Three Casualties, One Ambulance: Triage at a Rice Mill Dust Flash Fire
A dust flash fire in a rice mill injures three workers. Casualty A is a 45-year-old man who is walking and talking, with singed nasal hair, a hoarse voice, and a cough. Casualty B is a 30-year-old woman with partial-thickness burns over about 25% of her arms and chest; she is pale, BP 90/60, pulse 130. Casualty C is a 22-year-old man who is unconscious with snoring respirations and burns over about 40% of his body; his face and neck are swollen. One ambulance is 15 minutes away and can take one stretcher patient; a police van can carry one seated patient. Two first aiders are on scene, including you. The mill's dust is still settling, and the power is off.
1. Using a simple triage approach, assign priorities to A, B, and C and justify each.
Read the worked answer
Triage. Use a simple priority system. Casualty C is immediate: unconscious, snoring respirations, facial swelling, and 40% burns indicate airway obstruction and inhalation injury. Casualty B is immediate/urgent: 25% burns with hypotension and tachycardia indicate shock. Casualty A is delayed but high-risk: he is walking, but singed nasal hair and hoarseness suggest inhalation injury that can worsen. Reasoning. Triage is not just 'who looks worst'; C has the most immediate threat to airway and breathing, B has circulatory compromise, and A needs close observation because airway edema can develop. Reassess A frequently and upgrade if his voice changes or breathing worsens.
2. What immediate first aid would you provide to each casualty before transfer?
Read the worked answer
C: open the airway with a head-tilt/chin-lift or jaw thrust if trauma, suction, give oxygen, and be ready for rescue breathing; cover burns with dry sterile dressings and keep him warm. B: cover burns with clean dry dressings, give oxygen, lay flat if tolerated, keep warm, and monitor for shock; do not apply ice or ointments. A: sit upright, give oxygen, keep calm, and monitor voice and breathing; do not send him away because he is walking. Reasoning. C needs airway support first, B needs burn and shock care, and A needs inhalation-injury monitoring. All need contamination removed and burns cooled only with clean water if trained, not ice.
3. Sequence the transfer and describe the handover and recordkeeping.
Read the worked answer
Transfer sequence. Call for a second ambulance immediately. If only one ambulance is available, send C by ambulance with a first aider because he needs airway support. Send A by police van seated with a responsible escort and oxygen if portable, because he can sit but has an airway risk. Keep B with the remaining first aider, lying flat and warm, until the second ambulance arrives; do not put B in a police van in shock. Handover. Give times, burn size, airway findings, vitals, oxygen, and treatments. Documentation. Record triage category, times, transfer destination, and who accompanied each patient. Reasoning. The decision balances immediate airway threat, shock, and transport resources; the sickest patient gets the limited ambulance, but A must not be left unmonitored.