1. Disaster Medical Operations — Part 1 CERT Basic Training Unit 3

2. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-1 Assumptions ●Need for CERT members to learn disaster medical operations is based on two assumptions:  Number of victims could exceed local capacity for treatment  Survivors will assist others ‒ They will do whatever they know how to do ‒ They need to know lifesaving first aid or post- disaster survival techniques

3. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-2 Importance of Quick Action ●Phase 1: Death within minutes, result of severe trauma ●Phase 2: Death within several hours, result of excessive bleeding ●Phase 3: Death in several days or weeks, result of infection

4. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-3 CERT Training ●Treatment for life-threatening conditions  Airway obstruction, bleeding, shock ●Treatment for other, less urgent conditions Provide greatest good for greatest number by conducting simple triage and rapid treatment

5. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-4 START ●STart = Simple Triage  Victims sorted based on priority of treatment ●stART = And Rapid Treatment  Rapid treatment of injuries assessed and prioritized in first phase

6. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-5 Unit Objectives ●Identify “killers” ●Apply techniques for opening airway, controlling bleeding, and treating for shock ●Conduct triage under simulated disaster conditions

7. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-6 Unit Topics ●Treating life threatening injuries ●Triage

8. Recognize & Treat the Three “Killers” 1.Airway obstruction 2.Bleeding (uncontrolled) 3.Shock (circulation) DBFD CERT Annual Recertification Review Updated 11.8.12 http://www.citizencorps.gov/cert/videos/Triage/index.shtm

9. Approaching a Victim ●Be sure victim can see you ●Identify yourself  “I’m Sue from the Community Emergency Response Team” ●Request permission to treat  “May I treat you?” DBFD CERT Annual Recertification Review Updated 11.8.12

10. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-9 Open vs. Obstructed Airway

11. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-10 Head-Tilt/Chin-Lift Method

12. Opening Airway Head Tilt – Chin Lift Look & Listen for Response

13. Open Airway: Head-Tilt/Chin-Lift Method ●HAND POSITIONS  Palm of hand on forehead  2 fingers of other hand under chin  Tilt jaw upward while tilting head back slightly ●HEAD POSITION  Ear close to victim’s mouth  Look toward victim’s feet  Place hand on abdomen ●SENSES  Look for chest rise  Listen/Feel for air exchange  Feel for abdominal movement DBFD CERT Annual Recertification Review Updated 11.8.12

14. Opening Airway ●If Breathing Is Restored:  Maintain Airway  Tag Red ●If Breathing Is Not Restored:  Reposition Head & Try again ●If Breathing Is Still Not Restored after second try:  Tag Black  Move on DBFD CERT Annual Recertification Review Updated 11.8.12

15. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-14 Types of Bleeding - 1 ●Arterial bleeding  Bleeding from artery spurts ●Venous bleeding  Bleeding from vein flows ●Capillary bleeding  Bleeding from capillaries oozes

16. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-15 Types of Bleeding - 2

17. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-16 Control Bleeding ●3 main methods for controlling bleeding:  Direct pressure  Elevation  Pressure points Video: How to Treat a Bleeding Arm Wound (2:53 min): http://www.monkeysee.com/play/7016-how-to-treat-a-bleeding-arm-wound Get victims to help themselves whenever possible

18. Control Bleeding ●Direct Pressure  Apply a Clean Dressing if available  Press firmly ●Wrap & Tie  Wrap wound firmly  Tie with bow ●Elevate ●Tag Red DBFD CERT Annual Recertification Review Updated 11.8.12

19. Direct Pressure & Elevation ●Step 1: Place direct pressure over the wound by putting a clean dressing over the wound and pressing firmly. ●Step 2: Maintain pressure on the dressing over the wound by wrapping firmly with a pressure bandage. ●Step 3: Elevate the wound above the level of the heart.

20. Pressure Points Brachial Pressure Point Femoral Pressure Point just above the elbow in the upper thigh

21. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-20 Shock ●Result of ineffective circulation of blood ●Remaining in shock will lead to death of:  Cells  Tissues  Entire organs

22. Recognizing Shock ●Mental Status  Can they follow simple commands  If they can’t squeeze your hand, treat for shock  “What is your name”  “Squeeze my hand” ●Breathing  Rapid and shallow  If more than 30 breaths per minute, treat for shock ●Circulation  Blanch Test on palm of hand or fingernail to test Capillary Refill  If color does not return in 2 seconds, treat for shock What is an obvious form of shock? (unconscious) DBFD CERT Annual Recertification Review Updated 11.8.12

23. CERT Basic Training Unit 3 Disaster Medical Operations — Part 1 3-22 Recognizing Shock ●Symptoms of shock are easily missed… pay careful attention to your patient! Video: How to Treat a Victim in Shock (1:22 min): http://www.monkeysee.com/play/7018-how-to-treat-a-victim-in-shock http://www.monkeysee.com/play/7018-how-to-treat-a-victim-in-shock

