Triage Theo
In a mass casualty event, the sickest client doesn't always go first — resources go where they can save the most lives
Try 5 free Disaster Triage & Prioritization questions
Try a free question
During mass casualty triage, a victim has agonal respirations, no pulse, and does not improve after one airway repositioning attempt. This victim should be tagged:
Answer it, read the rationale, then keep practicing Disaster Triage & Prioritization — free.
Want Triage Theo and all 158 characters on paper?
The Recall Binder collects every story, 659 flashcards and 580 practice questions in one printable PDF.
See the Recall BinderMeet the character
Triage Theo
Disaster Triage & Prioritization
In a mass casualty event, the sickest client doesn't always go first — resources go where they can save the most lives
Twelve casualties arrive within ten minutes of a highway pileup, and Theo has one physician, two nurses and a single trauma bay. He has seconds to sort who gets seen first.
mnemonurse.com
The story
Twelve casualties arrive within ten minutes of a highway pileup, and Theo has one physician, two nurses and a single trauma bay. He has seconds to sort who gets seen first.
Theo is the charge nurse when a multi-vehicle crash sends a wave of casualties to a small emergency department at once. Disaster triage flips everyday priority thinking: instead of treating whoever is sickest first, the goal is doing the greatest good for the greatest number, so victims are sorted into color-coded categories using rapid criteria such as the ability to walk, breathe and follow commands. Clients unlikely to survive even with maximal intervention are tagged black (expectant), a decision that feels wrong until you understand the math of scarce resources.
The full story of Triage Theo
Theo built a distinguished career as an air traffic controller before transitioning into emergency nursing, and his colleagues nicknamed him Triage Theo for his uncanny, almost eerie ability to rapidly sort chaotic, competing priorities into a clear, workable sequence under intense pressure. Just as he once decided within seconds which incoming aircraft needed immediate runway clearance, Theo now applies that same rapid, high-stakes sorting instinct to sorting human casualties during overwhelming emergencies. Disaster triage fundamentally inverts everyday clinical thinking, shifting the guiding principle away from treating whichever single client appears sickest first, toward achieving the greatest possible good for the greatest possible number of victims given genuinely scarce and finite available resources.
On an unusually chaotic Friday evening, a devastating multi-vehicle pileup on the nearby interstate sends twelve critically injured casualties pouring into Theo's small rural emergency department almost simultaneously, all arriving within roughly ten minutes of each other. Theo, serving as charge nurse that overwhelmed night, finds himself with only one physician, two available nurses, and a single functional trauma bay to somehow manage this sudden surge. There is no time whatsoever for detailed, comprehensive individual assessments; instead, Theo must apply the rapid START triage algorithm, evaluating each victim's ability to walk independently, their respiratory rate, their capillary refill or palpable pulse, and their ability to follow simple verbal commands within mere seconds per person.
Moving methodically down the growing line of casualties, Theo encounters one victim exhibiting only agonal, irregular gasping respirations with absolutely no palpable pulse anywhere, and completely unresponsive, fixed pupils despite Theo's immediate attempt at repositioning the airway. Just steps away, another victim has a visibly threatened, partially obstructed airway but remains breathing independently and still responds purposefully to painful stimuli. This gut-wrenching moment represents disaster triage at its most difficult, because the physiologically sound decision runs directly counter to Theo's every instinct as a compassionate nurse trained to help the most critically injured client first, regardless of the broader resource picture around him.
Theo swiftly tags the ambulatory, minimally injured victims green, designating them safely as the walking wounded who can reasonably wait. Following strict START protocol, he tags the pulseless, apneic victim black, or expectant, only after that single failed airway repositioning attempt confirms survival is genuinely unlikely even with every available resource thrown at the case. He immediately tags the victim with the threatened but still functioning airway red, directing immediate hands-on treatment their way without any further delay. Throughout the unfolding chaos, Theo continuously directs his limited remaining staff to repeatedly reassess every yellow-tagged, delayed victim, understanding fully that any single individual's triage category can shift rapidly as both their condition and the department's available resources continue evolving.
