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The image is from a MFSU - Peradeniya (Medical Faculty Students' Union, University of Peradeniya, Sri Lanka) exam paper dated March 2019. The image is upside-down. Here is the question and a full explanation:
Question 10: In a triage,
- a) ATLS guidelines are used to sort victims
- b) Children are given priority
- c) Individual should get best care ❌ (marked wrong)
- d) Done by Senior experienced person ✓ (marked correct)
- e) Done in daily hospital admissions ❌ (marked wrong)
The Correct Answer: d) Done by Senior experienced person
What is Triage?
Triage (from French "to sort") is the process of rapidly sorting patients - especially in mass casualty incidents (MCIs) or disasters - to direct them to the most appropriate level of care and maximize overall survival across the greatest number of patients.
Why Each Option is Correct or Incorrect
✅ d) Done by Senior Experienced Person - CORRECT
This is the defining feature of proper triage. As Sabiston's Textbook of Surgery explains:
"The triage officer should be one of the most experienced and organized personnel; for in-hospital triage, the triage officer is frequently an experienced surgeon; and for field triage, either an ED physician or an experienced prehospital provider."
The triage officer must rapidly recognize life-threatening injuries, make difficult prioritization decisions, and assign correct categories. This requires significant clinical experience - it cannot be delegated to junior staff.
❌ a) ATLS guidelines are used to sort victims - INCORRECT
ATLS (Advanced Trauma Life Support) guidelines govern the assessment and management of individual trauma patients (the ABCDE protocol: Airway, Breathing, Circulation, Disability, Exposure). They are not triage sorting tools. Triage uses its own specific systems such as:
- START (Simple Triage and Rapid Treatment)
- SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport)
- Manchester Triage System (MTS)
- Emergency Severity Index (ESI)
ATLS comes into play during the primary survey of an already-triaged patient, not during the triage sorting process itself.
❌ b) Children are given priority - INCORRECT
Children are not automatically given priority in triage. Triage is based on clinical urgency and survivability, not age. Adult and pediatric patients are assessed by the same principle - those who will not survive without immediate treatment get priority, regardless of age. However, it is important to use pediatric-specific triage systems (e.g., JumpSTART) because adult vital sign thresholds do not apply to children - but this is about accuracy, not about giving children automatic priority.
❌ c) Individual should get best care - INCORRECT
This is a common misconception. In triage, especially during MCIs and disasters, the goal is the greatest good for the greatest number, NOT the best possible care for each individual. Resources are deliberately rationed.
"Triage is the process of sorting patients to provide the greatest amount of good for the greatest (highest) number of patients." - Sabiston's Textbook of Surgery
For example, a patient who is clearly non-survivable ("expectant" category) will receive minimal resources so that salvageable patients can be saved. This is a deliberate departure from the usual principle of best individual care.
❌ e) Done in daily hospital admissions - INCORRECT
Standard triage in the disaster/mass casualty context is specifically designed for situations of scarce resources and overwhelming patient numbers. Daily ED triage (routine hospital admissions) uses a milder form of triage (determining urgency level), but the classical triage philosophy of rationing care and prioritizing survivability is specific to MCI/disaster scenarios - it does not govern daily hospital admissions where every patient is expected to receive full individual care.
Summary Table
| Option | Verdict | Reason |
|---|---|---|
| a) ATLS guidelines sort victims | ❌ | ATLS = individual trauma management, not triage sorting |
| b) Children given priority | ❌ | Priority based on urgency/survivability, not age |
| c) Individual gets best care | ❌ | Triage = greatest good for greatest number, not best for individual |
| d) Done by senior experienced person | ✅ | Triage officer must be the most experienced clinician |
| e) Done in daily admissions | ❌ | Disaster triage is for MCIs, not routine admissions |
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This is another MFSU - Peradeniya exam question. Here is the full breakdown:
Question 11: ATLS
- a) PR examination
- b) Children should be given priority ❌ (marked wrong)
- c) Best should to be done to each individual ✓ (marked correct)
- d) BP PR measured
Wait - Understanding the Question Correctly
This question asks: In ATLS, which of the following is TRUE?
The handwritten tick is on c) and the cross is on b). However, this question requires careful analysis of each option, because the phrasing is abbreviated and somewhat ambiguous. Let me explain each option:
What is ATLS?
ATLS (Advanced Trauma Life Support) is a structured, standardized approach to trauma patient management developed by the American College of Surgeons (ACS) Committee on Trauma in the late 1970s. It provides a framework for the rapid assessment and management of seriously injured patients.
The core principle of ATLS is: "Treat the greatest threat to life first."
The primary survey follows the xABCDE sequence (updated in the 11th edition, 2025):
- x - Exsanguinating external hemorrhage control (new addition)
- A - Airway with cervical spine protection
- B - Breathing
- C - Circulation
- D - Disability (neurological assessment)
- E - Exposure and Environmental control
Analysis of Each Option
❌ b) Children should be given priority - INCORRECT
As with triage (Q.10), ATLS does not give automatic priority to children. ATLS applies to all trauma patients regardless of age. Pediatric ATLS adaptations exist (different vital sign thresholds, weight-based dosing), but age alone does not determine priority - severity of injury and clinical urgency do.
✅ c) Best should be done to each individual - CORRECT (marked answer)
Unlike triage (which prioritizes the greatest good for the greatest number and may intentionally withhold care from some), ATLS is an individual patient management framework. Its guiding philosophy is to give the best possible care to the individual trauma patient in front of you. Every step - from airway to circulation to disability - is aimed at optimizing that single patient's outcome.
"ATLS provides a structured approach to the trauma patient with standard algorithms of care... to prevent death and disability." - Schwartz's Principles of Surgery
This distinguishes ATLS from triage: triage allocates scarce resources across many patients; ATLS guides the management of each individual patient to the best possible standard.
a) PR examination - Context Matters
PR (Per Rectum / Digital Rectal Examination) is performed as part of the ATLS secondary survey, not the primary survey. It is done to:
- Assess rectal tone (spinal cord injury)
- Check for blood (lower GI / pelvic injury)
- Detect a high-riding prostate (urethral injury)
- Assess sphincter function
So PR examination IS part of ATLS - specifically the secondary survey. If the question is asking whether PR is included, the answer would be yes, but it is not the defining feature of ATLS, and the option is listed without clear context here.
d) BP PR measured
BP (Blood Pressure) and PR (Pulse Rate) are measured as part of the Circulation (C) component of the primary survey. Vital signs including BP, heart rate, respiratory rate, and GCS are all monitored. So this is also technically correct in context, but it is not the best/most characteristic answer.
Summary Table
| Option | Verdict | Reason |
|---|---|---|
| a) PR examination | Partially true | Done in secondary survey to check spinal injury, urethral injury, rectal bleeding |
| b) Children given priority | ❌ WRONG | Age doesn't confer automatic priority in ATLS |
| c) Best done to each individual | ✅ CORRECT | ATLS is an individual management protocol - best care for each patient |
| d) BP PR measured | Partially true | Vital signs measured during Circulation assessment, but not the defining principle |
Key Distinction to Remember
| Feature | ATLS | Triage |
|---|---|---|
| Goal | Best care for each individual patient | Greatest good for greatest number |
| Setting | Individual trauma resuscitation | Mass casualty / disaster |
| Children | No automatic priority | No automatic priority |
| Performed by | Trauma team | Senior experienced officer |
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