1. Reference Handout for Disaster Medicine— Triage SAVING LIVES: Airway (Head-Tile/Chin-Lift) Bleeding (Pressure/Elevation) Shock (Keep Warm/Lie Down) TRIAGE STEPS: 1.Stop, Observe, Think 2.Voice Triage First 3.Be Systematic 4.Evaluate/Tag All Victims 5.Treat “I” On The Spot 6.Document Findings TRIAGE CATEGORIES: (I) Immediate (D) Delayed (M) Minor (DEAD) Dead (= Deceased) CERT Supplemental Module #1 – Disaster Triage 0 RESCUER PPE: Exam Gloves New Each Victim OR Sterilize (10% bleach) Helmet Goggles N95 Face Mask TRIAGE PROCESS: 1.Can Victim Walk? 2.Victim Breathing? 3.Respiration Rate? 4.Blanch Test 5.Responsive? Respiration < 30/min Blanch Test < 2 sec Mental Status: Responsive - twice

2. Disaster Medical Operations — Triage CERT Supplemental Training Module 1

3. CERT Supplemental Module #1 – Disaster Triage 1-2 Module Objectives ●Specify “killers” requiring immediate treatment ●Review how to open airway, control bleeding, and treat for shock ●Conduct triage under simulated disaster conditions

4. CERT Supplemental Module #1 – Disaster Triage 1-3 Importance of Quick Action ●Immediate: Death within minutes; result of severe trauma, not breathing, shock ●Immediate: Death within several hours; result of excessive bleeding ●Delayed: Death in several days or weeks; result of infection Provide greatest good for greatest number by conducting START (Simple Triage And Rapid Treatment)

5. CERT Supplemental Module #1 – Disaster Triage 3-4 Importance of Quick Action ●Emergency medicine “killers”  Airway obstruction  Bleeding  Shock ●First priority of medical operations:  Open airway  Control excessive bleeding  Treat for shock

6. CERT Supplemental Module #1 – Disaster Triage 3-5 How to Approach a Victim ●Be sure victim can see you ●Identify yourself  Your name and CERT Volunteer ●Request permission to treat, if possible (unconscious = permission) ●Respect cultural differences

7. CERT Supplemental Module #1 – Disaster Triage 3-6 What Do You Think? ●What is the most common airway obstruction? What is the most obvious sign of arterial bleeding? What does it mean if a victim cannot follow simple commands, such as “Squeeze my hand”? Student Manual pg 3-5 & 3-6 Student Manual pg 3-9 Student Manual pg 3-15

8. CERT Supplemental Module #1 – Disaster Triage 3-7 Head-Tilt/Chin-Lift Review Only the head is manipulated to avoid spine injury Listen and feel for breathing If none, try second time before giving up

9. CERT Supplemental Module #1 – Disaster Triage 3-8 Types of Bleeding ●Arterial bleeding  Bleeding from artery spurts ●Venous bleeding  Bleeding from vein flows ●Capillary bleeding  Bleeding from capillaries oozes  Bleeding from head abundant “flow” Direct pressure & elevation will stop most bleeding of any type

10. CERT Supplemental Module #1 – Disaster Triage 3-9 Shock ●Ineffective circulation of blood in body ●Shock can lead to unconsciousness and death ●Maintain body temp with blanket under victim plus covering

11. CERT Supplemental Module #1 – Disaster Triage 3-10 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 (use as assistants?) ●Dead (DEAD): No respiration after two attempts to open airway

12. CERT Supplemental Module #1 – Disaster Triage 3-11 Triage Concept Process for helping many victims 1.Victims are evaluated quickly 2.Victims are sorted by urgency of treatment they need 3.Victims are set up for immediate or delayed treatment 4.Minor injured may be used to help move or assist

13. CERT Supplemental Module #1 – Disaster Triage 3-12 Triage Steps ●Step 1: Stop, Look, Listen, and Think ●Step 2: Conduct voice triage ●Step 3: Follow systematic path around ●Step 4: Evaluate each victim and tag  Check airway and breathing  Check circulation and bleeding  Check mental status (shock) ●Step 5: Treat “I” victims immediately ●Step 6: Document triage results

14. CERT Supplemental Module #1 – Disaster Triage 3-13 Triage Pitfalls ●Poor team sizeup, organization, or goal ●Indecisive leadership ●Too much focus on one injury ●Treatment (rather than triage) performed

15. CERT Supplemental Module #1 – Disaster Triage 3-14 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 face mask  Work gloves  Sturdy shoes or boots  Non-latex exam gloves

