{ "abstract": "Background: Preparing nursing students for mass casualty incidents requires more than foundational knowledge; it demands the ability to apply triage principles under pressure. While simulation-based education is widely used, there is limited evidence examining how students integrate established triage frameworks, such as the Canadian Triage and Acuity Scale (CTAS) and Glasgow Coma Scale (GCS), within high-acuity disaster contexts. This study evaluated nursing students’ knowledge application, clinical prioritization, and perceived preparedness following a Code Orange simulation. Methods: cross-sectional survey was conducted with undergraduate nursing students (n = 26) following participation in a high-fidelity Code Orange simulation. The survey included multiple-choice knowledge items assessing CTAS and GCS application, Likert-scale measures of perceived knowledge, confidence, and preparedness, and open-ended questions exploring student experiences. Quantitative data were analyzed using descriptive statistics and Chi-square tests, while qualitative responses underwent content analysis. Results: Participants demonstrated strong knowledge of CTAS and GCS principles, with most correctly identifying triage priorities and neurological assessment parameters. Variability was observed in students’ ability to distinguish between CTAS Levels 2 and 3, with recognition of vital signs as a key differentiator (χ² = 57.18, p < .001). Likert-scale responses indicated high levels of perceived preparedness, confidence, and knowledge following the simulation. Qualitative findings highlighted the importance of realism, cognitive demand, and teamwork in shaping learning, with students emphasizing the value of applying theoretical knowledge in a dynamic, high-pressure environment. Conclusion: Findings suggest that high-fidelity disaster simulations extend beyond reinforcing baseline knowledge by promoting the application of triage decision-making in complex clinical contexts. Integrating structured triage frameworks within immersive simulation may enhance preparedness for mass casualty response, particularly in areas requiring nuanced clinical prioritization. These results underscore the role of simulation in bridging the gap between theoretical knowledge and real-world emergency decision-making.", "abstract_shown": true, "affiliations": [ "Nursing, Brock University, St. Catharines, Ontario, Canada." ], "article_type": "Research Article", "arxiv": null, "author_total": 10, "authors": [ { "affs": [ 0 ], "name": "Vanessa Silva E Silva", "orcid": "0000-0002-0717-2011" }, { "affs": [ 0 ], "name": "Magdalena Dobosiewicz", "orcid": "0009-0007-9840-671X" }, { "affs": [ 0 ], "name": "Karina Tamy Kasawara" }, { "affs": [ 0 ], "name": "Emily Bot" }, { "affs": [ 0 ], "name": "Sylas Coletto" }, { "affs": [ 0 ], "name": "Rebecca Larocca" }, { "affs": [ 0 ], "name": "Shelley Oakes" }, { "affs": [ 0 ], "name": "Tori McDowall" }, { "affs": [ 0 ], "name": "Dawn Prentice" }, { "affs": [ 0 ], "name": "Amina Silva" } ], "bibtex": "https://research.draconitic.com/paper/9rfgte12xgs8t.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0360652", "fulltext_url": "https://europepmc.org/articles/PMC13722163", "id": "9rfgte12xgs8t", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0360652", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Anatomy" ], [ "heading", "Biology and Life Sciences" ], [ "heading", "Clinical Medicine" ], [ "heading", "Cognition" ], [ "heading", "Cognitive Psychology" ], [ "heading", "Cognitive Science" ], [ "heading", "Critical Care and Emergency Medicine" ], [ "heading", "Decision Making" ], [ "heading", "Emotions" ], [ "heading", "Eyes" ], [ "heading", "Head" ], [ "heading", "Health Care" ], [ "heading", "Human Learning" ], [ "heading", "Learning" ], [ "heading", "Learning and Memory" ], [ "heading", "Medicine and Health Sciences" ], [ "heading", "Neuroscience" ], [ "heading", "Nursing Science" ], [ "heading", "Ocular System" ], [ "heading", "Pain" ], [ "heading", "Psychology" ], [ "heading", "Psychometrics" ], [ "heading", "Research Article" ], [ "heading", "Signs and Symptoms" ], [ "heading", "Social Sciences" ], [ "heading", "Triage" ], [ "plos", "/Biology and life sciences/Anatomy/Head/Eyes" ], [ "plos", "/Biology and life sciences/Anatomy/Ocular system/Eyes" ], [ "plos", "/Biology and life sciences/Neuroscience/Cognitive science/Cognition/Decision making" ], [ "plos", "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive psychology/Decision making" ], [ "plos", "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive psychology/Learning/Human learning" ], [ "plos", "/Biology and life sciences/Neuroscience/Learning and memory/Learning/Human learning" ], [ "plos", "/Biology and life sciences/Psychology/Cognitive psychology/Decision making" ], [ "plos", "/Biology and life sciences/Psychology/Cognitive psychology/Learning/Human learning" ], [ "plos", "/Biology and life sciences/Psychology/Emotions" ], [ "plos", "/Biology and life sciences/Psychology/Psychometrics" ], [ "plos", "/Medicine and health sciences/Anatomy/Head/Eyes" ], [ "plos", "/Medicine and health sciences/Anatomy/Ocular system/Eyes" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Pain" ], [ "plos", "/Medicine and health sciences/Critical care and emergency medicine/Triage" ], [ "plos", "/Medicine and health sciences/Health care/Nursing science" ], [ "plos", "/Social sciences/Psychology/Cognitive psychology/Decision making" ], [ "plos", "/Social sciences/Psychology/Cognitive psychology/Learning/Human learning" ], [ "plos", "/Social sciences/Psychology/Emotions" ], [ "plos", "/Social sciences/Psychology/Psychometrics" ] ], "openalex": null, "pdf_url": "https://europepmc.org/articles/PMC13722163?pdf=render", "pmcid": "PMC13722163", "pmid": "42961854", "published": "2026-10-30", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/9rfgte12xgs8t.ris", "sources": [ { "first_seen": "2026-10-31T12:20:55Z", "native_id": "10.1371/journal.pone.0360652", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0360652" }, { "first_seen": "2026-11-02T03:21:21Z", "native_id": "MED:42961854", "source": "europepmc", "url": "https://europepmc.org/article/MED/42961854" }, { "first_seen": "2026-11-03T12:22:43Z", "native_id": "PMC13722163", "source": "pmc", "url": "https://doi.org/10.1371/journal.pone.0360652" } ], "subjects": [ { "field": "biology", "origin": "plos:neuroscience", "subfield": "neuroscience" }, { "field": "medicine", "origin": "plos:anatomy", "subfield": "physiology" } ], "title": "Triage under pressure: Nursing students’ learning and preparedness in a code orange simulation using CTAS", "title_text": "Triage under pressure: Nursing students’ learning and preparedness in a code orange simulation using CTAS", "type": "peer-reviewed", "updated_at": "2026-11-03T12:22:43Z", "url": "https://research.draconitic.com/paper/9rfgte12xgs8t", "venue": "PLOS One", "versions": [] }