Remember Triage Theo whenever the NCLEX presents a disaster or mass casualty scenario: his air traffic controller background is your cue that rapid sorting for the greatest collective good, not individual-focused prioritization, governs every single decision in this specific context. Lock in firmly that black, or expectant, means a victim is unlikely to survive even given maximal available resources, freeing scarce staff and supplies for those who genuinely stand a realistic chance. Anchor that red means immediate, life-threatening yet survivable injuries requiring urgent treatment right away. And never forget Theo's most important ongoing lesson, that every single triage tag remains fluid and must be continuously reassessed as both victim conditions and available resources inevitably shift throughout the unfolding disaster response.
Story arc
The setup
A multi-vehicle crash overwhelms Theo's rural emergency department with a dozen casualties and minimal staff to match.
The turn
Theo quickly assesses each victim's ability to walk, respiratory rate, capillary refill and ability to follow simple commands.
The crisis
One victim has agonal, gasping respirations with no palpable pulse and unresponsive pupils despite airway repositioning, while another has a threatened airway but is still breathing and responsive to pain.
The save
Theo tags the walking wounded green, sends the unresponsive non-breathing victim to black after one airway repositioning attempt fails, tags the victim with the threatened airway red for immediate treatment, and directs staff to reassess yellow-tagged victims frequently as resources free up.
0 of 4 story beats read (0%)Saved on this device — sign in to sync
More characters
Acidotic Andy
Metabolic Acidosis
Alkalotic Alice
Metabolic Alkalosis
Retaining Ray
Respiratory Acidosis
Panicking Pam
Respiratory Alkalosis
Potassium Pete
Hyperkalemia
Low-K Lena
Hypokalemia
Salty Sal
Hypernatremia
Diluted Dana
Hyponatremia / SIADH
Chvostek Chuck
Hypocalcemia
Stony Stella
Hypercalcemia
Magnesium Maggie
Magnesium Imbalance
Septic Sam
Distributive Shock
Pumpless Paul
Cardiogenic Shock
Bleeding Bea
Hypovolemic Shock
Anaphylactic Ana
Anaphylaxis
Embolic Emma
Pulmonary Embolism
Rigid Rita
ARDS
Wheezing Wanda
Asthma Exacerbation
Consolidated Carl
Pneumonia
Vented Vince
Mechanical Ventilation
Ketone Kyle
Diabetic Ketoacidosis
Hyperosmolar Hank
Hyperosmolar Hyperglycemic State
Shaky Shawna
Hypoglycemia
Storming Tori
Thyroid Storm
Sluggish Myra
Myxedema Coma
Addison Ada
Adrenal Crisis
Cushing Cora
Cushing's Syndrome
Dry Dwayne
Diabetes Insipidus
Pressured Priya
Increased Intracranial Pressure
Stroke Stan
Ischemic Stroke
Seizing Simone
Seizures & Status Epilepticus
Failing Frank
Heart Failure
Infarcting Ivan
Myocardial Infarction
Fibrillating Fay
Atrial Fibrillation
Warfarin Wally
Anticoagulation
Ammonia Amy
Cirrhosis & Hepatic Encephalopathy
Anuric Alan
Acute Kidney Injury
Digoxin Dot
Digoxin Toxicity
Preeclamptic Penny
Preeclampsia & Magnesium Sulfate
Pancreatic Pablo
Acute Pancreatitis
Sober Sully
Alcohol Withdrawal & Delirium Tremens
Manic Mia
Bipolar Mania & Lithium Toxicity
Voices Victor
Schizophrenia & Antipsychotic Side Effects (EPS, NMS, tardive dyskinesia)
Sinking Sadie
Major Depression & Suicide Risk
Flashback Felix
PTSD & Panic Disorder
Narcan Nate
Opioid Overdose & Withdrawal
Mirror Mila
Anorexia Nervosa & Refeeding Syndrome
Serotonin Sylvia
