Can they walk?
If yes → GREEN. Send them to a treatment area and move on. These are your walking wounded.
Scene Size-Up
Every call starts the same way — before you open the door, before you get out of the unit, before you do anything, you assess the scene. In ERLC just like IRL, running into a dangerous scene gets you killed and creates more patients.
The scene size-up happens in seconds and answers four questions:
- Is it safe? — Active shooter, fire, downed power lines, unstable vehicle, hazmat. If it's not safe, stage and wait. You cannot help anyone if you become a patient yourself.
- What happened? — Mechanism of injury (MOI) for trauma, nature of illness (NOI) for medical. This guides your entire assessment.
- How many patients? — Request additional resources before you're overwhelmed, not after.
- Do I need more help? — Fire, police, ALS, additional units. Call early.
⚠️
Scene Safety Rule
If you arrive and a patient is down in a dangerous location (active shooter scene, live power line on car, etc.) — do not approach until law enforcement or the utility company clears the scene. Your safety comes first, always.
PPE & Body Substance Isolation (BSI)
PPE goes on before you contact any patient. In ERLC this is represented by your uniform and equipment — in IRL EMS this means gloves, eye protection, and mask at minimum for every patient contact.
- Gloves — Minimum PPE for every patient contact. Change between patients.
- Eye protection — Any situation with potential blood, body fluid, or airway secretion splash.
- Mask — Suspected airborne illness (coughing patient, TB, COVID, etc.).
- Gown — High-splash risk (major trauma, active bleeding, childbirth).
💡
Standard Precautions
Treat every patient as if they have a bloodborne pathogen. You don't know their history, and they often don't either. This isn't paranoia — it's professionalism.
START Triage — Mass Casualty Incidents
When you have more patients than you can immediately treat, triage determines who gets care first. The START (Simple Triage and Rapid Treatment) system categorizes patients in 30–60 seconds each. You are sorting, not treating — move quickly.
🔴
Immediate
Life-threatening but survivable with immediate intervention
🟡
Delayed
Serious but can wait; stable for now
🟢
Minor
Walking wounded; minor injuries only
⚫
Expectant
Non-survivable or deceased
START Algorithm (30 seconds per patient)
1
2
Are they breathing?
If no → reposition the airway (head tilt or jaw thrust). Still not breathing → BLACK. If breathing after repositioning → RED.
3
Respiratory rate
Under 10 or over 30 breaths/min → RED. Between 10–30 → continue to step 4.
4
Radial pulse / perfusion
No radial pulse or capillary refill >2 seconds → RED. Pulse present → continue to step 5.
5
Mental status
Can't follow simple commands → RED. Can follow commands → YELLOW.
🎯
Key Triage Rule
In START triage, a patient who is NOT breathing but starts breathing after you open their airway is tagged RED (Immediate) — not Black. They needed your intervention to live, which means they need immediate care.
Incident Command System (ICS)
On large scenes — MCIs, structure fires, hazmat — the Incident Command System organizes everyone. You need to know the basics so you understand your role.
- Incident Commander (IC) — Overall scene authority. All decisions flow through or from IC.
- Medical Branch / EMS Branch — Oversees all medical operations at the scene.
- Treatment Sector — Where patients are treated after triage. Divided by priority color.
- Transport Sector — Coordinates ambulances and hospital destinations.
- Staging — Where units wait until assigned. Never freelance on an MCI — stage and wait for assignment.
In ERLC: when multiple units respond, one unit takes command and assigns roles. Don't all pile in on the same patient — communicate, coordinate, and stage if not needed yet.
30sMax time per patient in START
2sCap refill threshold in START
10–30Normal RR in START (breaths/min)
⚠️
Most Common Exam Mistake
Students tag non-breathing patients as Black without attempting to open the airway first. Always attempt the airway — one simple head tilt. Only tag Black if they still don't breathe after repositioning.