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Arab Board Emergency & Disaster Nursing Part 1 study materials
Arab Board Emergency & Disaster Nursing Part 1 study resources

Arab Board Emergency & Disaster Nursing Part 1 practice questions

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Question 1Emergency Nursing Foundations and Triage

During the primary survey of a trauma patient, which action is performed first?

  1. Assessment of the airway Correct answer.
  2. Obtaining a 12-lead electrocardiogram
  3. Insertion of a urinary catheter
  4. Recording a complete medical history

Explanation

The primary survey follows an ABCDE sequence, and airway problems kill faster than any other issue, so airway assessment with cervical spine protection comes first. Vital signs, history and procedures such as catheterisation belong to later phases.

Question 2Emergency Nursing Foundations and Triage

In START mass casualty triage, a casualty who is not walking and who has a respiratory rate of 35 breaths per minute after airway positioning is assigned which category?

  1. Red Correct answer.
  2. Black
  3. Green
  4. Yellow

Explanation

In START triage, any casualty who is not walking and has a respiratory rate above 30 per minute is tagged red (immediate) after airway positioning. The red category reflects a life threat that needs intervention within minutes.

Question 3Emergency Nursing Foundations and Triage

Which patient is most appropriately assigned Emergency Severity Index level 1?

  1. A patient with severe abdominal pain rated 8 out of 10
  2. A patient who is unresponsive and apnoeic Correct answer.
  3. A patient requesting a sick leave certificate
  4. A patient with a displaced ankle fracture and normal vital signs

Explanation

ESI level 1 is reserved for patients who need immediate life-saving intervention, such as resuscitation or control of an airway. Apnoea in an unresponsive patient is such a condition.

Question 4Emergency Nursing Foundations and Triage

In the JumpSTART paediatric mass casualty system, a child remains apnoeic after five rescue breaths and has no palpable pulse. Which triage category applies?

  1. Black Correct answer.
  2. Green
  3. Red
  4. Yellow

Explanation

In JumpSTART, an apnoeic child receives five rescue breaths; if there is still no spontaneous breathing and no palpable pulse, the child is triaged black (deceased or expectant). This reflects injuries incompatible with survival in the mass casualty setting.

Question 5Emergency Nursing Foundations and Triage

Which statement best distinguishes the Emergency Severity Index from the Canadian Triage and Acuity Scale?

  1. ESI has three acuity levels, while CTAS has five acuity levels
  2. ESI adds expected resource use; CTAS uses complaint and time targets Correct answer.
  3. ESI is used only for paediatric patients, while CTAS is used only for adults
  4. ESI is designed for mass casualty incidents, while CTAS is used for everyday hospital triage

Explanation

ESI is a five-level scale that combines acuity with predicted resource consumption, whereas CTAS is a five-level scale driven by presenting complaint and maximum time-to-physician targets. Both are hospital triage systems, not mass casualty systems.

Question 6Emergency Nursing Foundations and Triage

Which element of the SBAR handover contains the action the sender wants the receiver to take?

  1. Recommendation Correct answer.
  2. Situation
  3. Assessment
  4. Background

Explanation

SBAR structures handover as Situation, Background, Assessment and Recommendation. The recommendation states clearly what the sender wants the receiver to do next.

Question 7Emergency Nursing Foundations and Triage

An adult opens the eyes only to painful stimulation, speaks in a confused manner and withdraws the limb from pain. What is the Glasgow Coma Scale score?

  1. 11
  2. 9
  3. 10 Correct answer.
  4. 8

Explanation

Eye opening to pain scores 2, confused conversation scores 4 and withdrawal from pain scores 4, giving a total of 10. The score is the sum of the best eye, verbal and motor responses.

Question 8Emergency Nursing Foundations and Triage

Which finding is the earliest reliable indicator of hypovolaemic shock in an adult trauma patient?

  1. Unrecordable blood pressure
  2. Bradycardia with warm extremities
  3. Absent peripheral pulses
  4. Narrowing of the pulse pressure Correct answer.

Explanation

Compensatory tachycardia and peripheral vasoconstriction narrow the pulse pressure before systolic pressure falls, so narrowing is an early warning sign of hypovolaemia. Absent pulses and unrecordable blood pressure occur in decompensated shock.

Question 9Emergency Nursing Foundations and Triage

Which adult respiratory rate falls within the normal resting range?