Serotonin Syndrome
Wheezy Winnie
Bronchiolitis & RSV
Sickled Simon
Sickle Cell Vaso-Occlusive Crisis
Cystic Cassie
Cystic Fibrosis
Strawberry Kai
Kawasaki Disease
Telescope Tommy
Intussusception
Droopy Dani
Infant Dehydration & Gastroenteritis
Leaded Liam
Lead Poisoning
Gushing Gwen
Postpartum Hemorrhage & Uterine Atony
Previa Paula
Placenta Previa
Abrupting Abby
Placental Abruption
Sugary Selena
Gestational Diabetes
Decel Dina
Fetal Heart Rate Decelerations & Intrapartum Monitoring
Yellow Yusuf
Newborn Hyperbilirubinemia & Phototherapy
Cord Callie
Umbilical Cord Prolapse
Feverish Fiona
Postpartum Infection & Mastitis
Neutropenic Nia
Neutropenia & Chemotherapy Precautions
Lysing Luis
Tumor Lysis Syndrome
Transfusing Tina
Blood Transfusion Reactions
Clotless Clara
Disseminated Intravascular Coagulation
Pale Priscilla
Iron Deficiency Anemia
Spore Sean
Clostridioides difficile & Isolation Precautions
CD4 Hana
HIV & Opportunistic Infections
Butterfly Bella
Systemic Lupus Erythematosus
Compartment Cody
Fractures & Compartment Syndrome
Reflexive Rex
Spinal Cord Injury & Autonomic Dysreflexia
Myasthenic Marge
Myasthenia Gravis & Myasthenic Crisis
Tremor Tomas
Parkinson's Disease
Barrel Bart
COPD
Tarry Tara
Upper GI Bleed & Peptic Ulcer Disease
Blocked Bruno
Bowel Obstruction
Crisis Camila
Hypertensive Crisis
Aneurysm Arturo
Abdominal Aortic Aneurysm
Claudicating Clara
Peripheral Arterial Disease vs Venous Insufficiency
Endocarditis Eli
Infective Endocarditis
Pericardial Pearl
Pericarditis & Cardiac Tamponade
Valve Vera
Valvular Heart Disease & Rheumatic Fever
Paced Pia
Pacemakers & ICDs
Clotted Cliff
Deep Vein Thrombosis & VTE Prevention
Appendix Annie
Appendicitis & Peritonitis
Gallstone Gina
Cholecystitis & Cholelithiasis
Crohn's Colin
Inflammatory Bowel Disease (Crohn's vs Ulcerative Colitis)
Diverticular Dee
Diverticulitis
Hepatitis Hugo
Viral Hepatitis A, B & C
Dialysis Dina
Chronic Kidney Disease & Hemodialysis
Kidney Kwame
UTI & Pyelonephritis
Prostate Percy
BPH & TURP Care
Burned Bella
Burns & Fluid Resuscitation
Ulcer Uma
Pressure Injury Staging & Prevention
Confused Connie
Delirium vs Dementia & Restraint Alternatives
Delegating Deb
Delegation, Assignment & Scope of Practice
Insulin Ike
Insulin Types, Peaks & Administration Safety
Consent Carmen
Informed Consent, Advance Directives & Privacy
ACE Angie
ACE Inhibitors: Cough, Angioedema & Hyperkalemia
Beta Betty
Beta Blockers: Apical Pulse, Masked Hypoglycemia & Rebound
Lasix Larry
Loop Diuretics: Hypokalemia & Ototoxicity
Lithium Lila
Lithium: Therapeutic Levels, Toxicity & Sodium Balance
Tyramine Tessa
MAOIs & the Tyramine Hypertensive Crisis
Nitro Nina
Nitroglycerin: Sublingual Rules, Headache & Dangerous Combinations
Heparin Holly
Heparin: aPTT, Protamine Sulfate & HIT
Phenytoin Phil
Phenytoin: Narrow Range, Nystagmus & Gummy Smiles
Rhabdo Rory
Rhabdomyolysis: Tea-Colored Urine, Potassium & Kidney Rescue
Osteo Opal
Osteoporosis: Silent Bone Loss, Fall Prevention & Bisphosphonates
Glaucoma Gloria
Glaucoma: Silent Peripheral Loss vs Acute Angle-Closure Emergency
Meningitis Mia
Bacterial Meningitis: Stiff Neck, Droplet Precautions & Rapid Antibiotics
Sclerosis Sadie
Multiple Sclerosis: Demyelination, Relapses & Heat Intolerance
Gout Gus
Gout: Uric Acid Crystals, the Angry Big Toe & Purine Teaching
Meniere Mira
Meniere's Disease: Vertigo, Tinnitus & Hearing Loss
Rheumatoid Rosa
Rheumatoid Arthritis: Symmetric Joints, Morning Stiffness & DMARDs