24. Treating Shock ●Position victim on his/her back ●Elevate feet 6 to 10 inches above heart ●Maintain body temperature ●Tag red DBFD CERT Annual Recertification Review Updated 11.8.12

25. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-24 Responding to Mass Casualty Event ●Have a plan ●Follow that plan ●Document your actions throughout

26. 1.Assess: Assess the Situation  Gather Facts  Assess Damage  Consider Probabilities  Assess Your Situation 2.Plan: Make a Plan  Establish Priorities  Make Decisions  Develop Plan of Action 3.Act: Take Action REMEMBER: CERT SIZEUP IS A CONTINUAL PROCESS Size-up: Assess, Plan, Act DBFD CERT Basic Training Assess Act Plan

27. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-26 What Is Triage? ●Process for managing mass casualty event 1.Victims are evaluated 2.Victims are sorted by urgency of treatment needed 3.Victims are set up for immediate or delayed treatment Video: 3 ½ minutes Bus Triage http://www.citmt.org/start/background.htm

28. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-27 Triage ●Immediate (I): Victim has life-threatening injuries (airway, bleeding, or shock) ●Delayed (D): Injuries do not jeopardize victim’s life; treatment can be delayed ●Minor (M): Walking wounded and generally ambulatory ●Dead (DEAD): No respiration after two attempts to open airway

29. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-28 Rescuer Safety During Triage ●If hazmat or terrorist event is suspected, CERT members DO NOT respond  Evacuate as safely as possible ●ALWAYS wear PPE:  Helmet  Goggles  N95 mask  Work gloves  Sturdy shoes or boots  Non-latex exam gloves

30. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-29 Triage Process ●Step 1: Stop, Look, Listen, and Think ●Step 2: Conduct voice triage ●Step 3: Start where you stand; follow systematic route “go right, stay right” ●Step 4: Evaluate each victim and tag ●Step 5: Treat “I” victims immediately ●Step 6: Document triage results

31. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-30 Triage Evaluation ●Check airway and breathing ●Check circulation and bleeding ●Check mental status

32. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-31 Perfusion & Respiration Videos Watch Perfusion Video Watch Respiration Video

33. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-32 Triage Pitfalls ●No team plan, organization, or goal ●Indecisive leadership ●Too much focus on one injury ●Treatment (rather than triage) performed

34. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-33 Unit Summary ●You should now be able to:  Identify 3 “killers”  Apply techniques for opening the airway, controlling bleeding, and treating for shock  Conduct triage under simulated disaster conditions

35. Review Question a. Victims that are bleeding from injuries on their extremities. b. Victims showing signs of being upset or stressed. c. Victims whose injuries could become infected after initial treatment. d. Victims gasping for air without an obvious reason. Which of the following is a “STOP” sign for CERTs responding to a medical emergency?

36. Review Questions a. Shock. b. Headache. c. Dizziness. d. Nausea. The three life-threatening conditions that always get first priority are obstructed airway, excessive bleeding, and:

37. Review Question a. Tilt the head and lift the chin to clear any obstruction. b. Look at the victim’s chest and watch for the chest to rise. c. At arm’s length, shake the victim and shout, “Can you hear me?” d. Move near the victim’s mouth and listen for breathing. What is the first step that CERT members should take if someone appears to be unconscious?

38. Review Question a. Immersing the wound in water. b. Direct pressure and elevation. c. Covering the wound with ice. d. Packing the wound with salve. Most bleeding can be controlled by:

39. Review Qustion a. Failure to follow simple commands. b. Fewer than 30 breaths per minute. c. Capillary refill of less than 2 seconds. d. Excessive bleeding from an injury. During triage, what determines the victim's mental status?

40. Review Question a. Internal injuries. b. Psychological trauma. c. Closed-head injuries. d. The 3 “killers”. The goal of triage is to identify victims who have:

41. Review Question a.“#1” for first priority level, “#2” for second priority level, or “#3” for third priority level. b. “G” for green (for release), “Y” for yellow (for observation), or “R” for red (for treatment). c. “I” for immediate treatment, “D” for delayed treatment, or “Dead.” d. “L” for life-threatening injuries, “S” for severe injuries, and “M” for minor injuries. To indicate the results of triage, every victim receives a tag with:

42. Review Question a. Treat the highest priority victims. b. Conduct voice triage. c. Triage and tag victims. d. Document triage results. After sizing up the situation, the next step for you and your buddy is to:

43. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-42 Homework Assignment 1.Read unit 4 2.Add something to your Emergency Kit 3.Make a Wallet Card with out-of-state contact