1. Public Health Emergencies By: Dr. M. Nowak, Assistant Professor Dr. C. Schmidt, Associate Professor Disaster Response Nurses 2014

2. What is a Public Health Emergency?

3. Are you Prepared to help?

4. http://www.youtube.com/watch?v=5PDY7z40BFk

5. Educational Objectives  Demonstrate START  Practice in Virtual Disaster Scenario  Review Implicatins of Different types of Disasters

6. 1)COORDINATION Is Key 2) “KNOW YOUR LANE”: START, NIMS, fire,police etc. 3) Need More Event Team Preparedness Lessons Learned In The Field Post 911

7. Triage is a dynamic process and is usually done more than once. Generally takes 15 Sec/pt.

8. Common Elements Pre Disaster Planning Event Post Event

9. What is S.T.A.R.T.?

10. What & When? Simple triage and rapid treatment is a triage method used by first responders. It quickly classify victims during a mass casualty incident. It is based on the severity of their injury.

11.  Word that comes from an Old French word, meaning sorting, sifting, from trier to sort.  National / Internationally used.  Used with an MCI.  MCI is 5 or more victims.

12. S.T.A.R.T. Simple Triage And Rapid Transport

13. Example: Bus Accident

14. Example: 911 Terrorist

16. Katrina (RN on Bridge)

17. TRIAGE Categories

18. RED=Stop/Urgent (Ambulance Light) Yellow= Caution/Can Wait Green= Go/Walk Black box/Black/dead

19. RACE AGAINST TIME…when seconds count.

20. RPM…

21. 32 Q

22. R P M = RED Greater than 30 Respirations Greater 2 sec. –Cap refill NO Radial Pulse Confused Disoriented Mental

23. Minor/Walking Green Deceased. (Check/position head)No Breathing Black All others Yellow

24. Nurses Always Have With Them…  Head  Heart  Hands

25. Remember RPM…

27. HAZ MAT?  DECON TEAM Directs:  Initiate START Triage  Primary Deacon  Strip & Bag Evidence  Tag Patients  Initiate Secondary Deacon  Secondary Triage  Move to Treatment

28. TABLE TOP SIM LAB  Hands On  Triage Practice (ADULT)  Note there are different triage techniques; START is most commonly used.

29. Remember RPM Traffic Light 32 Q

30. PRACTICE: Multiple Casualty 7:45 am on a Saturday in August the weather is clear, temperature is 70 degrees. You go with a friend for a relaxing weekend breakfast at a small local airport. A commuter plane with 40 passengers onboard begins speeding down the runway. As the plane lifts off the landing gear retracts, suddenly a catastrophic equipment failure causes the aircraft to crash in the field just west of the airport. Upon impact the plane is torn apart, the debris field is 100 yards long.

31. WHAT DO YOU DO?

32. Patient walks over to you and has an obvious broken arm Respirations are 22 Cap Refill 2 sec. (Radial 88) He is awake, alert, and crying What Triage Category? GREEN

33. Patient states he can’t move or feel his legs. Respirations are 26 Cap refill 2 He is awake and oriented What Triage Category? YELLOW

34. Patient is soaked with blood no obvious killer bleed Respirations are 38 Pulse is weak, no radial He is awake What Triage Category? RED

35. Patient is face down in the field. Not Breathing Weak Carotid Pulse She is unresponsive What do you do first? What Category? BLACK

36. Patient has an open head wound, bleeding controlled Respirations are 16 Pulse is intact (88) He is unconscious What Triage Category? RED

37. Triage Tag Construction Synthetic paper Water resistant:100 % resistant to all commonly used decontamination solutions May be worn while patient is being decontaminated

38. Rapid Triage (START)

39. Front Back  This portion of the tag provides a Personal Property Receipt for valuables belonging to victims that may be contaminated.  Place the valuables and the tag into a bag and seal it.

40. Hints When Using Triage Tags Before tearing along perforation area of triage tag, fold area that will be affected. If triage tag is likely get wet, documentation prior to getting wet. Name/identification placed on the back of Personnel & Property/Evidence Tag

41. WMD? There is no widely recognized civilian MCI triage tool used in the US for any of the NRBC (radiologic & biologic )agents.

42. Agent Symbol Identification

43. Part of the Solution…keeping communities safe

44. What is MRC?

45. RN POD Point of Distribution MRC= Medical Reserve Corp ICC= Incident Com START = 5 More

46. References Atlantic County Department of Health MEC Handout. (2007).. Strategic National Stockpile. Meeting Handout California Fire Chiefs Association Rapid Triage PPT (2009).Retrieved From:www.emsaac.com/meetings/disaster/NewTriageTags1 Disaster Management Systems. (2007). Triage Training PPT retrieved from: http://www.ecifd.org/training/Triage%20- %20Presentation.pdf Niles, M., McEwen,M. (2007). Community/Public Health Nursing. (4 th ed.). St. Louis Missouri: Elsevier-Saunders. Rapp,J. (2005). Emergency Management Presentation.NJ Emergency Response Unit.ACSNA Meeting Presentation Handout. NJ Department of Health and Human Services. (2009).Trauma Treatment and Triage:A practical guide for prehospital care. Figures: Pictures retrieved from google images and sources above.