence that personal beliefs, values, and ethics affected the health care providers’ approach to triaging the patients?
4. An explanation of the treatment of each patient, and a judgment of whether or not the treatment was futile.
5. The outcome of each patient.
6. How can the outcome be associated with the triage category, the provider’s ethics, and subsequent treatment provided?
7. Any corrective actions that will occur as a result of the event.
8. Include ethical considerations in your corrective actions.

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