CERT Unit 3– DMO #1 Spring 2018
Assumptions
Disaster Medical Operations ● Need for CERT members to learn disaster medical operations is based on two — Part 1 assumptions: ! Number of victims could exceed local capacity for treatment ! Survivors will assist others ‒ They will do whatever they know how to do CERT Basic Training ‒ They need to know lifesaving first aid or post- Unit 3 disaster survival techniques Spring 2018 90% of disaster victims are rescued by other victims!
Importance of Quick Action Unit Objectives – Learn how to:
● Phase 1: Death within minutes, result of ● Identify “killers” severe trauma ● Conduct TRIAGE under ● Phase 2: Death within several hours, simulated disaster result of excessive bleeding conditions
● Phase 3: Death in several days or weeks, ● Open airway, control result of infection bleeding, and treat for shock
Rescuer Safety During Triage TRIAGE AND PPE’s
● If hazmat or terrorist event is suspected, CERT members DO NOT respond When doing TRIAGE, ! Evacuate as safely as possible ● ALWAYS wear PPE: you MUST protect ! Helmet ! Goggles yourself ! N95 mask ! Work gloves and your buddy ! Sturdy shoes or boots ! Non-latex exam gloves must do the same
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Personal Protective Equipment - PPE Personal Protective Equipment - PPE
● Personal protective equipment, commonly ● How to put on and take off Non-Latex referred to as "PPE", is equipment worn to Gloves minimize exposure to serious workplace ● Practice! injuries and illnesses. ● New gloves for every victim ● Wash or sanitize hands
Goggles Masks after de-gloving
Gloves
Personal Protective Equipment - PPE
IF IT’S WET AND NOT YOURS
DON’T TOUCH IT!
Three “Killers” - ABS CERT Sizeup ● Emergency medicine “killers” 1. Gather Facts ! Airway obstruction 2. Assess Damage ! Bleeding (Severe) 3. Consider Probabilities ! Shock (Circulatory) 4. Assess Your Situation REMEMBER: CERT SIZEUP IS ● First priority of medical operations: 5. Establish Priorities A CONTINUAL ! Open airway 6. Make Decisions PROCESS ! Control excessive bleeding 7. Develop Plan of Action ! Treat for shock 8. Take Action 9. Evaluate Progress We will learn how to handle each of the killers later, FIRST – let’s learn what TRIAGE is
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What Is Triage? START (during Search and Rescue)
TRIAGE – French term meaning “to sort ” HOW DO WE DECIDE URGENCY?
Process for managing mass casualty event ● STart = Simple Triage 1. Victims are evaluated ! Victims sorted based how urgently treatment needed 2. Victims are sorted by urgency of treatment needed ● stART = And Rapid Treatment 3. Victims are set up for immediate or delayed ! Rapid treatment of critical (“three killer”) injuries treatment discovered and prioritized in first phase
Remember your Priorities! R P M’s Determine Urgency
● A – Airway/Breathing There are 3 things to check (non-walking victims): ● Respirations ● B – Bleeding ! Adults (12 yrs +) under 30 Remember ! Children (0-11) 15-45 ● S – Shock (Circulatory) ● Perfusion 30 ! Less than 2 seconds 2 ● Mental Status Can do ! Can follow simple directions
R P M’s Determine Urgency Triage ● Minor (M): Walking wounded and Based on what you find generally ambulatory Pass ALL RPMs with voice triage and ● Delayed (D): Injuries do not jeopardize your RPM checks victim’s life; treatment can be delayed Fail ANY RPM you will categorize each 30-2-Can Do ● Immediate (I): Victim has life-threatening person into injuries (airway, bleeding, or shock) 1 of 4 categories ● Dead (DEAD): No respiration after two attempts to open airway
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Triage Triage
This is the tag that Some groups use FLAGGING TAPE WC CERT uses for identification purposes
You’ve been given a handout of this tag
Triage – Practice Categorizing Victims Triage Class Exercise/Homework
● Break into groups
● Each of you should have a handout
● You will have 10 minutes to categorize TRIAGE PRACTICE 10 victims (goal is 1 minute per victim) ANSWERS NEXT
● Discuss results, answer questions
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Mass Casualty: What do you do first? Remember your Priorities!