  1. 24 breaths per minute
  2. 8 breaths per minute
  3. 14 breaths per minute Correct answer.
  4. 30 breaths per minute

Explanation

The normal adult resting respiratory rate is approximately 12 to 20 breaths per minute, so 14 is within range. Rates of 24 and 30 breaths per minute indicate tachypnoea and should trigger further assessment.

Question 10Emergency Nursing Foundations and Triage

Which intervention is given first to an adult with severe anaphylaxis and airway swelling?

  1. A rapid intravenous bolus of isotonic crystalloid
  2. Nebulised salbutamol repeated every ten minutes
  3. Intravenous hydrocortisone followed by prolonged observation
  4. Intramuscular adrenaline to the thigh Correct answer.

Explanation

Intramuscular adrenaline 1:1000 into the anterolateral thigh is the first-line treatment for anaphylaxis because it reverses airway oedema and vasodilatation within minutes. Steroids, bronchodilators and fluids are adjuncts, not initial therapy.

Question 11Emergency Nursing Foundations and Triage

Which set of findings meets two or more qSOFA criteria in an adult with suspected infection?

  1. Respiratory rate 24, altered mentation, systolic pressure 92 Correct answer.
  2. Respiratory rate 18, normal mentation, systolic pressure 120
  3. Temperature 38.5 degrees Celsius, heart rate 96, white cell count 14
  4. Heart rate 110, temperature 39 degrees Celsius, systolic pressure 110

Explanation

qSOFA uses a respiratory rate of 22 per minute or more, altered mentation and a systolic blood pressure of 100 mmHg or less. Two or more positive criteria identify patients at higher risk of poor outcome from infection.

Question 12Emergency Nursing Foundations and Triage

Which patient meets major trauma criteria and requires the highest level of trauma team activation?

  1. A 30-year-old with a knee laceration after a fall from standing
  2. A 45-year-old with a flail chest after a high-speed collision Correct answer.
  3. A 22-year-old with an isolated wrist sprain after sport
  4. A 60-year-old with a minor head bump and no loss of consciousness

Explanation

Flail chest after high-energy trauma is a major trauma criterion because it signals severe thoracic injury and impending respiratory failure. The other presentations are isolated low-energy injuries.

Question 13Emergency Nursing Foundations and Triage

Which action best preserves forensic evidence in a patient who reports sexual assault?

  1. Place clothing in a paper bag and limit handling Correct answer.
  2. Wash the patient's skin thoroughly before examination
  3. Discard clothing that appears bloodstained
  4. Store swabs in a warm, humid environment

Explanation

Forensic evidence should be preserved in paper containers, handled minimally and documented through a chain of custody. Washing the patient or discarding clothing destroys trace evidence.

Question 14Emergency Nursing Foundations and Triage

An unconscious adult arrives with a life-threatening haemorrhage and no family member can be reached. What is the most appropriate action?

  1. Obtain telephone consent from a hospital administrator
  2. Wait for a court order before any treatment
  3. Withhold treatment until a relative arrives
  4. Treat under implied consent for a life-threatening emergency Correct answer.

Explanation

When an unconscious patient needs urgent treatment and no valid consent or substitute decision-maker is available, the emergency doctrine permits treatment under implied consent. Delaying care to obtain a court order or a distant relative's consent can cause preventable harm.

Question 15Emergency Nursing Foundations and Triage

What is the first step in SALT mass casualty triage?

  1. Perform a full secondary survey on each casualty
  2. Record a complete set of vital signs for every casualty
  3. Ask casualties who can walk to move to a marked area Correct answer.
  4. Attach triage tags before any assessment

Explanation

SALT begins with global sorting: casualties who can walk are moved to a designated area first, then those with purposeful movement or waving, then those who are still or have obvious life threats. Detailed assessment follows this sorting step.

Question 16Emergency Nursing Foundations and Triage

Which triage tag colour is used for a casualty who is dead or whose injuries are incompatible with survival given the available resources?

  1. Black Correct answer.
  2. Red
  3. Yellow
  4. Green

Explanation

The black category, sometimes called expectant, is used for casualties who are dead or whose injuries are incompatible with survival given available resources. It allows scarce resources to be directed to salvageable casualties.

Question 17Emergency Nursing Foundations and Triage

Which measure most directly reduces emergency department overcrowding caused by admitted patients awaiting beds?

