1. Terrorists Strike Back at the Federal Courthouse An Exercise in Emergency Triage

2. A highly publicized trial of a suspect with possible terrorist links is set to take place in your community at the local Courthouse. On the day of opening arguments the courtroom is packed and overflowing. You are standing on the lawn in front of the Courthouse waiting with others who also could not get seats for the local “Trial-of-the-Century”.

3. Suddenly, an explosion is heard from inside the Courthouse. Soon after, people begin pouring from the exits. Many are panicked, wounded, and in obvious distress. Putting all of your previous training into action, you immediately set up a triage area.

4. In talking with the victims, you learn more about the events that have taken place. Not only did a bomb explode in the courtroom, but as people were exiting from a main hallway, a secondary device on a time delay, hidden inside a trash can, released an unknown gas. A few of the victims noted a smell similar to “bitter almonds”.

5. Patient # 1 Unconscious Profuse bleeding from laceration on temple Labored respirations

6. Patient # 2 Ambulatory Increased heart rate Visibly agitated Alert and orientated Respirations- 15 rpm

7. Patient # 3 Disoriented 30 respirations per minute Red skin tone N&V

8. Patient # 4 Unconscious No respirations for > 5 min No pulse present

9. Patient # 5 Ambulatory Mild headache Nausea Dizziness Superficial cuts on arms and hands

10. Patient # 6 Ambulatory Superficial lacerations on face and arms Moderate burns to <10% BSA Hyperventilation Headache

11. Patient # 7 Unconscious Irregular, rapid, shallow breathing Red tint to skin Capillary refill > 2 seconds

12. Patient # 8 Conscious Severed arm with profuse bleeding Severe burns to left side of body Disoriented

13. Patient # 9 Walking and talking Pulse present Respirations- 20 rpm Agitated, but orientated X 3

14. Patient # 10 Ambulatory Mild headache N&V Increased respirations

15. Patient # 11 Non-ambulatory Broken arm and wrist Penetrating leg wound profusely bleeding No change in mental status

16. Patient # 12 No pulse No respirations Cold extremities

17. Patient # 13 Ambulatory Oriented with visible agitation Complains of nausea and indistinct pain Patient is aggressive and demands treatment. He states he knows that he caught a whiff of the gas and is going to go into convulsions any minute.

18. Patient # 14 Ambulatory Heaviness of arms and legs Reddening of eyes Pupil dilation Headache N&V

19. Patient # 15 Contusion to head Severe burns over head, arms and chest Convulsions Respiratory distress

20. Patient # 16 Ambulatory Oriented Increased heart rate Physical “guarding” of abdomen Complains of severe stomach pain SOB

21. Patient # 17 Heart pains Irritation of nose, throat, and mouth Weak irregular heart beat Malaise

22. Patient # 18 Blue tint to skin Loss of consciousness Radial pulse not palpable

23. Patient # 19 Convulsions Minor burns to 15% of body Apnea Reddish skin tone

24. Patient # 20 Deep lacerations throughout body lacking profuse bleeding Capillary refill time > 2 seconds Shallow, intermittent respirations Non-ambulatory Delirious

25. Patient # 21 Ambulatory Mild headache Nausea Dizziness Superficial cuts on arms and hands

26. Patient # 22 Labored respirations Sharp chest pain radiating down left arm Difficulty talking

27. Patient # 23 Labored respiration with gradual improvement Dizziness Malaise Weak, irregular heart beat

28. Patient # 24 Ambulatory Minor abrasions to left arm and leg Moderate burns to right side of body Slight hearing impairment

29. Patient # 25 Walking and talking Oriented X 3 Radial pulse present- slightly elevated Respirations WNL

30. Patient # 26 Gasping breaths Convulsions Altered mental status Mydriasis

31. Patient # 27 Non-ambulatory Severe abdominal pain Loss of hearing Broken leg

32. Patient # 28 Not responsive No radial pulse present No respirations Cold extremities

33. Patient # 29 Convulsions Minor burns and lacerations Cherry red lips Rapid respirations

34. Patient # 30 Ambulatory Headache Hyperventilation Complains extremities feel “heavy”

35. Patient # 31 Infant Bleeding from ears Moderate burns over 15% BSA including face

36. Patient # 32 Major burns to >75% BSA Delirium Rapid, shallow respirations Multiple severe lacerations with little bleeding

37. Patient # 33 Minor abrasions and burns to forearms Dazed Ambulatory

38. Patient # 34 Irritation of nose, throat and mouth Labored respirations gradually improving without treatment Reddening of eyes Weak, irregular heartbeat N&V

