Broward County Public SchoolsRevised: August 2007 Health Science Core Chapter 8 Disaster: Preparedness, Hazards, and Prevention Broward County Triage Broward County Incident Command

Broward County Public SchoolsRevised: August 2007 Chapter 18: Disasters: Preparedness

Broward County Public SchoolsRevised: August 2007 Disaster An unexpected event that causes great damage and depletes or exhausts currently available resources Earthquakes Hurricanes Floods Tornadoes Airplane accident Hazardous waste accident

Broward County Public SchoolsRevised: August 2007 Triaging Terms Triage - To sort or prioritize care for a group of patients Assessment – evaluation of the patient Objective – Information obtained from observing the patient Subjective – Information obtained from the patient The goal of triage – Prompt and efficient patient care

Broward County Public SchoolsRevised: August 2007 Disaster Preparedness 1. Disaster preparedness has become a recognized specialty which requires cooperation of many agencies. 2. Proper preparation takes: Foresight Thought Planning Experience is the best teacher

Broward County Public SchoolsRevised: August 2007 Disaster Basic Guidelines Remain calm Know who the designated person in charge of you Keep agency telephone lines clear for official business Communicate and cooperate with other workers Always speak in a firm voice but a caring tone

Broward County Public SchoolsRevised: August 2007 Occupational Safety OSHA – Occupational Safety and Health Administration – agency that develops safety standards and establishes maximum levels of exposure to many hazardous material. NIOSH – National Institute for Occupational Safety and Health – Investigates requests of unsafe working conditions and how they relate to employee illnesses.

Broward County Public SchoolsRevised: August 2007 Hospital Hazards Anesthesia – gases used to cause loss of sensation and/or consciousness caused by the administration of drugs Radiation and chemotherapy – toxic substances that can have a high risk of developing tissue damage Asbestos – fireproofing material in old construction Always read the label and mixing instructions before using any chemicals

Broward County Public SchoolsRevised: August 2007 Hazard Communication / HazCom Program that protects employees from the dangers of chemicals and medical gases. 1.Employee training 2.Written program 3.Material Safety Data Sheets 4.Warning Labels

Broward County Public SchoolsRevised: August 2007 Mass Casualty Incidents Uniform Pre-hospital MCI Procedure

Broward County Public SchoolsRevised: August 2007 What is an MCI ? Any Incident Which Overwhelms the Capabilities of the First Arriving Unit (s).

Broward County Public SchoolsRevised: August 2007 Predetermined Response Amount of resources that will automatically be issued based on the number of patients First responding unit will notify dispatch center the MCI Level There are 5 Levels of response

Broward County Public SchoolsRevised: August 2007 MCI Level 1 Response (5-10 Victims) 4 ALS Transport Units 2 Suppression units 1 Shift Supervisor 1 EMS Supervisor

Broward County Public SchoolsRevised: August 2007 MCI Level 2 Response (11-20 Victims) 6 ALS Rescue Units 3 Suppression Units 2 Shift Supervisors 2 EMS Supervisors

Broward County Public SchoolsRevised: August 2007 MCI Level 3 Responses ( Victims) 8 ALS Transport Units 4 Suppression Units 3 Shift Supervisors 3 EMS Supervisors 1 Operations Chief 1 Command Vehicle 1 Supply Trailer

Broward County Public SchoolsRevised: August 2007 MCI LEVEL 4 Response ( Victims) 5 MCI Task Forces (25 units) 2 ALS Transport Unit Strike Teams (10 units) 1 Suppression Unit Strike Team (5 units) 2 BLS Transport Unit Strike Teams (10 units) 2 Mass Transit Buses 5 Shift Supervisors 3 EMS Supervisors 1 EMS Chief 1 Operations Chief 1 Command Vehicle 2 Supply Trailers 1 Communications Trailer

Broward County Public SchoolsRevised: August 2007 MCI LEVEL 5 Response (Over 1000 victims) 10 MCI Task Forces (50 units) 4 ALS Transport Unit Strike Teams (20 units) 2 Suppression Unit Strike Teams (10units) 4 BLS Transport Unit Strike Teams (20 units) 4 Mass Transit Buses 10 Shift Supervisors 6 EMS Supervisors 2 EMS Chiefs 2 Operations Chief 2 Command Vehicles 4 Supply Trailers 1 Communication Trailers

Broward County Public SchoolsRevised: August 2007 First Arriving Unit Procedure

Broward County Public SchoolsRevised: August 2007 First Arriving A. Unit Officer will establish “COMMAND” 1. Size-up and estimate number of victims 2. Request MCI level response 3. Identify a Staging Area

Broward County Public SchoolsRevised: August 2007 First Arriving 4. Initiate triage with crew members and initial crews a. Perform START or JumpSTART Triage b. Prioritize victims RED (Immediate)RED (Immediate) YELLOW (Delayed)YELLOW (Delayed) GREEN (Minor)GREEN (Minor) BLACK (Non-salvageable)BLACK (Non-salvageable) 5. Direct walking wounded to one location

Broward County Public SchoolsRevised: August 2007 Mass Casualty Operational Structure

Broward County Public SchoolsRevised: August 2007 Operational Groups 1. Triage 2. Treatment 3. Transport 4. Staging

