Healthcare providers must make moral decisions based on ethical considerations. Ethics in the healthcare sector guide decision-making, especially in emergencies such as managing patients due to a mass causality incident. Triaging is a practical and critical principle in managing significant emergencies. It is the process of categorizing, prioritizing, and classifying patients and injured people based on their urgency of getting treatment (Bazyar et al., 2019). Triage works on the premise that patients who have a threat to life must be treated before other patients. The paper shall provide a post-action report on triaging and outcomes of the seven patients involved in a mass causality shooting at a local grocery store, including judging whether treatment or not the treatment was futile.
First patient
Triage evaluation, personal beliefs, values, and ethics: the first client is a pregnant female, 32 years of age, with a gestation of 36 weeks. The patient presented to the emergency department in an alert and oriented state with a respiratory rate of 25 breaths per minute, radial pulses palpable, and complaints of abdominal pain after being trampled during the incident. The first response at the scene used a simple triage and rapid treatment whereby the injured victims were triaged using color codes. In this case, the 32-year-old pregnant lady had a green tag indicating minor injuries in patients who can walk. Considering that she was pregnant, she should have been labeled with a yellow tag which means that one has serious injuries but not immediately life-threatening. The patient presented with abdominal pain, which could indicate blunt trauma. The outcomes of trauma in pregnancy include preterm labor and preterm delivery, uterine rupture, or placental abruption (Greco et al., 2019). The personal beliefs of the health care provider who attended to her altered her decision-making, leading to discharging the patient after 24 hours since the patient and fetus survived. An obstetric gynecologist should have been informed to review the patient before her discharge.
Treatment: the client was treated with extensive human and non-human resources, which were used to assess the condition of the patient and the fetus. According to Tasneem et al. (2021), trauma during pregnancy is the leading cause of fetal demise and non-obstetrics-related mortality. Although the client and fetus survived, the 32-year-old is likely to experience complications after discharge; therefore, she should have undergone further examination by an obstetric gynecologist.
Outcome: the 32-year-old pregnant lady was discharged after 24 hours; however, the outcome could have been worse following inappropriate color coding. The client can, however, experience further complications after discharge since she never underwent a detailed examination by an obstetric gynecologist.
Corrective action: although the case did not have any unethical actions made, the facility needs to do a follow-up to prevent any complications such as placenta abruption.
Second patient
Triage evaluation, personal beliefs, values, and ethics: the 45-year-old Caucasian female was triaged as red which is correct considering her unconscious condition and a gunshot to the right chest. The healthcare providers’ response was right at first, but after noticing that she was the shooter, they stopped providing unethical care. The emergency healthcare provider should treat criminals or suspects with the same respect and attention accorded to other patients. The ED healthcare providers let their personal beliefs guide their judgment regarding patient care.
Patient outcome: the patient did not survive due to the ED’s healthcare providers’ ignorance about the client being the shooter.
Corrective action: the chief nursing administrator must hold meetings with the ED healthcare providers and remind them about ethics whereby all patients should be treated equally despite being criminals or suspects.
Third patient
Triage evaluation, personal beliefs, values, and ethics: the 52-year-old Caucasian female was color coded effectively since she had a gunshot wound to the right leg, and respirations were shallow at 40 beats per minute with no palpable radial pulse.
Patient outcome: the course of treatment was quite aggressive, which helped to stabilize the patient. The patient is stable and recovering in the ICU.
Corrective action: the healthcare providers at the ED need to be sensitized about the corrective use of personal protective equipment, considering that they experienced fear after noticing that the patient is HIV positive.
Fourth patient
Triage evaluation, personal beliefs, values, and ethics: the fourth patient is a 45-year-old African American male Iraqi war veteran with a history of PTSD. Although the patient had no visible injuries, he should have been labeled red since he was hyperventilating at 45 breaths per minute. The literature states that patients with a respiratory rate of more than 30 breaths per minute should be assigned red tags.
Patient outcome: the patient was observed for several hours and released to the police since he allegedly shot the perpetrator. The ED staff should have monitored him further to identify the cause of tachypnea if he had been color coded effectively.
Corrective action: considering the patient’s history of PTSD, a therapist should have been assigned to the patient to help with counseling.
Fifth patient
Triage evaluation, personal beliefs, values, and ethics: the first patient is a six-year-old who presented with a gunshot wound to the abdomen, unconscious, and the radical pulse was not palpable. The triaging was appropriate, considering the presentation of the client.
Patient outcome: the patient did not survive despite the extensive treatment provided by the ED staff. Treatment was futile.
Corrective action: there are no ethical concerns since the ED staff provided the patient with extensive treatment.
Sixth patient
Triage evaluation, personal beliefs, values, and ethics: the 29-year-old Hispanic female, the mother to the six-year-old patient, presented with an open fracture, respirations at 40 breaths per minute, and hysterically screaming for her child was labeled with a yellow tag. Considering her respirations, she should have been labeled with a red tag.
Patient outcome: the patient was treated effectively with wound care and stabilization of the fractured leg after administration of a sedative; hence stable and recovering at the medical/surgical unit.
Corrective action: the ED should have informed her about her child, which indicates poor judgment among ED staff.
Seventh patient
Triage evaluation, personal beliefs, values, and ethics: the last patient is a Spanish-speaking migrant who appears to be in his 50s. He was labeled with a green tag which is incorrect considering that he had a laceration on his forehead and respirations of 30 breaths per minute. He would have been labeled with a red tag. Also, the ED staff should have valued the patient since they were not bothered to look for a translator considering the patient could not communicate verbally due to the language barrier.
Patient outcome: The patient outcome is not pleasing, considering that when the patient was responsive when brought to the ED, he changed into a vegetative state due to ignorance. The patient outcome could have been positive if the nursing staff at the ED had looked for a translator.
Corrective action: the facility should employ translators to help in cases of a language barrier (Labaf et al., 2019).
References
Bazyar, J., Farrokhi, M., & Khankeh, H. (2019). Triage Systems in Mass Casualty Incidents and Disasters: A Review Study with A Worldwide Approach. Open Access Macedonian Journal of Medical Sciences, 7(3), 482–494. https://doi.org/10.3889/oamjms.2019.119
Greco, P. S., Day, L. J., & Pearlman, M. D. (2019). Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstetrics &Amp; Gynecology, 134(6), 1343–1357. https://doi.org/10.1097/aog.0000000000003585
Labaf, A., Shahvaraninasab, A., Baradaran, H., Seyedhosseini, J., & Jahanshir, A. (2019). The Effect of Language Barrier and Non-professional Interpreters on the Accuracy of Patient-physician Communication in Emergency Department. Advanced journal of emergency medicine, 3(4), e38. https://doi.org/10.22114/ajem.v0i0.123
Tasneem, B., Fox, D., & Akhter, S. (2021). Blunt Abdominal Trauma in the Third Trimester: Eight Departments, Two Patients, One Survivor. Cureus. https://doi.org/10.7759/cureus.16688
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