INDIRA GANDHI MEDICALCOLLEGE SHIMLA

DISASTER MANAGEMENT

Professor Anil ohri Disaster Cell OF IMA HP

 DISASTERS ARE MORE COMMON THESE DAYS DUE TO DEFORESTATION,CONSTRUCTION ACTIVITIES,UNCONTROLLED EXAVATIONS AND HAPHAZARD CONSTRUCTIONS  ROAD ACCIDENTS AS MORE POPULATIONS,YOUNG RECKLESS DRIVERS,FAST DRIVING AND INCREASED NUMBER OF VEHICLES

?

 KEEP UR SELF SAFE-HELP URSELF BEFORE HELPING OTHERS  DO SOMETHING THAN DOING NOTHING

?

 CFR  ANY PERSON WHO REACH FIRST AT THE SITE  MAY OR MAY NOT BE A MEDICAL PERSON

HELP YOUR SELF BEFORE YOU HELP OTHERS......?

 WORKING ABILITY IN TEAM(MULTIFACTORIAL MANAGEMENT  REGULAR UPDATE AS TEAM MANAGER/EXPERT/MEDICAL EXPERT/VOLUNTEER  ASSOCIATING WITH PEOPLE WHO INVOLVE IN SUCH ACTIVITIES  READY TO LEARN  ATTITUDE OF GRATITUDE

PART-I  TRIAGE,Coloured  Acquity System  Establishing Morgue  Transportation PART-II Cardiopulmonary Resuscitation(CPR) PART-III Mass Casuality management

 MCI -has been DECLARED, a definite and well co-ordinated flow of events -three separate phases: triage,Treatment, and transportation.

 certified first responder ( Emergency Medical Responder, Medical First Responder, or First Responder) is a person who has completed a course and received certification in providing pre- hospital care for Medical Emergency. DON’T CONFUSE WITH FIRST RESPONDER  Not a substitute for more advanced emergency medical care  provide advanced FIRST AID level care, (CPR), and External Defibrilator usage.  Most police officers and all professional firefighters in the US and Canada must be at least certified first responders. This is the required level of training.

 Triage French TERM VERB TRIER meaning ‘to sort’ or ‘to choose’ classify patients according to urgency OF their conditions to get the Right patient to the Right place at the Right time with the Right care provider

 Treat patients ACCORDING TO clinical urgency APPROPRIATELY TIMELY

 MCI-START-BCC & REMEMBER T-T-T  COLOR TRIAGE:YELLOW,GREEN,RED,BLACK  ACQUITY TRIAGE: CROSS ROOM /CROSS DOOR  TENTS(ZONES)-SAFE COLD,HOT, WARM,  CARE-NEEDS GREATEST CARE LADIES,OLD & CHILDREN  GOLDEN HOUR:10,20 and 30 Min  MOURGUE  SMALL HOSPITAL IF STAY IS LONG

 SIMPLE TRIAGE AND RAPID TREATMENT  Check : breathing, circulation, consciousness

 Non disaster: Provide best care to individual patient.  Multi casualty/disaster: Most effective care To greatest number of patients.

 Definition : an incident, either natural or human-made, that produces patients in numbers needing services beyond immediately available resources. May involve large no. Or small no. of patients requiring significant demand on resources.  The key : care - who need greatest Care.  GOAL: Correct triage

1. Identify patients -immediate care. 2. Determine appropriate area - treatment 3. Facilitate patient -FLOW

4. Provide assessment and reassessment (arriving and waiting) 5. Provide information ( patients and families.) 6. PSYCHOSOCIAL ASPECTS:Allay anxiety (patient and family )and enhance public relations.

 Immediately accessible  Sign posted  Allow for patients examination  Privacy  Staff security  Fully equipped with Emergency equipment  Control Room  Communication services

TIME  Should be completed in 10 minutes  If >15 minutes call for additional nurse.  Accurate triage is key to the efficient operation  Effective triage – is based on knowledge, skills and attitude of the triage nurse.  Pediatric cases – record vital signs every 30 mts. and others – 60 mts. during reassessment.

IMPORTANCE  Triage is an essential function of EDs  Urgency Means need for time –critical intervention.  Patients not critical with low acuity categories –safe to wait for assessment and treatment but require admission.

“The eye’s don’t see what the mind doesn’t know!”