Broward County Public SchoolsRevised: August 2007 Basic Command Structure for Mass Casualty Incidents Incident Commander / Medical Branch Officer Triage GroupTreatment GroupTransport GroupStaging Group

Broward County Public SchoolsRevised: August 2007 Other Possible Operational Groups 1. Medical Branch 2. Landing Zone 3. Extrication 4. Hazmat 5. Rehabilitation 6. Safety 7. PIO 8. Medical Intelligence

Broward County Public SchoolsRevised: August 2007 Complex Command Structure for Mass Casualty Incidents Medical Branch Triage Group Triage Unit Litter Bearers Unit Medical Examiner Unit Treatment Group Red unit Yellow Unit Green Unit Aid Transport Group Aid Medical Communication Coordinator Staging Medical Supply

Broward County Public SchoolsRevised: August 2007 START Triage

Broward County Public SchoolsRevised: August 2007 Initial Triage Locate and direct all walking wounded Assign someone to keep green group together Assess non-ambulatory Use colored ribbons tied to upper extremity Borderline use higher priority tag

Broward County Public SchoolsRevised: August 2007 Perform during Treatment phase Use DMS All Risk Triage Tag Trauma criteria will apply Secondary Triage Procedure

Broward County Public SchoolsRevised: August 2007 Respirations Perfusion Mental Adult START Triage RPM

Broward County Public SchoolsRevised: August 2007 Less Than 30/minute – Go To Perfusion Over 30/Minutes – RED Tag No Respirations – Open Airway: – Breathing – RED Tag – Not Breathing – BLACK Tag Respirations

Broward County Public SchoolsRevised: August 2007 Radial Pulse present or Capillary Refill is < 2 seconds - Go To Mental Status No Radial Pulse or Capillary Refill > 2 Seconds – RED Tag Perfusion

Broward County Public SchoolsRevised: August 2007 Follows Simple Commands & AAOX3 – GREEN Does not follow commands, not AAOX3 or is Unconscious – RED Tag Depending on Injuries – YELLOW Tag Mental Status

Broward County Public SchoolsRevised: August 2007 START Flow Chart

Broward County Public SchoolsRevised: August 2007 Pediatrics Jump START Triage

Broward County Public SchoolsRevised: August 2007 JumpSTART Triage Triage system adapted for pediatrics < 8 years old, which use a modify version of evaluating: Respiration Perfusion Mental Status

Broward County Public SchoolsRevised: August 2007 Respiration Rate between 15 and 45 BPM – Go to Perfusion Rate over 45 BPM or under 15 BPM – RED Tag No Respiration – Open Airway and remove any obstruction Still no breathing, than check radial or pedal pulse No pulse - BLACK Tag Pulse present Give 5 respirations – Breathing begins – RED Tag No breathing – BLACK Tag

Broward County Public SchoolsRevised: August 2007 Perfusion Peripheral pulse present – Go to Mental Status Peripheral pulse absent – RED Tag

Broward County Public SchoolsRevised: August 2007 Mental Status Assess child with AVPU Scale (Alert, Verbal, Painful, or Unconscious) If unconscious or only responds to painful stimuli – RED Tag If child is alert or responds to verbal stimuli assess for further injuries - YELLOW Tag or GREEN Tag

Broward County Public SchoolsRevised: August 2007 JumpSTART Flow Chart

Broward County Public SchoolsRevised: August 2007 Secondary Triage with All Risk Triage Tag

Broward County Public SchoolsRevised: August 2007 All Risk Triage Tags

Broward County Public SchoolsRevised: August 2007 Contaminated Section Must remove if patient is not contaminated If strip is not remove patient is considered contaminated.

Broward County Public SchoolsRevised: August 2007 Contaminated Section When the patient’s cloths are removed, the strip should be placed in the bag for evidence

Broward County Public SchoolsRevised: August 2007 Back Front 1 watch, 2 rings, and 1 wallet Personal Property Receipt Patient valuables in plastic bag

Broward County Public SchoolsRevised: August 2007 Personal Property Receipt

Broward County Public SchoolsRevised: August 2007 Front Back HMW R19 John Smith Patient Ground Transport Tracking Tag Removed by Transport Officer for patient tracking

Broward County Public SchoolsRevised: August 2007 Chemical Exposure Symptoms and Treatment Salivation Lacrimation Urination Defecation G.I. Distress Emesis Miosis XX Mark 1 X

Broward County Public SchoolsRevised: August 2007 Patient Assessment Decontamination Area of injury WMD type X 28 X X X

Broward County Public SchoolsRevised: August 2007 Vital Signs Documenting B/P, Pulse, Respiration, and IV solution 11:30 180/ :30 Normal Saline KVO

Broward County Public SchoolsRevised: August 2007 Triage Category Remove all of the tags distal to desires color and half of the color. Above is Yellow Tag

Broward County Public SchoolsRevised: August 2007 START Triage Method XX X X

Broward County Public SchoolsRevised: August 2007 Personal Information John Smith SW 27 Street Miramar FL 33027

Broward County Public SchoolsRevised: August 2007 References Stevens, Kay, and Garber, Debra. Introduction to Clinical Allied Healthcare. 2nd ed. Clifton Park, New York: Thomson Delmar Learning, Jones and Bartlett Publishers. (2004). Florida Regional Common EMS Protocols, Sudbury, MA: Jones and Bartlett.