  1. Expediting admission of boarders to inpatient beds Correct answer.
  2. Lengthening the triage interview
  3. Reducing the number of triage nurses
  4. Adding chairs to the waiting room

Explanation

Boarding of admitted patients is the main driver of emergency department overcrowding; moving admitted patients to inpatient beds frees assessment space and staff time. Adding chairs or lengthening triage does not increase capacity.

Question 18Emergency Nursing Foundations and Triage

A patient arrives with sudden facial droop and arm weakness. Which action is the priority?

  1. Arrange an outpatient neurology clinic review within a week
  2. Give oral glucose and reassess the patient after one hour
  3. Activate the stroke pathway and note time last seen well Correct answer.
  4. Administer 300 mg of oral aspirin without delay

Explanation

Acute stroke care is time-critical, and activating the stroke pathway while documenting the time last known well determines eligibility for thrombolysis or thrombectomy. Aspirin is withheld until intracranial haemorrhage has been excluded.

Question 19Emergency Nursing Foundations and Triage

Which pair of identifiers is acceptable for patient identification before an emergency procedure?

  1. Bed number and room location
  2. Wristband colour and age
  3. Diagnosis and attending physician
  4. Full name and date of birth Correct answer.

Explanation

Two patient identifiers must be used, typically the full name and date of birth, before any procedure or medication. Bed location, diagnosis, wristband colour and age are not reliable identifiers.

Question 20Emergency Nursing Foundations and Triage

Which term describes the formal adjustment of care standards when demand exceeds resources during a disaster?

  1. Secondary triage
  2. Crisis standards of care Correct answer.
  3. JumpSTART
  4. Benchmarking

Explanation

Crisis standards of care are formally adopted when demand exceeds resources and usual standards cannot be maintained. They provide a transparent and ethical framework for allocating care during a disaster.

Question 21Emergency Nursing Foundations and Triage

A patient arrives after exposure to an unknown chemical powder. What should happen before the patient enters the emergency department?

  1. Decontaminate outside the emergency department before entry Correct answer.
  2. Obtain blood cultures before decontamination
  3. Place the patient in the general waiting area
  4. Give the antidote before any decontamination

Explanation

Patients exposed to an unknown hazardous substance must be decontaminated at the scene or in a dedicated external area before entering the emergency department, to protect staff and other patients. Diagnostic tests and antidotes follow decontamination when safe.

Question 22Emergency Nursing Foundations and Triage

Which presentation is most typical of acute coronary syndrome in an older adult?

  1. Classic crushing chest pain radiating to the left arm
  2. Localised tenderness over the sternum
  3. Isolated high fever with rigors
  4. Sudden confusion or breathlessness without chest pain Correct answer.

Explanation

Older adults often present with atypical symptoms of acute coronary syndrome, such as sudden dyspnoea, confusion, fatigue or syncope, rather than classic chest pain. A high index of suspicion is needed in this population.

Question 23Emergency Nursing Foundations and Triage

Which finding should prompt immediate transfer to a resuscitation bay?

  1. A sprained ankle after sport
  2. A bloody nose with normal vital signs
  3. Stridor and drooling Correct answer.
  4. A repeat prescription request

Explanation

Stridor with drooling suggests upper airway obstruction, such as epiglottitis or a foreign body, and demands immediate transfer to a resuscitation area. The other complaints are non-urgent.

Question 24Emergency Nursing Foundations and Triage

During a mass casualty incident with limited ventilators, which allocation framework is most appropriate?

  1. A random lottery for all patients
  2. First-come, first-served order
  3. Objective scoring that prioritises saving the most lives Correct answer.
  4. Preferential treatment for those able to pay

Explanation

In resource-limited disasters, allocation should be guided by objective, reproducible triage criteria aimed at saving the most lives and should be reassessed as resources change. First-come, ability to pay and lotteries are not accepted frameworks.

Question 25Emergency Nursing Foundations and Triage

Which entry represents the most appropriate triage documentation?

  1. A single acuity score without vital signs
  2. Acuity, vital signs, findings and time of assessment Correct answer.
  3. A note written at the end of the shift
  4. Only the patient's stated complaint

Explanation

Triage documentation should record the acuity level, vital signs, relevant findings and the time of assessment so that decisions can be reviewed and continuity of care maintained. Retrospective or incomplete notes undermine safety and accountability.

