Nursing care
Disaster Triage Tags: the method, the errors, and the exam
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Disaster triage tags sort casualties into red (immediate), yellow (delayed), green (walking wounded) and black (expectant), using respiratory rate, perfusion and mental status rather than the patient's own report of pain or urgency. A respiratory rate over 30 is red regardless of what the patient says or how calm they appear.
Why this skill decides answers
Mass casualty questions test whether you can override your instinct to treat the loudest patient first. A nurse who spends four minutes on a screaming patient with a fractured wrist while a quiet patient with a respiratory rate of 34 goes unassessed has failed the triage, not just the question. The tag system exists precisely because instinct is unreliable under chaos, and the exam rewards the nurse who follows the algorithm instead of the noise.
The four-colour system is not a preference among several acceptable methods. It is the standard taught across START (Simple Triage and Rapid Treatment) and used in disaster drills nationwide. Red means immediate life threat with a chance of survival. Yellow means the injury can wait without dying in the interim. Green means the patient can walk and wait longest. Black means resources will not change the outcome. Every NCLEX item on this topic is really asking whether you can apply that logic under pressure, not whether you know the colour names.
How to do it reliably
Work the RPM sequence: respirations, perfusion, mental status. Check breathing first. If the patient is not breathing, reposition the airway once; if breathing still does not resume, tag black. If respirations are present, count the rate. Anything over 30 breaths per minute is red, immediately, before you assess anything else about that patient. This is the fact the exam anchors on, and it does not bend for a patient who is talking, walking, or insisting they are fine.
If respirations are under 30, move to perfusion: capillary refill or radial pulse. Absent radial pulse or capillary refill beyond 2 seconds is red. If perfusion is adequate, check mental status with a simple command such as 'squeeze my hand.' Inability to follow a simple command is red. A patient who breathes under 30, has a pulse, and follows commands is yellow if injured and cannot walk, or green if they can walk unassisted. Tag the patient before moving to the next casualty. Do not treat during initial triage; the sorting pass comes first, treatment second.
The common errors
The most tested error is treating patient-reported severity as the deciding factor. A patient calmly stating 'I'm fine, just help her' with a respiratory rate of 34 is still red. The exam will place a distressed but stable patient next to a quiet, tachypneic one specifically to see if you tag by volume of complaint instead of physiology.
A second error is spending treatment time during the sorting phase. Applying a tourniquet or repositioning an airway more than once during initial triage burns the minutes other casualties need to be seen. The one exception is airway repositioning for an apparent non-breather, done once, before moving on. A third error is tagging by visible injury alone, such as marking every amputee red without checking respirations and perfusion first. Severity of wound does not equal triage category; physiologic status does.
Drills that build it
Timed multi-casualty vignettes build this skill faster than isolated recall questions. Set up five or six mock casualties on cards, each with a respiratory rate, pulse, and mental status, and give yourself 60 seconds per patient to assign a tag using RPM. Repeat until the sequence is automatic rather than something you reason through each time.
Practise verbalising the algorithm out loud as you triage each card: 'breathing, rate, perfusion, mental status, tag.' Speaking the sequence catches the habit of jumping straight to a mental status check because it feels faster, skipping the respiratory rate that actually decides the tag. Mix in distractor cards where the patient is shouting or bleeding visibly but ventilating normally, so you build the reflex of tagging by RPM and not by drama.
Exam application
NCLEX items on this topic are usually multiple-casualty scenarios or drag-and-drop prioritisation sets, sometimes paired with a Next Generation NCLEX case study spanning several questions. Expect the item to give you numbers, not adjectives; a respiratory rate of 32, a capillary refill of 4 seconds, a Glasgow-adapted command test. Convert the numbers to a tag before you read the answer options.
Watch for options that tag by injury description alone, such as 'open fracture, tag yellow' with no respiratory or perfusion data given. If the stem withholds RPM data, the correct answer is usually to obtain the missing vital sign, not to guess the tag from the injury. Also expect at least one distractor patient who is red by every measure but is not screaming, testing whether you found them at all during a rapid sweep.
Quick reference
Red, immediate: respiratory rate over 30, absent radial pulse or capillary refill over 2 seconds, or unable to follow a simple command. Treat and transport first. Yellow, delayed: breathing under 30 with adequate perfusion and mental status, but injured and unable to walk. Care can wait without loss of life.
Green, minor: walking wounded, able to self-ambulate to a treatment area. Black, expectant: apnoeic after one airway repositioning attempt, or injuries incompatible with survival given available resources. The sequence is always RPM, in that order, and the respiratory rate over 30 rule overrides every other impression of the patient.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our prioritization and delegation practice questions are the closest set to what this page covers.
Common questions
What is the first step in START triage?
Check whether the patient can walk. Anyone who can walk to a designated area is tagged green immediately and moved out of the way so you can focus on those who cannot. For everyone who cannot walk, proceed to the RPM assessment: respirations, perfusion, mental status.
Is a patient who is talking and alert ever tagged red?
Yes. Mental status is only one of three criteria. A patient can be alert and oriented and still be red if their respiratory rate is over 30 or their perfusion is inadequate. Talking does not rule out a respiratory or circulatory emergency.
How do you tag a patient with no pulse and no breathing?
Reposition the airway once. If breathing does not return after that single attempt, tag the patient black. Do not attempt CPR during initial mass casualty triage; resources go to salvageable patients.
Why does respiratory rate over 30 override everything else?
A sustained respiratory rate above 30 signals impending respiratory failure or significant physiologic compromise, and it can deteriorate to arrest within minutes. START triage sets this threshold so that a nurse working quickly through many casualties catches the ones about to crash before slower signs, like altered mental status, appear.
More on prioritization and delegation