Obsessive Owen
OCD: Obsessions, Compulsions & Anxiety Relief
Hyperemesis Hazel
Hyperemesis Gravidarum: Vomiting, Ketones & Dehydration
Mastitis Mabel
Mastitis: Flu-Like Fever, a Red Wedge & Keep Nursing
Nephrotic Nolan
Childhood Nephrotic Syndrome: Puffy Eyes, Frothy Urine & Protein Loss
Phosphate Franklin
Phosphorus Imbalance: The Calcium See-Saw & Binders With Meals
Overloaded Olive
Fluid Volume Overload: Crackles, Bounding Pulse & Stop the Infusion
Collapsing Callum
Tension Pneumothorax & Chest Tubes: Tracheal Deviation and the Water Seal
Ascending Abe
Guillain-Barré Syndrome: Weakness That Climbs Toward the Lungs
Sundowning Sid
Alzheimer's Disease: Sundowning, Safety and Calm Redirection
Quarantined Quinn
Tuberculosis: Airborne Precautions, Rifampin and the Orange Secret
Croupy Cora
Croup vs Epiglottitis: The Barking Cough and the Child You Never Lie Down
Fractured Frida
Hip Fracture & Fat Embolism: The Shortened Leg and the Confusion That Follows
Shingles Sheila
Herpes Zoster: The One-Sided Band of Blisters and Airborne Rules
Warfarin Winnie
Warfarin & INR: Vitamin K, Bleeding Precautions and the Salad Problem
Slow-Drip Delia
IV Potassium Safety: Never Push, Always Dilute, Always Pump
Central Line Cesar
Central Lines & Air Embolism: Clamp It, Position It, Protect It
Infiltrated Ivy
Infiltration vs Extravasation vs Phlebitis: Cool and Swollen or Red and Warm
Trach Tomas
Tracheostomy & Suctioning Safety: Oxygenate First, Suction Out Only
Feeding Fiona
Enteral Feeding & Aspiration Prevention: Head of Bed Up, Placement Verified
Steroid Stan
Corticosteroid Therapy: Never Stop Abruptly, Watch Sugar and Hidden Infection
Levo Lucy
Levothyroxine: Empty Stomach, Same Time, Lifelong — and the Signs of Too Much
Vanco Vera
Vancomycin: Slow the Infusion, Watch the Trough, Protect the Kidneys and Ears
Oxygen Omar
Oxygen Delivery Devices: Matching the Mask to the Need — and Fire Safety
Post-Op Priya
Postoperative Complications: The Day-by-Day Timeline Every Nurse Watches
PCA Pablo
PCA & Opioid Safety: Only the Patient Presses the Button
Restraint Rita
Restraints & Fall Prevention: Least Restrictive First, and the Order Rules
Vaccine Vivian
Immunizations: Live Vaccines, Real Contraindications and the Reactions to Expect
TPN Tessa
Total Parenteral Nutrition: High Sugar, Central Line, and Never Stop It Suddenly
Listening Theo
Therapeutic Communication: What to Say, and What Never to Say
Milestone Maya
Growth, Development and Age-Appropriate Safety
Labor Lena
Stages of Labor and the Normal Newborn Assessment
Screening Sam
Cancer Warning Signs and Screening Teaching
Pressure Pam
Antihypertensive Classes: Orthostatic Safety and Client Teaching
Ectopic Erica
Ectopic Pregnancy: The Pain on One Side and the Shoulder That Screams Rupture
Tet Spell Tilda
Tetralogy of Fallot: The Blue Spell and the Squat That Saves It
Pyloric Piper
Pyloric Stenosis: The Olive, the Fountain and the Hungry Baby
Phantom Petra
Amputation Care: The Limb That Is Gone but Still Hurts
Glomerular Greta
Post-Streptococcal Glomerulonephritis: The Tea-Colored Urine After the Sore Throat
B12 Bianca
Pernicious Anemia: The Beefy Red Tongue and the Wobbly Walk
Retinal Rhea
Retinal Detachment: The Curtain, the Flashes and the Painless Emergency
Ostomy Oscar
Ostomy Care: The Rose-Red Stoma and the Skin That Must Stay Whole
Unlock all 158 characters
Unlock all 158 characters — see passes