Question 26Emergency Nursing Foundations and Triage

What is the main purpose of triage in an emergency department?

  1. To establish a definitive diagnosis before treatment
  2. To register patients in the order they arrive
  3. To rank patients by urgency and allocate care fairly Correct answer.
  4. To decide which specialist will admit the patient

Explanation

Triage sorts patients by medical urgency so that limited resources go first to those who need them most. It does not establish a diagnosis, follow arrival order, or determine the admitting specialty.

Question 27Emergency Nursing Foundations and Triage

During the primary survey of a patient with arterial bleeding from a limb wound, which action comes first?

  1. Obtaining a full medical history
  2. Performing a secondary survey
  3. Controlling the external haemorrhage Correct answer.
  4. Splinting the injured limb

Explanation

The primary survey follows a priority sequence in which catastrophic external haemorrhage is controlled before airway, breathing, and circulation are assessed in detail. History, splinting, and secondary survey come after immediate threats are managed.

Question 28Emergency Nursing Foundations and Triage

In a mass casualty incident, which triage tag colour indicates a casualty who needs immediate life-saving intervention?

  1. Green
  2. Black
  3. Yellow
  4. Red Correct answer.

Explanation

Red tags identify casualties who require immediate intervention to survive. Yellow means delayed care, green means minor injury, and black means deceased or injuries incompatible with survival.

Question 29Emergency Nursing Foundations and Triage

Four adults arrive at triage at the same time. Which patient should be assessed first?

  1. An adult requesting a repeat prescription
  2. An adult with mild abdominal pain lasting three days
  3. An adult with stridor and drooling Correct answer.
  4. An adult with a sprained ankle and normal vital signs

Explanation

Stridor with drooling suggests impending airway obstruction and is an immediate life threat. The other patients have stable or minor problems that can safely wait.

Question 30Emergency Nursing Foundations and Triage

A patient who truly requires level 2 acuity is assigned level 3 during triage. Which term describes this error?

  1. Over-triage
  2. Misregistration
  3. Under-triage Correct answer.
  4. Diversion

Explanation

Under-triage means assigning a lower acuity than the patient's condition warrants, which can delay necessary care. Over-triage is the opposite error, while misregistration and diversion are unrelated to acuity assignment.

Question 31Emergency Nursing Foundations and Triage

Which finding most strongly raises the triage acuity of an adult with abdominal pain?

  1. Vomiting twice at home
  2. Pulse 118 beats/min and cold, clammy skin Correct answer.
  3. Pain score of 4 out of 10
  4. Pain relieved by antacids

Explanation

Tachycardia with cold, clammy skin suggests shock and makes abdominal pain a high-acuity presentation. Moderate pain, vomiting alone, or acid relief are less concerning on their own.

Question 32Emergency Nursing Foundations and Triage

An older adult with a suspected hip fracture is alert but confused and has a systolic blood pressure of 88 mm Hg. Which conclusion is most appropriate for triage?

  1. The low blood pressure is reassuring because it reduces bleeding
  2. The confusion is expected with age and does not affect priority
  3. The patient needs immediate assessment for shock and possible delirium Correct answer.
  4. The patient can wait because hip fractures are not emergencies

Explanation

Hypotension and new confusion in an older adult with a fracture suggest shock and delirium, both of which raise urgency. Age alone does not explain new confusion, and hip fractures can cause major occult blood loss.

Question 33Emergency Nursing Foundations and Triage

A patient becomes unresponsive while waiting in the triage area. Which action is most appropriate?

  1. Ask the patient to sit upright and drink water
  2. Send the patient back to the waiting room
  3. Call for help and start airway and breathing support Correct answer.
  4. Finish the triage form before intervening

Explanation

Unresponsiveness is an immediate threat to airway and breathing, so help must be summoned and resuscitation started at once. Documentation and waiting are secondary to immediate life support.

Question 34Emergency Nursing Foundations and Triage

A patient with a suspected rib fracture reports difficulty breathing. Which finding most increases the urgency of triage?

  1. Pain on deep inspiration
  2. Respiratory rate of 32 breaths/min and oxygen saturation of 89% Correct answer.
  3. A small bruise over the rib
  4. A history of asthma controlled with an inhaler

Explanation

A high respiratory rate with low oxygen saturation indicates inadequate oxygenation and possible respiratory failure, which is high acuity. Local pain, bruising, and controlled asthma are less urgent on their own.