39. Patient # 35 Unconscious Convulsions Cherry red lips and skin Deep breathing

40. Patient # 36 Short, gasping breaths Weak irregular heart beat N&V Mydriasis LOC

41. Patient # 37 Ambulatory Oriented with visible agitation 20 respirations per minute Capillary refill < 2 min Superficial abrasions to palms of hands

42. Patient # 38 Ambulatory Reddening of eyes Malaise HA Irritation of nose, mouth and throat

43. Patient # 39 Blue tint to skin Weak, intermittent heart beat Shallow, gasping intermittent breaths Convulsions Loss of consciousness

44. Patient # 40 Contusion to head Severe burns over head, arms and chest Convulsions Respiratory distress

45. Patient # 41 Ambulatory No altered mental status Minor lacerations on right thigh and right forearm with mild bleeding Minor contusion to forehead Intact hearing

46. Patient # 42 Brought in on stretcher Labored respirations Abdominal pain and guarding Profusely bleeding head wound Broken leg with bone protrusion through skin

47. Patient # 43 Non-ambulatory Apnea Reddening of eyes N&V Disoriented

48. Patient # 44 Ambulatory Weak, irregular heart beat Dizziness Headache Nausea

49. Patient # 45 Infant Deep laceration above eye with poor bleeding Blue tint to skin Not responsive Shallow breaths

50. Patient # 46 Ambulatory Irritation of nose, mouth and throat Deep, labored breathing Headache Sudden progression to convulsions and LOC during examination

51. Patient # 47 Ambulatory Minor abrasions to left arm and leg Minor burns to right side of body Slight hearing impairment

52. Patient # 48 Short, gasping breaths Weak irregular heart beat N&V Mydriasis LOC

53. Patient # 49 Non-ambulatory Gaping head wound spurting blood Unresponsive Broken arm Sprained wrist

54. Patient # 50 Non-ambulatory Broken leg Sprained ankle Minor abrasions to left shoulder and arm Alert and oriented

55. Patient # 51 Convulsing Major burns to right forearm and hand Severed right leg spurting blood Moderate abrasions to left side of body

56. Patient # 52 Ambulatory Oriented Improving headache Nausea Dizziness

57. Patient # 53 Deep lacerations throughout body lacking profuse bleeding Capillary refill time > 2 seconds Shallow, intermittent respirations Non-ambulatory Delirious

58. Patient # 54 Ambulatory Minor laceration on right leg N&V Hyperventilation Headache

59. Patient # 55 Convulsions Minor burns to 15% of body Apnea Reddish skin tone

60. Patient # 56 Non-ambulatory Severe abdominal pain Loss of hearing Broken leg

61. Patient # 57 Irritation of nose, throat and mouth Labored respirations gradually improving without treatment Reddening of eyes Weak, irregular heartbeat N&V

62. Patient # 58 Unconscious Irregular, rapid, shallow breathing Red tint to skin Capillary refill > 2 seconds

63. Patient # 59 Labored respirations with gradual improvement Dizziness Malaise Weak, irregular heart beat

64. Patient #60 Nonambulatory Very confused No physical injury apparent Smells of alcohol Slurred speech

65. Patient #61 Badly sprained ankle Deep cut on right shoulder, bleeding profusely Bruising on forehead

66. Patient #62 Legs badly crushed Unconscious Labored breathing

67. Patient #63 No physical injuries apparent Eager to help very emotional

68. Patient #64 Elderly patient with chest tightness Left arm tingling Complains of headache nausea

69. Patient #65 Minor burns Difficulty breathing Coughing

70. Patient #66 Shortness of breath Right leg hurts Limping

71. Patient #67 Shortness of breath Cannot see Minor scrapes and bruises

72. Patient #68 Missing 2 fingers on left hand Shortness of breath Rapid respirations Minor bruising on head

73. Patient #69 Blunt force trauma to head No bleeding Confused and agitated

74. Patient #70 Cradling right arm, apparent fracture Deep cut on right cheek Complains of severe pain

75. Patient #71 Hyperextended right knee Severe pain

76. Patient #72 Burns to upper face and torso Severe pain Shortness of breath

77. Patient #73 Pain in abdomen Minor burns to arms Difficulty breathing

78. Patient #74 >60 BSA covered with burns Patient reports feeling no pain Difficulty breathing

79. Patient #75 Bleeding from right ear Unconscious Barely breathing

80. Patient #76 Pencil stuck through right arm Bleeding under control

81. Patient #77 Minor scraps and bruises Complains of severe pain Demands pain medication

82. Patient #78 Unconscious patient now alert Very confused No bleeding or apparent injuries

83. Patient #79 Unconscious Bleeding from nose Swelling abdomen

84. Patient # 80 Unconscious Apnea Contusion to head above left eye Reddish tint to skin Pupil dilation Laceration of left arm with moderate bleeding