1. RAPIDLY identify urgent life threatening conditions 2. Assess/ determine severity and acuity of the problem 3. Ensure patients treated TIMELY in Appropriate Manner 4. Allocate patients appropriate and treatment area 5. Re-evaluate who in waiting area

1. Streamlines patient flow 2. Reduces risk of further injury/ deterioration 3. Improves communication and public relations 4. Enhances team work 5. Identifies resource requirements 6. Establishes national benchmarks

 I-COLOURED TRIAGE  II-TRIAGE ATS-SySTEM

 Based ON medical responder's findings-Colour-coded TAGS-triage levels.  2-level-GREEN AMBULANCE " Walking Wounded”  1-Level Yellow. TURTLE"Delayed Treatment“  3 Level Red RABBIT "Immediate Treatment life- threatening injuries but salvageable-who need immediate advanced care, but can wait until additional crews arrive.  4-Level-Black CROSS “lowest level of triage” is called "Dead/Non-Salvageable“ is assigned to those who are obviously deceased, Patient needs (CPR) orArtifcial Respiration would be classified as "Dead/Non- Salvageable“.

 Casualties Transported According To Treatment Priority  Red Tagged- Yellow Tagged-Green-Tagged- finally Black-Tagged.

 An “ across the room assessment”  AIRWAY  BREATHING  CIRCULATION  NEUROGENIC

 The triage nurse scan the area where patients enter the emergency door, while interviewing other patient.

 An “across-the room” assessment;H-P-D  The triage history  The triage physical assessment  The triage decision

 The triage team  Triage of Victims - first victims to arrive are frequently not the most seriously injured. They are 1. Critical patients 2. Fatally Injured Patients 3. Non critical patients 4. Contaminated patients

CLEARLY ESTABLISH ZONES: COLD,HOT,WARM  chemical or biological incident -safety zones-clean zone(COLD)-roughly 200–300 yards from the incident and uphill and upwind from the incident.  Cold zones is-safe zone and Here incident command is established.  Hot zone-contaminated zone  Warm zone-Decontamination occurs. Warm zone at least 50 yards up hill up wind from the cold zone.  Clearly identify Zones with engineer tapes, lights, or cones.  Responders, Patients must leave the hot zone to warm zone in Designated Way where they will be decontaminated. Each Zone officer should be posted at the hot zone and warm zone to make sure Decontamination

 Divided into 5 levels or categories : REMEMBER “7” determinants-VITAL SIGNS,BLEEDING,Sound From MOUTH/RESPIRATION,STATUS OF LIMBS,COLOUR OF SKIN,LOC 1. Chief complaint 2. Brief triage history 3. Injury/ illness 4. General appearance 5. Vital signs The most urgent clinical feature that is identified will determine ALS category

REUL-N Level 1- Resuscitation Level 2- Emergent Level 3- urgent Level 4- less urgent Level 5- Non urgent

Resuscitation -- threat to life Time to nurse assessment IMMEDIATE Time to physician assessment IMMEDIATE  Cardiac and respiratory arrest  Major trauma  Active seizure  Shock  Status Asthmatics

Potential threat to life, limb or function Nurse Immediate, Physician <10 minutes  Decreased level of consciousness  Severe respiratory distress  Chest pain with cardiac suspicion  Over dose (conscious)  Severe abdominal pain  G.I. Bleed with abnormal vital signs  Chemical exposure to eye

Condition with significant distress Time Nurse < 15min, physician < 30 min Head injury without decrease of LOC but with vomiting  Mild to moderate respiratory distress  G.I. Bleed(actively bleed)  Acute psychosis

Mild to Moderate Discomfort Time for Nurse assessment < 30 minutes Time for physician assessment < 1hour Head injury, alert, no vomiting Chest pain, no distress, no cardiac suspicion. Depression with no suicidal attempt

Delayed(no distress) Time for nurse 60 minutes Physician assessment more than 2h or 120 minutes  Minor trauma  Sore throat with temperature < 39 degree centigrade  Chronic medical illnesses.  Alcoholics

MUST HAVE IT ON SITE-Far away from public sight, and is enclosed area e.g Temporary tent, or Nearby Building  Handle bodies of Deceased while awaiting transfer to Permanent morgue, or While Needs Deceased persons to be removed to Access injured. When this is used, care and consideration is given to respect for the deceased, family members, the public at the scene, and the responders at the scene..

To identify obvious life threat conditions General appearance Air way Breathing Circulation Disability (neurogenic)

 Air way Abnormal airway sounds, strider, wheezing grunting Unusual posture e.g.. Sniffing position, inability to speak, drooling or inability to handle secretion  Breathing Altered skin signs, cyanosis, dusky skin, tachypnea bradypnea, or apnea periods, retractions, use accessory muscles, nasal flaring, grunting, or audible wheezes

 Circulation Altered skin signs, pale, mottling, flushing Un controlled bleeding  Disability (neuro.) LOC Interaction with environment Inability to recognize family members Unusual irritability Response to pain or stimuli Flaccid or hyper active muscle tone

 Extensive knowledge to emergency medical treatment  Adequate training and competent skills, language, terminology  Ability to use the critical thinker process  Good decision maker

 Greet patients and identify your self.  Maintain privacy and confidentiality  Visualize all incoming patients even while interviewing others.  Maintain Excellent communication between triage and treatment area,Waiting areas  Use all resources to maintain high standard of care.  Crowd control.  Telephone.  Communicate with team leader and seek feed back on decisions.