Question 35Emergency Nursing Foundations and Triage

Which factor is most important when deciding how often to reassess a patient in the waiting room?

  1. The number of empty chairs
  2. The patient's triage acuity and clinical course Correct answer.
  3. The patient's arrival time
  4. The patient's insurance status

Explanation

Reassessment intervals are based on acuity and the likelihood of deterioration; sicker or changing patients need more frequent review. Arrival time, seating, and insurance do not determine clinical risk.

Question 36Emergency Nursing Foundations and Triage

Using the Emergency Severity Index, which patient best fits level 2?

  1. A patient needing a simple suture removal
  2. A patient with a suspected ectopic pregnancy and stable vital signs Correct answer.
  3. A patient with a stable ankle sprain needing one resource
  4. A patient in cardiac arrest

Explanation

ESI level 2 is for high-risk situations that are not in imminent danger, such as a suspected ectopic pregnancy. Cardiac arrest is level 1, and simple suture removal or a stable one-resource ankle sprain is lower acuity.

Question 37Emergency Nursing Foundations and Triage

A patient with a suspected cervical spine injury arrives at triage. Which action best protects the airway during initial assessment?

  1. Apply manual in-line stabilisation while assessing breathing Correct answer.
  2. Place a pillow under the head
  3. Delay airway assessment until imaging is available
  4. Ask the patient to flex the neck

Explanation

Manual in-line stabilisation keeps the neck in a neutral position while allowing airway and breathing assessment. Flexing the neck or using a pillow can worsen a spinal injury, and airway assessment must not be delayed.

Question 38Emergency Nursing Foundations and Triage

A woman at 32 weeks of pregnancy arrives with vaginal bleeding. Which triage statement is most appropriate?

  1. She should be sent to the antenatal clinic the next day
  2. She needs prompt assessment because haemorrhage can worsen rapidly Correct answer.
  3. She can wait because fetal viability is not assessed at triage
  4. She is low acuity if her maternal vital signs are normal

Explanation

Vaginal bleeding in late pregnancy can signal placental abruption or praevia and may rapidly cause maternal and fetal compromise. Normal maternal vital signs do not exclude serious bleeding, so prompt assessment is needed.

Question 39Emergency Nursing Foundations and Triage

In START mass casualty triage, which casualty is correctly tagged as delayed (yellow)?

  1. A casualty who is walking and has a minor cut
  2. A casualty who is not breathing after airway repositioning
  3. A casualty with a stable abdominal injury and no signs of shock Correct answer.
  4. A casualty with a respiratory rate of 34 breaths/min and a weak radial pulse

Explanation

In START, yellow means serious but stable enough to wait briefly, such as a stable abdominal injury without shock. Walking casualties are green, those with respiratory rate above 30 or poor perfusion are red, and those not breathing after airway repositioning are black.

Question 40Emergency Nursing Foundations and Triage

Which handover best communicates triage findings to the emergency team?

  1. Omitting triage findings so the team can assess independently
  2. Giving the full past medical history before the chief complaint
  3. Reporting acuity, chief complaint, vital signs, and care given Correct answer.
  4. Reporting only the patient's name and room number

Explanation

A useful triage handover gives a concise summary of acuity, the presenting problem, objective vital signs, and any interventions already provided. This lets the receiving team plan care without losing time.

Question 41Disaster Preparedness, Response, and Recovery

In the four-phase disaster cycle, which phase consists of actions taken before an event to reduce a community's long-term vulnerability?

  1. Response
  2. Recovery
  3. Mitigation Correct answer.
  4. Activation

Explanation

Mitigation covers pre-event measures that reduce or remove long-term risk to people and property, such as enforcing building codes, relocating flood-prone services or hardening infrastructure. Preparedness also occurs before an event but focuses on readiness to respond rather than on reducing the hazard's impact. Response and recovery follow the event itself.

Question 42Disaster Preparedness, Response, and Recovery

In START mass-casualty triage, what tag is given to a casualty who remains apnoeic after the airway is opened?

  1. Black Correct answer.
  2. Yellow
  3. Green
  4. Red

Explanation

START assigns the black (deceased or expectant) tag when a casualty does not breathe after the airway is repositioned, because survival is not expected with the resources available. Breathing casualties with life threats are tagged red, those with delayed needs yellow, and walking wounded green.

