1. Contra Costa County CERT Program Unit 4 – Emergency Medical Operations Part 2 Released: 18 August 2011

2. Visual 4.1 Community Emergency Response Team  Personal safety is ALWAYS the number one priority  Work as a team  Wear personal protective equipment…gloves, helmet, goggles, N95 mask and boots  The CERT goal is to do the Greatest Good for the Greatest Number  Hope for the best but plan for the worst

3. Visual 4.2 Unit Objectives  Personal Protection  Take appropriate sanitation measures to help protect public health  Perform head-to-toe patient assessments  Establish Treatment Areas  Treating injuries (Warning: some graphic pictures)

4. Visual 4.3 Public Health Considerations  Maintain proper hygiene  Maintain proper sanitation  Purify water (if necessary)  Prevent spread of disease

5. Visual 4.4 Steps to Maintain Hygiene  Wash hands frequently using soap and water  for at least 12 to 15 seconds  use alcohol based sanitizer if soap and water not available  Wear non-latex gloves; change or disinfect after each patient  1 part bleach to 10 parts water for 30 seconds  Wear N95 mask and goggles  Keep dressings sterile  Avoid contact with body fluids If it’s wet or sticky and it’s not yours  DON’T TOUCH IT!

6. Visual 4.5 Maintaining Sanitation  Control disposal of bacterial sources by putting waste products in plastic bags  Tie off and mark as medical waste  Bury or bag human waste

7. Visual 4.6 Water Purification  Boil for 1 minute or  Use Water Purification Tablets or  Use ⅛ tsp of bleach per gallon of clear water  Use ¼ tsp of bleach per gallon of cloudy water  no soaps or scents in bleach  4% to 6% sodium hypochlorite  Let solution stand for 30 minutes  If that solution does not smell or taste of bleach, add another ⅛ tsp of bleach and let solution stand for another 15 minutes before using

8. Visual 4.7 Disaster Medical Operations  Triage  Transport  Treatment  Morgue  Supply Functions:

9. Visual 4.8 Disaster Medical Operations  Select site and set up treatment area as soon as injured victims are confirmed  When determining best location(s) for treatment area, consider:  Safety of rescuers and victims  Most effective use of resources

10. Visual 4.9  In a safe area  Close to but upwind, upstream and uphill from the hazard zones  Accessible by transportation vehicles  Expandable Establishing Treatment Areas Site selected should be: TREATMENT SITE Hazard Wind

11. Visual 4.10 Establishing Treatment Areas “Immediates” need immediate attention Transport “Immediates” to a higher level of medical care if possible Assign treatment leader to each treatment area

12. Visual 4.11 Documentation in Treatment Areas  Available identifying information  name, phone number, address, etc……..  Description  age, sex, body build, approximate height and weight  clothing  Injuries the victim sustained  Treatment and actions taken  Transfer location

13. Visual 4.12 Head-to-Toe Assessment  R espirations – Airway obstruction  P erfusion – Circulation, excessive bleeding  M ental Status – Signs of shock Look for “The Killers”

14. Visual 4.13 Indicators of Injury  Bruising  Swelling  Severe pain  Disfigurement Provide immediate treatment for life-threatening injuries!

15. Visual 4.14 Types of Injury  Deformities  Contusions  Abrasions  Punctures  Burns  Tenderness  Lacerations  Swelling

16. Visual 4.15 Conducting Head-To-Toe Assessment  Get permission to conduct assessment  Determine the extent of injuries and treatment  Look for “The Killers”  Determine the type of treatment needed  Document injuries and actions taken Be aware of “mechanism of injury”

17. Visual 4.16 Head-to-Toe Assessment  Look for medical identification  Conduct on all victims, even those who seem to be alright  Children are assessed Toe-to-Head  Everyone gets a tag  Verbal assessment  Hands-on assessment  look, listen and feel for anything unusual Victim has the right to refuse treatment

18. Visual 4.17 Head to Toe Assessment 1.Head 2.Neck 3.Shoulders 4.Chest 5.Arms 6.Abdomen 7.Pelvis 8.Legs 9.Back Anyone unconscious or with injuries to the head, neck, trunk or upper legs are “Immediates” Let them know what you are doing. Communicate!

19. Visual 4.18 Symptoms  Change in consciousness  Inability to move one or more body parts  Severe pain or pressure in the head, neck or back  Tingling or numbness in extremities  Difficulty breathing or seeing  Heavy bleeding, bruising or deformity of the head or spine  Blood or fluid in the nose or ears  Bruising behind the ears  “Raccoon” eyes (bruising around the eyes)  “Uneven” pupils  Seizures  Nausea or vomiting  Victim found under collapsed building materials or heavy debris Signs of a closed-head, neck or spinal injury Minimize movement of head, neck and spine

20. Visual 4.19 Layers of Skin  Epidermis - First Degree  Dermis - Second Degree  Subcutaneous layer - Third Degree

21. Visual 4.20 Treating Burns  Remove victim from burning source  Cool the burned area  no more than 15% or approximately one arm at a time  Cover with sterile cloth to reduce infection risk  Elevate burned extremity higher than heart No ice, antiseptics, ointments, butter, etc… Extra caution with infants, young children or elderly

22. Visual 4.21 Treating Chemical Burns  Remove cause of burn & affected clothing/jewelry  If irritant is dry, gently brush away as much as possible  Always brush away from eyes, victim, and you  Flush with lots of cool running water  Apply cool, wet compress to relieve pain  Cover wound loosely with dry, sterile or clean dressing  Treat for shock if appropriate

