2. Response Stages Recognition Stage Response Stage Intervention Stage Recovery Stage

3. Key Response Tasks Assessment Personal Protection Control of Situation Casualty Management Communication Call for Additional Resources

4. Assessment Recognize was the expectation at the Basic Level Analyze and intervention is the expectation at the Intermediate Level

5. Personal Protection At the Basic Level we avoided rushing in, remained uphill and upwind and avoided contact with contaminated victims At the Intermediate Level we will make carefully considered entry, and decontaminate and treat contaminated victims

6. Personal Protection Level A – Fully Encapsulating Air Tight – SCBA inside Level B – Splash Protection with SCBA Level C – Splash Protection with APR Active Carbon Garment with APR

7. Control of Situation At the Basic Level, you establish inner and outer perimeters, safe gathering points, use bullhorn techniques, and conduct emergency wash down At the Intermediate Level, you establish full control zones, control access/egress corridors, forward treatment areas, handle patients, and perform technical decontamination

8. Cold Zone Warm Zone Wind Outer (Security) Perimeter Inner (Safety) Perimeter Protective Action Zone Hot (Initial Isolation) Zone

9. Wind Protective Action Zone Hot (Initial Isolation) Zone Warm Zone Cold Zone Outer (Security) Perimeter Inner (Safety) Perimeter

10. Principles of Decontamination Minimize Contamination Minimize Spread of Contamination Reduce Contamination to Safe Level Use PPE Until Safe to Remove Arrange Disposal of Contaminated Items

11. Principles of Decontamination Minimize Contamination Avoid/minimize direct contact with contaminant Establish decontamination line uphill, upwind Avoid cross contamination

12. Principles of Decontamination Minimize Spread of Contamination Use controlled access/egress corridors Perform gross decon as early as possible Control runoff, secure contaminated equipment/PPE Delineate and control movement in decon

13. Principles of Decontamination Reduce Contamination to Safe Level ALARA Use appropriate decon measures… (absorbents, adsorbents, vacuuming, evaporation, chemical degradation, clothing removal) Measures with vary according to contaminant

14. Principles of Decontamination Use PPE until safe to remove No PPE should be doffed until it is assured safe to do so Use an appropriate decon process prior to doffing PPE Doff PPE in a safe, systematic manner Secure removed PPE appropriately

15. Principles of Decontamination Arrange Disposal of Contaminated Items Appropriate arrangements must be made of site remediation/clean-up Ongoing site security must be arranged Site security must be maintained until transition to appropriate agency/agencies

16. Casualty Management At the Basic Level we were unable to handle contaminated casualties or enter the area of gross contamination, thus decon and treatment of non-ambulatory patients might not be possible At the Intermediate Level we will be able to effect rescue, decon and treatment of the non- ambulatory patients

17. Triage Definition: A dynamic, on-going process of sorting casualties throughout an event Goal: Establishes medical priorities, organizes chaos and plans treatment ****Do the greatest good for the greatest number****

18. S.T.A.R.T. - Triage Classification Protocol Simple Triage And Rapid Treatment

19. Able to Walk NoYes Delayed Assess Ventilation Step 1 Ventilation Present Yes < 30/min> 30/min Immediate Assess Cap Refill No Position Airway Ventilation Present? No Yes Immediate Expectant or Dead Step 2

20. Capillary Refill < 2 sec> 2 sec Immediate Control Bleeding Assess Mental Status Mental Status Follows Simple Commands Fails to Follow Simple Commands Immediate Delayed Step 3 Step 4

21. Treatment Area Definition: A casualty collecting point Goal: –organize casualties by acuity –initiate treatment/mitigate life threat until the casualty can be decontaminated (if needed) and transported

22. Communications Basic Level involves relaying scene information, estimating numbers affected, alerting hospitals and calling for additional resources (specialists) At the Intermediate Level we confirm numbers affected and expand the communications network

23. Call for Additional Resources You are the additional resources If you are not enough (Canadian Examples) : –CANUTEC Phone: 1-613-996-666 –DRDC Suffield Phone: 1-403-544-4000 –Joint National CBRNT Team via RCMP National Operations Center Phone: 1-613-993-4460

24. Summary There will continue to be assessments to make, a scene to control, patients to care for, and communications to maintain The methods, mechanisms and tools will change