2. CERT - Class 3 Disaster Medical Operations Session I

3. Cell Phones, Pagers, etc. Please turn to OFF, VIBRATE, or SILENT

4. Session Objectives Identify the “Three Killers” Apply techniques for opening airways, controlling bleeding, and for treating shock Understand and perform “Triage” in a simulated disaster situation.

5. This is NOT a First Aid Class Disaster Medical Operations Triage Rapid Assessment Patient Movement We recommend you attend Red Cross First Aid Classes

6. ASSUMPTIONS A massive disaster has struck the area. Local agencies are overwhelmed. You cannot expect assistance for a significant amount of time. The number of injured victims will exceed your ability to treat Survivors will help loved ones, neighbors, and friends. People don’t know much about life saving first aid and post disaster survival

7. KNOW YOUR LIMITS Over 100 rescuers were lost in the Mexico City Earthquake Make a plan Stop, Look, Listen, and Think!

8. 40% CHANCE OF SURVIVAL FOR VICTIMS IN THE 2nd AND 3rd PHASES OF DEATH The Phases of Death Following Trauma 1st Phase - Death within minutes 2nd Phase - Death within several hours 3rd Phase - Death within several days

9. The Three Killers Airway Bleeding Shock

10. AIRWAY Tongue is the #1 Airway Obstruction Can you swallow you tongue?

11. OPEN THE AIRWAY Open the Airway Use the “Head-tilt Chin-lift” Don’t lift at the back of the neck!

12. LOOK, LISTEN, & FEEL LOOK to see the rise and fall of the chest. LISTEN for the sounds of breathing or attempted breathing FEEL the rise and fall of the chest & the breath on your ear

13. BLEEDING The average adult has 5 liters of blood. Loss of just 1 liter poses a risk of death.

14. Types of Bleeding Arterial Bright red, Pulsing, Squirting Capillary Spots of blood, Red sheen Venous Dark red, Flowing

15. Remember D.E.P.T. D = Direct Pressure E = Elevate P = Pressure Point T = Tourniquet

16. Control of Bleeding - Direct Pressure Direct Pressure Directly on the wound With absorbent material Sterile Clean Anything

17. Direct Pressure + Elevation Continue Direct Pressure AND Elevate injury as high as possible above the heart.

18. Direct Pressure + Elevation + Pressure Points Continue Direct Pressure & Elevation Add pressure over a Pressure Point Wherever there is a pulse Anywhere that an artery passes close to the surface and over a firm surface

19. Use the techniques together 95% OF BLEEDING CAN BE CONTROLLED BY DIRECT PRESSURE COMBINED WITH ELEVATION

20. Tourniquet - The Final Option Will usually result in the loss of the limb below the tourniquet site. Last resort only when other techniques have failed to control bleeding. Incorrect application increases damage and bleeding. May damage nerves, blood vessels, & muscle.

21. Correct Application Soft material, 3” wide. Place stick and tighten only until bleeding is controlled. Secure stick in place to insure it doesn’t loosen.

22. SHOCK Inadequate perfusion of the bodies cells Inability of oxygen, nutrients to reach the cells Inability of waste & warmth to leave the cells

23. SHOCK Signs & Symptoms Pale, cool, moist skin Rapid shallow breathing Nausea, vomiting Thirst Rapid pulse Altered Mental Status Confused Disoriented

24. Treatment for Shock LAY VICTIM ON BACK. ELEVATE FEET 10” – 12”. MAINTAIN AIRWAY. MAINTAIN BODY TEMPERATURE.

25. TRIAGE – “ To Sort ” (FR) To Do The Greatest Good For The Greatest Number Of People

26. TRIAGE Immediate - At risk of death or permanent disability if not seen by a physician ASAP Delayed - May need a physician’s care to prevent permanent injury or disability, but can wait while Immediate patients are treated first Minor - May or may-not need to see a physician or health care professional, but are able to wait a significant amount of time DEAD - Not breathing Immediate - At risk of death or permanent disability if not seen by a physician ASAP Delayed - May need a physician’s care to prevent permanent injury or disability, but can wait while Immediate patients are treated first Minor - May or may-not need to see a physician or health care professional, but are able to wait a significant amount of time DEAD - Not breathing