23. Visual 4.22 Inhalation Burns  Sudden loss of consciousness  Evidence of respiratory distress or upper airway obstruction  Soot around mouth or nose  Singed facial hair  Burns around face or neck

24. Visual 4.23 Wound Care  Control bleeding  Prevent secondary infection Objective of wound care: Treatment of wounds :  Clean wounds – don’t scrub  Apply dressing to wound  Apply bandage to hold dressing in place No tourniquets No Hydrogen Peroxide

25. Visual 4.24 Rules of Dressing  In the absence of active bleeding, remove dressing and flush, check wound at least every 4-6 hours, redress as necessary  If there is active bleeding, redress over existing dressing and maintain pressure and elevation

26. Visual 4.25 Signs of Infection  Swelling around wound site  Discoloration  Discharge from wound  Red striations from wound site

27. Visual 4.26 Treating Amputations  Control bleeding and elevate part  Treat for shock if present  Save tissue parts, wrapped in clean cloth  Place in baggy w/ patient’s name, date, and time  Keep tissue cool, not frozen  Keep tissue with the victim  Duct tape to body

28. Visual 4.27 Treating Impaled Objects  Immobilize  Don’t move or remove  Control bleeding  Clean and dress wound  Wrap

29. Visual 4.28 Fractures, Dislocations, Sprains, Strains Symptoms:  Tenderness at injury site  Swelling and/or bruising  Restricted use or loss of use Objective:  Immobilize the injury and joints above and below the injury and elevate  If questionable, treat as a fracture  Improvise items to use as splints

30. Visual 4.29 Guidelines for Splinting  Support the injured area  Assess color, warmth and sensation  Splint injury in the position that you find it  Don’t try to realign bones  Immobilize above and below the injury  After splinting, recheck for color, warmth, and sensation below the injury site All fracture & suspected fractures require splinting

31. Visual 4.30 Dislocations  Dislocation is injury to ligaments around joint  So severe that it permits separation of bone from its normal position in joint  Treatment  Immobilize; do NOT relocate  Check PMS before and after splinting/ immobilization

32. Visual 4.31 Signs of Sprain  Tenderness at site  Swelling and bruising  Restricted use or loss of use

33. Visual 4.32 Types of Fractures OpenClosed Nondisplaced Closed Displaced

34. Visual 4.33 Treating an Open Fracture DO:  Cover wound  Splint fracture without disturbing wound  Place a moist 4" x 4" dressing over bone end to prevent drying DO NOT:  Draw exposed bones back into tissue  Irrigate wound

35. Visual 4.34 Nasal Bleeding  Causes: blunt force, skull fracture, non-trauma related conditions  Blood loss can lead to shock  Victims may become nauseated and vomit if they swallow blood Treating Nasal Bleeding  Pinch the nostrils together, lean forward  Put pressure on the upper lip just under the nose

36. Visual 4.35 Bites and Stings  If bite or sting is suspected, and situation is non-emergency:  Remove stinger if still present by scraping edge of credit card or other stiff, straight- edged object across stinger  Wash site thoroughly with soap and water  Place ice on site for 10 minutes on and 10 minutes off

37. Visual 4.36 Anaphylaxis  Check airway and breathing  Calm individual  Remove constrictive clothing and jewelry  Find and help administer victim’s Epi-pen  Watch for signs of shock and treat appropriately

38. Visual 4.37 Symptoms of HypOthermia Primary signs and symptoms:  A body temperature of 95 o Fahrenheit (35 o Celsius) or less  Redness or blueness of the skin  Numbness accompanied by shivering Later stages of Hypothermia:  Slurred speech  Unpredictable behavior  Listlessness and confusion

39. Visual 4.38 Treating HypOthermia  Remove wet clothing  Wrap victim in a blanket or sleeping bag and cover head and neck or  Place victim in warm bath  Protect victim from weather  Provide warm fluids to conscious victims  No alcohol, caffeine or soda  Place unconscious victim in recovery position Even mild degrees of hypothermia can have serious consequences

40. Visual 4.39 Symptoms of Frostbite  Skin discoloration  Burning or tingling sensation  Partial or complete numbness

41. Visual 4.40 Treatment of Frostbite  Immerse injured area in warm (NOT hot) water  Warm slowly!  Do NOT allow part to re-freeze  Do NOT attempt to use massage  Wrap affected body parts in dry, sterile dressing

42. Visual 4.41 Symptoms of HypERthermia Heat Exhaustion Heat Stroke Heavy sweating Body Temperature over 103˚F Paleness Red, hot, dry skin (no sweating) Muscle cramps Rapid, strong pulse WeaknessThrobbing headache Tiredness Dizziness Dizziness or headache Nausea Nausea or vomiting Confusion Fainting Unconsciousness Heat Stroke is the most severe form of hyperthermia and is a life-threatening emergency!

43. Visual 4.42 Treating HypERthermia  Get victim to a cool place / air conditioned if you can  Cool victim as rapidly as possible  Immerse in cool water / shower / garden hose  In low humidity, wrap in wet sheet and fan the victim vigorously  Monitor body temperature until it drops to 101-102˚F  Give exhaustion victim fluids to drink unless nauseated, cramping or losing consciousness (no caffeine, alcohol or soda).  No fluids for stroke victims!  Transport Immediately!

44. Visual 4.43 Unit Summary  Public health concerns  Organization of disaster medical operations  Conducting head-to-toe assessments  Bandaging and splinting  Treating other injuries and conditions  Written START Triage Exercise

45. Visual 4.44 Exercise Anyone with an injury to the head, neck, trunk or upper legs are “Immediates”