● Size up the situation to make sure the ● A – Airway/Breathing scene is safe for you to enter and develop plan with buddy ● B – Bleeding
● Conduct voice triage ● S – Shock
● Approach remaining In mass casualty situations we do not begin CPR or do victims rescue breathing
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How to Approach a Conscious Victim
● Be sure victim can see you
● Identify yourself – first name / “search & rescue”, City of Walnut Creek. I’m trained in basic first aid. ● Request permission to treat ● Respect cultural differences ● Check RPMs & Tag
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If the Victim is Unresponsive Open the Airway
● Implied consent given by unconscious/ confused
● Tap and Shout – “Can you hear me?”
● If no response and no breathing OPEN THE AIRWAY
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Open vs. Obstructed Airway Demo & Practice: Head-Tilt/Chin-Lift
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LOOK, LISTEN, FEEL - 5 to 10 seconds Airway Management
● If breathing has been restored, ! Clear airway must be maintained by keeping the head tilted back. ! Place unconscious victim in recovery position (will be shown in later slides). ! Tag victim Immediate.
● If no breathing after two attempts to open the airway: Triage = Black/Dead
● Do not begin CPR nor rescue breathing
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Take 5
Types of Bleeding Control Bleeding
● Arterial bleeding ● 3 main methods for ! Bleeding from artery controlling bleeding: spurts . ! Direct pressure – ● Venous bleeding BEST METHOD!!! ! Bleeding from vein flows ! Elevation .
● Capillary bleeding ! Pressure points ! Bleeding from capillaries oozes
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Control Bleeding Control Bleeding
If you cannot control Direct Local Pressure the bleeding using one over the actual bleeding site by putting a clean pad over the wound and method, try another, or pressing firmly. Maintain compression a combination of by wrapping the wound firmly with a pressure bandage. direct pressure and elevation Elevate the wound above the level of the heart.
Pressure Point - apply pressure on the nearest pressure point between the wound and the heart to slow the flow of blood to the wound. The pressure point to be used depends on the location of the wound.
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Control Bleeding Position for RESPONSIVE Victim
Leave a breathing, responsive LET’S PRACTICE victim in the position found or a position of comfort in teams of 2 unless you must move victim to safer location outside due to structural damage
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Recovery Position – UNRESPONSIVE Victim Recovery Position – UNRESPONSIVE Victim
Protect a victim’s Alternate airway by recovery placing them position with in the lower arm RECOVERY extended POSITION straight before above head. * Refer to C-8 Field Operating Guide (FOG) for more information on moving on recovery position
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Recovery Postion
LET’S PRACTICE in teams of 3
Take 5 Controlling Bleeding with a Tourniquet
When direct pressure is not possible or not effective at controlling heavy bleeding from a limb, apply a tourniquet as a LAST resort
If none of the methods for controlling bleeding is successful and professionals are delayed in responding, a tourniquet may be necessary.
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Controlling Bleeding (Continued) Tourniquets Tourniquets - Dangers
A tourniquet is rarely required and should be used only as ● Incorrect materials or application a last resort—a "life or limb" situation. ! Use any long, flat, soft material (bandage, neck Tourniquets are considered appropriate treatment for tie, belt, or stocking). crushing - type injuries and for partial amputations. ! Use something strong for the windlass (lever).
Using a tourniquet can pose serious risks to the affected ● Damage to the limb from a tourniquet limb, so it should not be used unless not using it will ! Survival of a limb is almost never possible after endanger the person's life from excessive blood loss. a correctly applied tourniquet is left in place too
long.
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Tourniquet Shock
Only a physician should remove a tourniquet. ● Result of ineffective circulation of blood If you apply a tourniquet: ● Twist only until bleeding stops ● Remaining in shock ● Leave it in plain sight (don't bandage over it) will lead to death of: ● Attach an adhesive label to victim's forehead stating ! Cells ! Tissues time/date the tourniquet was ! Entire organs applied.
