Mass casualty bus crash — START triage, incident command and population ethics

Triage framework (5 marks). I activate the hospital disaster plan and establish perimeter triage. I use START (Simple Triage and Rapid Treatment) or preferably SALT (Sort, Assess, Lifesaving interventions, Treatment/Transport) as the national-style mass-casualty system. Categories are Immediate (red) — life-threatening but salvageable with rapid intervention; Delayed (yellow) — serious injuries that can wait hours; Minimal (green) — walking wounded; Expectant (grey/black) — unsurvivable given current resources. START decisions use respirations, perfusion (radial pulse/cap refill) and mental status in under 60 seconds per patient. I retriage continuously as resources change. I remember the first patients through the door are often the least injured; the critically injured arrive later by ambulance.^[1][2]

Incident command (5 marks). I implement the Incident Command System. The Incident Commander coordinates and does not treat patients — a commander who treats loses the overview. Operations manages clinical streams; planning tracks capacity; logistics supplies; finance/admin tracks costs and documentation. I freeze elective work, open overflow, notify ICU/theatre/blood bank, and control media and family flows. If CBRNE is possible I lock down and decontaminate before ED entry.^[3]

Ethical shift (5 marks). Care shifts from the individual best interest to the greatest good for the greatest number (population / crisis standards of care). Expectant categorisation is explicit, documented and reversible if resources improve. Resource-intensive interventions of marginal benefit are deferred so more salvageable lives can be saved. Communication with staff and public must be honest about the temporary standard.^[3]