16. CERT Supplemental Module #1 – Disaster Triage 3-15 What Do You Think? 1.Victims will be shown and symptoms listed 2.You determine which category they are in 3.Press Enter to show “book” solution Like this Triage Evaluation

17. CERT Supplemental Module #1 – Disaster Triage 3-16 Triage Evaluation Victim #1: ●Bleeding from legs ●Unresponsive ●After two attempts to open airway, still not breathing Dead

18. CERT Supplemental Module #1 – Disaster Triage 3-17 Triage Evaluation Victim #2: ●Can walk and talk ●Bleeding from left arm ●Blanch test < 2 sec ●Respiration 25/min Minor

19. CERT Supplemental Module #1 – Disaster Triage 3-18 Triage Evaluation Victim #3: ●Bleeding from left arm ●Conscious but won’t follow commands ●Respiration 38/min Immediate

20. CERT Supplemental Module #1 – Disaster Triage 3-19 Triage Evaluation Victim #4: ●Responds to voice triage ●Bleeding from right arm and left leg ●Respiration 26/min ●Blanch test < 2 sec Minor

21. CERT Supplemental Module #1 – Disaster Triage 3-20 Triage Evaluation Victim #5: ●Bleeding from head and left shoulder ●Follows commands ●Respiration 30/min ●Complains of chest pain ●Blanch test > 2 sec Immediate

22. CERT Supplemental Module #1 – Disaster Triage 3-21 Triage Evaluation Victim #6: ●No bleeding ●Leg pain and unable to walk ●Breathing 20/min ●Pulse 108 bpm Delayed

23. CERT Supplemental Module #1 – Disaster Triage 3-22 Triage Evaluation Victim #7: ●Bleeding from head ●Responds to voice triage ●Breathing 30/min ●Blanch test < 2 sec Delayed

24. CERT Supplemental Module #1 – Disaster Triage 3-23 Triage Evaluation Victim #8: ●No bleeding ●Deformity to left wrist ●Respiration 23/min ●Blanch test < 2 sec Delayed

25. CERT Supplemental Module #1 – Disaster Triage 3-24 Triage Evaluation Victim #9: ●Bleeding from leg with bone visible ●Follows all commands ●Respiration 29/min ●Blanch test 2 sec Immediate

26. CERT Supplemental Module #1 – Disaster Triage 3-25 Triage Evaluation Victim #10: ●No bleeding ●Complains of back pain ●Follows all commands ●Respiration 20/min ●Blanch test 2 sec Minor

27. CERT Supplemental Module #1 – Disaster Triage 3-26 Triage Evaluation Victim #11: ●Abrasions on torso ●Airway is clear ●Does not follow commands ●Respiration 17/min ●Blanch test > 5 sec Immediate

28. CERT Supplemental Module #1 – Disaster Triage 3-27 Triage Evaluation Victim #12: ●Can move all limbs ●No bleeding found ●Does not follow commands ●Respiration 22/min ●Blanch test 3 sec Immediate

29. CERT Supplemental Module #1 – Disaster Triage 3-28 Triage Evaluation Victim #13: ●Minor head bleeding ●Airway seems clear ●Does not follow commands ●Respiration 30/min ●Blanch test < 2 sec Immediate

30. CERT Supplemental Module #1 – Disaster Triage 3-29 Triage Evaluation Victim #14: ●Minor bleeding from arm & obviously pregnant ●Complains of back pain ●Follows all commands ●Respiration 26/min ●Blanch test < 2 sec Delayed

31. CERT Supplemental Module #1 – Disaster Triage 3-30 Triage Evaluation Victim #15: ●Right leg bleeding ●Complains of severe pain in leg ●Follows all commands ●Respiration 20/min ●Blanch test 3 sec Delayed

32. CERT Supplemental Module #1 – Disaster Triage 3-31 Triage Evaluation Victim #16: ●No bleeding ●Deformity in left leg ●Crying; does not follow commands ●Respiration 26/min ●Blanch test 2 sec Immediate

33. CERT Supplemental Module #1 – Disaster Triage 3-32 Triage Evaluation Victim #17: ●No bleeding visible ●Unresponsive child ●No respiration after head tilt and retry ●Blanch test > 5 sec Dead

34. CERT Supplemental Module #1 – Disaster Triage 3-33 Triage Evaluation Victim #18: ●Minor bleeding ●Deformed right wrist ●Follows all commands ●Respiration 28/min ●Blanch test 2 sec Delayed

35. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-34 Module Summary You should now be able to:  Identify primary 3 “killers”  Apply techniques to open the airway, control bleeding, and treat for shock  Safely conduct triage in a disaster  Immediate  Delayed  Minor