 Reassess within 1-2hours of initial triage and continue on regular basis,WHO Presented without cardinal signs of severe illness may develop during waits.  Patients appear intoxicated actually may have life threatening problems such as DKA, and not permitted to keep off in the waiting room.

 The last person along line at triage may have serious medical problem that requires immediate attention  Patient should wait no longer than 10 minutes for triage  In doubt-category, Use ACUITY to avoid under triaging a patient

 You have two patients:  The woman  The unborn fetus  Any trauma to the woman has a direct effect on the fetus.

 Pregnant women may be the victims of:  Assaults  Motor vehicle crashes  Shootings  Domestic abuse  Pregnant women also have an increased risk of falls.

 Pregnant women have an increased amount of overall total blood volume and a 20% increase in heart rate.  May have a significant amount of blood loss before you will see signs of shock  Uterus is vulnerable to penetrating trauma and blunt injuries.

 When a pregnant woman is involved in a motor vehicle crash, severe hemorrhage may occur from injuries to the pregnant uterus.  Trauma is one of the leading causes of abruption placenta.  Significant vaginal bleeding is common with severe abdominal pain.

 Cardiac arrest  Focus is the same as with other patients.  Perform CPR and provide transport.  Notify the receiving facility personnel that you are en route with a pregnant trauma patient in cardiac arrest.

 Follow these guidelines when treating a pregnant trauma patient:  Maintain an open airway.  Administer high-flow oxygen.  Ensure adequate ventilation.  Assess circulation.  Transport the patient on her left side.

 Some cultures may not permit a male health care provider to assess or examine a female patient.  Respect these differences and honor requests from the patient.  A competent, rational adult has the right to refuse all or any part of your assessment or care.

 The Golden Period is the time from injury to definitive care.  Treatment of shock and traumatic injuries should occur.  Aim to assess, stabilize, package, and begin transport within 10 minutes (“Platinum 10”).

 Rapid scan assists in determining transport priority.  High-priority patients include those with any of the following conditions:  Difficulty breathing  Poor general impression  Unresponsive with no gag or cough reflex

 High-priority patients (cont’d):  Severe chest pain  Pale skin or other signs of poor perfusion  Complicated childbirth  Uncontrolled bleeding

 High-priority patients (cont’d):  Responsive but unable to follow commands  Severe pain in any area of the body  Inability to move any part of the body

 Transport decisions should be made at this point, based on:  Patient’s condition  Availability of advanced care  Distance of transport

 Transport decision  Provide rapid transport for pregnant patients who: Have significant bleeding and pain Are hypertensive Are having a seizure Have an altered mental status

 Circulation  If there are signs of shock, control bleeding, give oxygen, and keep the patient warm.  Transport decision  If delivery is imminent, prepare to deliver at the scene.  If delivery is not imminent, prepare the patient for transport.

 Triage and 1 st Step of Treatment Accomplished,Final stage IN pre-hospital management of a mass casualty incident- Transport injured for definitive care by ambulances,or emergency vehicles such asPolice Car, Fire Truck, Helocopter, Emergency Medicalservice or civilian vehicles  Decide transport priority-Usually, the most seriously injured are transported first.  Reversal Of PRIORITY:When It Difficult to Access Serious  Incident Commander may-least seriously injured transported to local hospitals or interim-care centres to provide more room for emergency personnel to work.

 It is temporary treatment centre Where assessment and treatment of patients until discharged or transported to hospital. Like gymnasiums, schools, arenas, community centres, hotels, and anywhere else that can support a FIELD HOSPITAL set-up.  Permanent buildings are preferred to tents as they provide shelter, power, and running water,  Many governments maintain complete field hospital setups that can be deployed anywhere within their jurisdiction within 12–24 hours.  Full field hospitals require a significant amount of time to deploy (in relation to the length of most incidents),  Temporary interim-care centres can be set up by emergency services fairly quickly if needed using the personnel and resources they have on-hand.  Staff - combination of doctors, nurses, paramedics/emergency medical technicians, first responders, and social workers such as those from theRed Cross who work to get families reunited after a disaster.

 MCI-START-BCC & REMEMBER T-T-T  COLOR TRIAGE:YELLOW,GREEN,RED,BLACK  ACQUITY TRIAGE: CROSS ROOM /CROSS DOOR  TENTS(ZONES)-SAFE COLD,HOT, WARM,  CARE-NEEDS GREATEST CARE LADIES,OLD & CHILDREN  GOLDEN HOUR:10,20 and 30 Min  MOURGUE  SMALL HOSPITAL IF STAY IS LONG

 