28. Part 2 - The START System Simple Triage And Rapid Transport

29. Doing CERT Triage Immediate= I Delayed= D Minor= M Dead= DEAD

30. TRIAGE - FIRST STEP ASSESS THE SCENE Safety Call for more help Make a plan START WHERE YOU STAND If patients aren’t tagged, then they haven’t been Triage’d

31. CALL OUT Have ambulatory come to you Tell them what to do and where to go Make sure they wait and don’t leave scene Ambulatory are initially categorized as “M” Minor Injuries Remember to check the “Minor” category patients when time permits Walking Wounded Tag “ M ” MINOR INJURIES & use as assistants

32. TRIAGE - Respiration Assess & Position Airway ARE THEY BREATHING? / Look, Listen, & Feel NO Re-position Airway NO Tag “ DEAD ” Check The Rate Of Breathing YES LESS Than 30 Times Per Min. CONTINUE ON TO PERFUSION MORE Than 30 Times Per Min. Tag “ I ” IMMEDIATE & Treat For Bleeding & Shock Now YES

33. TRIAGE - Perfusion ASSESS CIRCULATION Blanch Test Check The Radial Pulse GREATER Than 2 Seconds Tag “ I ” IMMEDIATE & Treat For Bleeding & Shock NOT Present Tag “ I ” IMMEDIATE & Treat For Bleeding & Shock Present LESS Than 2 Seconds CONTINUE ON TO SHOCK

34. TRIAGE – Mental Status Remember To Assess The MINOR Injured “The Walking Wounded” NO Tag “ I ” IMMEDIATE & Treat For Bleeding & Shock Assess Shock By Checking Mental Status YES Tag “ D ” DELAYED Follows Simple Commands

35. Triage Procedure STOP, LOOK, LISTEN, AND THINK. CONDUCT VOICE TRIAGE. FOLLOW A SYSTEMATIC ROUTE. CONDUCT TRIAGE EVALUATION. CONTROL BLEEDING. TREAT FOR SHOCK. DOCUMENT RESULTS.

36. Triage - PITFALLS è Inadequate medical size-up. è No team plan, organization, or goal. è Indecisive leadership. è Too much focus on one injury. è Treatment (rather than triage) performed.

37. MINOR DELAYED Scenario Examples 35 y/o female with large laceration on forehead. Resp. = 25 Blanch < 2 sec. Follows commands and walks to treatment area. 67 y/o male with sub- sternal chest pain. Resp. = 28 Pulse is present. Follows commands but remains seated.

38. DEAD Scenario Examples 5 y/o female with no sign of injury. Resp. = 0 Blanch > 2 sec. Fails to follow commands. 45 y/o male with open fracture of the arm. Resp. = 28 Pulse is present. Follows commands but remains seated. DELAYED

39. Scenario Examples 25 y/o female 8 mo. pregnant and in active labor. Resp. = 28 Blanch < 2 sec. Follows commands 18 y/o male unable to move arms or legs. Resp. = 18 Pulse is present Conscious DELAYED

40. Scenario Examples 15 y/o female with small laceration on forehead. Resp. = 35 Blanch < 2 sec. Follows commands and walks to treatment area. 57 y/o male no sign of injury. Resp. = 18 Pulse is present Fails to follow commands. IMMED.

41. Scenario Examples 33 y/o female with severe back pain. Resp. = 25 Blanch > 2 sec. Follows commands. 44 y/o male broken left forearm. Resp. = 0 Pulse is present. Unconscious. IMMED.DEAD

42. HOMEWORK Review Chapter 3 Scan Chapter 4 Appropriate Clothing Bring Old Blanket

43. THE END