Question 43Disaster Preparedness, Response, and Recovery

A patient walks into the emergency department with visible powder on the skin and clothing after an industrial chemical release. What is the priority action?

  1. Obtain a full set of vital signs first
  2. Decontaminate before entry Correct answer.
  3. Draw blood cultures immediately
  4. Direct the patient to the waiting room

Explanation

Contaminated patients must be decontaminated in a designated area outside or at the edge of the treatment zone before entering, so that staff, other patients and the facility are not contaminated. Removing clothing alone eliminates most of the contamination and should be done first, followed by washing.

Question 44Disaster Preparedness, Response, and Recovery

Within the Hospital Incident Command System, which role holds overall authority and accountability for the incident?

  1. Logistics section chief
  2. Incident commander Correct answer.
  3. Public information officer
  4. Safety officer

Explanation

The incident commander sets objectives, approves the action plan and has overall authority for the incident, with section chiefs reporting through the command structure. Other command staff advise or support but do not hold overall authority.

Question 45Disaster Preparedness, Response, and Recovery

Which term describes a facility's ability to rapidly expand resources and services to manage a sudden influx of casualties?

  1. Surge capacity Correct answer.
  2. Standard of care
  3. Triage acuity
  4. Case management

Explanation

Surge capacity is the ability to obtain and use additional staff, beds, supplies and equipment quickly during a mass-casualty event. Surge capability refers more specifically to the ability to manage patients with unusual or specialised needs, such as burns or contamination.

Question 46Disaster Preparedness, Response, and Recovery

Which document defines an organisation's roles, responsibilities and procedures for responding to a declared emergency?

  1. The discharge planning policy
  2. The nursing care plan
  3. The emergency operations plan Correct answer.
  4. The hospital infection prevention manual

Explanation

The emergency operations plan describes the command structure, roles, communication pathways, evacuation procedures and resource arrangements that apply during an emergency. It is exercised and revised through drills and after-action reviews.

Question 47Disaster Preparedness, Response, and Recovery

Which activity best evaluates a hospital's disaster response readiness?

  1. Reviewing staff attendance records
  2. Conducting a simulated mass-casualty exercise Correct answer.
  3. Auditing patient satisfaction scores
  4. Analysing monthly medication error reports for trends

Explanation

A simulated mass-casualty exercise tests the plan, command structure, communication, triage, staffing and logistics under realistic conditions and reveals gaps that documents alone cannot. Findings are then addressed through a corrective action plan.

Question 48Disaster Preparedness, Response, and Recovery

Which action is consistent with psychological first aid in the immediate aftermath of a disaster?

  1. Providing safety, comfort and practical information Correct answer.
  2. Encouraging survivors to avoid discussing the event
  3. Debriefing survivors about traumatic details of the event
  4. Prescribing sedatives to all affected persons

Explanation

Psychological first aid aims to establish safety, stabilise survivors, provide practical information and connect people with support, without pressuring them to recount the trauma. Mandatory psychological debriefing is not recommended because it may worsen distress.

Question 49Disaster Preparedness, Response, and Recovery

A hospital uses a hazard vulnerability analysis to rank risks. Which set of factors most appropriately determines a hazard's priority?

  1. Probability, impact, preparedness Correct answer.
  2. Season of year, geographic location and bed count
  3. Cost, staffing and media interest
  4. Bed count, budget and staff mix

Explanation

Hazard vulnerability analysis scores each hazard on the likelihood of occurrence, the human and operational impact, and the organisation's current preparedness or vulnerability. Combining these elements yields a relative risk that guides planning and resource allocation.

Question 50Disaster Preparedness, Response, and Recovery

When crisis standards of care are formally activated during a disaster, clinicians are expected to:

  1. give priority to patients who arrive at the facility first
  2. continue delivering usual care until every resource in the hospital is exhausted
  3. allow each clinician to decide independently which patient receives care
  4. allocate scarce resources using an approved, transparent scoring framework Correct answer.

Explanation

Crisis standards of care replace usual standards with a formally adopted, publicly transparent framework that allocates scarce resources according to objective criteria such as short-term survival benefit. Consistency, fairness and documentation are central, and decisions are made at system rather than individual clinician level.