1. Visual 3.1 Unit 3: Disaster Medical Operations

2. Visual 3.2 Unit Objectives 1. Identify the “killers.” 2. Apply techniques for opening airways, controlling bleeding, and treating for shock. 3. Conduct triage.

3. Visual 3.3 Identify the “killers” The “Killers”:  Airway obstruction  Bleeding  Shock (circulation)

4. Visual 3.4 Respiratory System Components of a respiratory system:  Lung  Bronchus  Larynx  Pharynx  Nasal Air Passage  Trachea

5. Visual 3.5 Airway Obstruction  In an unconscious or semi-conscious victim the tongue-which is a muscle- may relax and block the airway.  A victim with a suspected airway obstruction must be checked immediately for breathing and, if necessary, the airway must be opened!

6. Visual 3.6 Head-Tilt/Chin-Lift

7. Visual 3.7 Maintaining the Airway  If breathing is not restored on the first try using the Head-Tilt/Chin- Lift method, CERT members should try again.  If breathing IS NOT restored, move on.  If breathing IS restored place a soft object under the victim’s shoulders, then move on.

8. Visual 3.8 Spinal Precaution  Head, neck and spinal injuries are common during disasters. Used properly the Head- Tilt/Chin-Lift method causes little spinal manipulation because the head pivots on the spine.  Option: Use the jaw-thrust method. Grasp under the jaw and displace it forward.

9. Visual 3.9 Controlling Bleeding  The average adult has about 5 liters of blood. Losing one liter can result in death.

10. Visual 3.10 Controlling Bleeding  Arterial Bleeding- Arteries transport blood under high pressure. Bleeding from an artery is spurting.  Venous Bleeding- Veins transport blood under low pressure. Bleeding from a vein is flowing.  Capillary Bleeding- Capillaries also carry blood under low pressure. Bleeding from capillaries is oozing.

11. Visual 3.11 Controlling Bleeding

12. Visual 3.12 Tourniquet Usage  Tourniquets are a LAST RESORT option. In a disaster setting response resources may be delayed. CERT members may have to resort to tourniquet usage to “save life & limb”.

13. Visual 3.13 Treating Shock  Definition: Shock is a disorder resulting from ineffective circulation of blood.  Remaining in shock will lead to the death of cells, tissues then entire organs  The body will attempt to compensate for any blood loss by: Rapid, shallow breathing Increased capillary refill >2 seconds Failure to follow simple commands

14. Visual 3.14 Blanch Test (capillary refill)

15. Visual 3.15 Procedures for Controlling Shock

16. Visual 3.16 Conducting Triage  Triage is an effective strategy in situations where:  Victims outweigh rescuers  Limited resources  Time is critical

17. Visual 3.17 Haz Mat Situations  CERT members should leave the scene to avoid harm to themselves, and to reduce the risk of spreading the contamination.

18. Visual 3.18 The Goal of Triage  Do the greatest good for the greatest number.

19. Visual 3.19 Triage Categories Immediate Injuries jeopardize “the killers” Delayed Injuries do not jeopardize “the killers” Minor “walking wounded” Dead No life status Virginia Triage Tag

20. Visual 3.20 Contaminated Victims  Victims that have been exposed to contaminates in some regions get tagged BLUE. This tag remains with the victim until proper decontamination has been completed.

21. Visual 3.21 Personal Protection Equipment (PPE)  CERT members must wear all safety equipment to prevent accidental exposure.  Helmet  Latex gloves*  Goggles  Particle mask (N95 or duck-bill) *allergy caution!

22. Visual 3.22 Triage Equipment Ground Tarps Triage Tape (notice the black is now striped!) Triage Tags MCI Trailer

23. Visual 3.23 Conducting Triage  Step 1: Stop, look, listen, and think  Step 2: Conduct voice triage  Step 3: Start where you stand  Step 4: Evaluate, tag them and move on  Step 5: Treat a red tag’s problem immediately  Step 6: Document results How many victims There location

24. Visual 3.24 S.T.A.R.T. Triage

25. Visual 3.25 Jump S.T.A.R.T.

26. Visual 3.26 Performing Triage Evaluation  Airway  Position yourself on one side of the victim.  Gently shake the victim for response. If no response: –Open the airway –Look, listen and feel for breathing –>30 respirations ? (RED TAG) –Not breathing after two attempts (BLACK)

27. Visual 3.27 Performing Triage Evaluation  Bleeding  All victims are tagged YELLOW unless:  Uncontrolled bleeding Tag RED Hold direct pressure, do not cut-off circulation! Use GREEN victims for assistance.  Perform a blanch test >2 seconds tag RED

28. Visual 3.28 Performing Triage Evaluation  Mental Status (level of consciousness)  Inability to respond to simple commands tag RED Shock? Diabetic? Drunk? Stroke? Seizure?

29. Visual 3.29 Triage Documentation  Come up with a means to track your triage findings and the victims location (if necessary). Chart method Cloths pins Pieces of ribbon Hash marks Etc……

30. Visual 3.30 Reverse Triage  Used for MCI lightening injuries.  The BLACK tags are treated first.  High potential for respiratory arrest  High potential for cardiac arrest conversion with a AED

31. Visual 3.31 Triage Pitfalls  No team plan, organization, or goal  Indecisive leadership  Too much focus on one injury  Treatment (rather than triage) performed

32. Visual 3.32 “Break” Time !