Recognizing Shock Treatment of Shock
● Main signs of shock ● Control major bleeding ! Rapid and shallow breathing ● Maintain normal body ! Capillary refill of greater than 2 seconds temperature ! Failure to follow simple commands, such as ● Loosen restrictive “Squeeze my hand” clothing ● Symptoms of shock are easily missed… ● No food or drink pay careful attention to your patient! ● Reassure/keep calm ● Leg elevation
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Video: Search & Rescue Triage Triage Process
● Step 1: Stop, Look, Listen, and Think ● Step 2: Conduct voice triage https://www.youtube.com/watch?v=MDLla8JtcXc ● Step 3: Start where you stand; follow systematic route https://www.youtube.com/watch?v=-uahsgmpvfs ● Step 4: Identify yourself to each victim and ______ask permission to touch victim ● Step 5: Evaluate each victim, tag and document ● Step 6: Treat “I” victims immediately for 3 killers
Don’t forget to count victims to report totals by category!
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TRIAGE RELAY
There are 3 things to check (non-walking victims): ● Respirations ! Adults (12 yrs +) under 30 Remember ! Children (0-11) 15-45 ● Perfusion 30 ! Less than 2 seconds 2 ● Mental Status Can do ! Can follow simple directions
Take 5 Responding to Mass Casualty Event
● Stay safe ● Work expeditiously ● Develop/follow plan ● Treat only 3 killers
● Document your actions for clear communication
CERT Sizeup TRIAGE – When and Where
1. Gather Facts ● CERTs use triage to sort victims at mass casualty events 2. Assess Damage ! victims are evaluated, sorted by urgency of treatment needed, & tagged for immediate or delayed treatment 3. Consider Probabilities 4. Assess Your Situation REMEMBER: ● Triage a victim up to three times: CERT SIZEUP IS 5. Establish Priorities A CONTINUAL ! Once during Search and Rescue operations PROCESS 6. Make Decisions ! Again before transporting victim 7. Develop Plan of Action ! Lastly on arrival at Med Ops at Command Post 8. Take Action 9. Evaluate Progress Remember, during triage – IF IT’S WET AND NOT YOURS DON’T TOUCH IT!
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TRIAGE IN THE FIELD TRIAGE IN THE FIELD
The FIRST time we TRIAGE The SECOND time we TRIAGE is during is in Search And Rescue. TRANSPORT. In TRANSPORT we : ! TRIAGE ! Reassess RPM’s ! Treat for life-threatening ‒ In case victim’s situation has changed conditions (‘3 killers’) ! Treat victim with bandaging ‒ Airway Obstruction, Severe bleeding, Shock or splinting to immobilize ! Document by assigning a category color and before moving, if needed triage tag ! Notify Incident Command of findings so they know what victim transport is needed
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TRIAGE AT THE COMMAND POST The NEXT time we TRIAGE is after intake into MED OPS. In MED OPS we : ! Reassess RPM’s - in case victim’s situation changed ! Treat for what we find - according to the medical protocols* in your binder ! Provide care and treatment and document ! Determine who has greatest need for advanced care * Medical protocols will be acovered in next class.
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Unit Summary DMO Acronyms
● You should now be able to: ● ABS – Airway/Breathing, Bleeding, Shock ● CFW – Color, Feeling, Warmth ! Conduct triage under ● DMO – Disaster Medical Operations simulated disaster conditions ● HTTA – Head to Toe Assessment ● LLF – Look, Listen, Feel ! Identify 3 “killers” ● Med Ops – Medical Operations ● PPE – Personal Protective Equipment ! Apply techniques for opening ● Ops – Operations the airway, controlling ● RPM – Respiration, Perfusion, Mental status bleeding, and treating for ● SAR – Search And Rescue shock ● STart = Simple Triage ● stART = And Rapid Treatment
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Homework Assignment
1. Read Unit 4 to prepare for next session 2. Do homework handouts 3. Wear appropriate clothes for the next session 4. Bring a yoga mat for comfort during hands on exercises on floor
NEXT SESSION IS DISASTER FIRST AID
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