在社區災害發生、需要清空病床時，護理師應優先考慮讓哪位病人出院？
Which of the following clients should the nurse prioritize for discharge to free up beds during a community disaster?
- AA 65-year-old client admitted 12 hours ago with an acute MI, currently stable on a heparin drip.65歲病人，因急性心肌梗塞於12小時前入院，目前靜脈注射肝素滴注中且狀況穩定。
- BA 25-year-old client with a compound fracture who had surgery 4 hours ago and is receiving IV antibiotics.25歲病人，因複雜性骨折於4小時前接受手術，目前正在接受靜脈注射抗生素治療。
- CA 40-year-old client with a history of asthma who was admitted for observation after a minor flare-up and has had no wheezing for 24 hours.✓ 正解40歲病人，有氣喘病史，因輕微發作後入院觀察，過去24小時內無哮鳴音。
- DA 70-year-old client with end-stage renal disease who missed their last dialysis treatment and has a potassium of 6.2 mEq/L.70歲病人，患有末期腎臟疾病，錯過上次透析治療，血鉀濃度為6.2 mEq/L。
災害管理（Disaster Management）中的出院優先順序判斷，旨在識別那些「最不需急性醫療資源且出院風險最低」的病人。急性心肌梗塞（A）在 12 小時內仍處於高風險期，且使用肝素需嚴密監控。術後 4 小時的骨折病人（B）有感染與出血風險，且需 IV 抗生素。高血鉀（D）是致命性心律不整的急症。而氣喘觀察病人（C）若 24 小時無症狀，通常只需居家口服藥物即可管理，其風險最低且不需要複雜的院內設備支持。在災害情境下，護理師必須進行「反向檢傷」，優先釋放那些能安全回家或轉至低階照護機構的床位。
The client with a resolved minor asthma flare-up is the priority for discharge because they are stable, symptom-free for 24 hours, and require minimal acute care resources. In contrast, clients with recent myocardial infarction, post-operative fractures, or hyperkalemia remain high-risk and require continuous monitoring and complex interventions.
美國在災害應變中有一套成熟的「反向檢傷（Reverse Triage）」標準，護理師受訓如何快速識別可安全轉運的病人。台灣醫院雖有大量傷病患應變計畫，但臨床上醫師對於出院決定權較大，護理師多扮演執行者角色，在主動篩選出院名單上的權限與美國護理師相比稍顯受限。