1. Disaster Medical Operations — Part 1 CERT Basic Training Unit 3

2. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-1 Assumptions ●Need for CERT members to learn disaster medical operations is based on two assumptions:  Number of victims could exceed local capacity for treatment  Survivors will assist others ‒ They will do whatever they know how to do ‒ They need to know lifesaving first aid or post- disaster survival techniques

3. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-2 Importance of Quick Action ●Phase 1: Death within minutes, result of severe trauma ●Phase 2: Death within several hours, result of excessive bleeding ●Phase 3: Death in several days or weeks, result of infection

4. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-3 CERT Training ●Treatment for life-threatening conditions  Airway obstruction, bleeding, shock ●Treatment for other, less urgent conditions Provide greatest good for greatest number by conducting simple triage and rapid treatment

5. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-4 START ●STart = Simple Triage  Victims sorted based on priority of treatment ●stART = And Rapid Treatment  Rapid treatment of injuries assessed and prioritized in first phase

6. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-5 Unit Objectives ●Identify “killers” ●Apply techniques for opening airway, controlling bleeding, and treating for shock ●Conduct triage under simulated disaster conditions

7. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-6 Unit Topics ●Treating life threatening injuries ●Triage

8. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-7 Three “Killers” ●Emergency medicine “killers”  Airway obstruction  Bleeding  Shock ●First priority of medical operations:  Open airway  Control excessive bleeding  Treat for shock

9. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-8 How to Approach a Victim ●Be sure victim can see you ●Identify yourself  Your name and name of your organization ●Request permission to treat, if possible ●Respect cultural differences

10. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-9 Open the Airway

11. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-10 Open vs. Obstructed Airway

12. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-11 Head-Tilt/Chin-Lift Method

13. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-12 Types of Bleeding - 1 ●Arterial bleeding  Bleeding from artery spurts ●Venous bleeding  Bleeding from vein flows ●Capillary bleeding  Bleeding from capillaries oozes

14. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-13 Types of Bleeding - 2

15. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-14 Control Bleeding ●3 main methods for controlling bleeding:  Direct pressure  Elevation  Pressure points

16. Direct Local Pressure

17. Dressing & Bandaging ●Sterile dressing directly over the wound.

18. Dressing & Bandaging cont. ●Clean bandage over the sterile dressing covering as much of the dressing as possible.

19. Pressure Dressing WaddingBandage over wadding

20. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-19 Pressure Points

21. In a Disaster Environment ●Where can one find sterile materials for dressings? ●Where can you find clean bandages?

22. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-21 Shock ●Result of ineffective circulation of blood ●Remaining in shock will lead to death of:  Cells  Tissues  Entire organs

23. CERT Basic Training Unit 3 Disaster Medical Operations — Part 1 3-22 Recognizing Shock ●Main signs of shock  Rapid and shallow breathing  Capillary refill of greater than 2 seconds  Failure to follow simple commands, such as “Squeeze my hand” ●Symptoms of shock are easily missed… pay careful attention to your patient!

24. Treatment Of Shock Conditions Sign Breathing Skin Consciousness Symptom Rapid, shallow Cold, pale Anxious/Apathetic; unconscious/comatose Test Greater than 30 per minute Capillary refill Response to simple commands

25. Treating for Shock ●Step 1 – Lay victim on back if possible. Raise feet 6” to 10” ●Step 2 – Control Bleeding ●Step 3 – Maintain Body Temperature ●Step 4 – Avoid rough or excessive handling

26. Treating for Shock Raise Feet Cover Victim

27. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-26 Responding to Mass Casualty Event ●Have a plan ●Follow that plan ●Document your actions throughout

28. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-27 1.Gather Facts 2.Assess Damage 3.Consider Probabilities 4.Assess Your Situation 5.Establish Priorities 6.Make Decisions 7.Develop Plan of Action 8.Take Action 9.Evaluate Progress REMEMBER: CERT SIZEUP IS A CONTINUAL PROCESS CERT Sizeup

29. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-28 What Is Triage? ●Process for managing mass casualty event 1.Victims are evaluated 2.Victims are sorted by urgency of treatment needed 3.Victims are set up for immediate or delayed treatment

30. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-29 Triage ●Immediate (I): Victim has life-threatening injuries (airway, bleeding, or shock) ●Delayed (D): Injuries do not jeopardize victim’s life; treatment can be delayed ●Minor (M): Walking wounded and generally ambulatory ●Dead (DEAD): No respiration after two attempts to open airway

31. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-30 Rescuer Safety During Triage ●If hazmat or terrorist event is suspected, CERT members DO NOT respond  Evacuate as safely as possible ●ALWAYS wear PPE:  Helmet  Goggles  N95 mask  Work gloves  Sturdy shoes or boots  Non-latex exam gloves

32. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-31 Triage Process ●Step 1: Stop, Look, Listen, and Think ●Step 2: Conduct voice triage ●Step 3: Start where you stand; follow systematic route ●Step 4: Evaluate each victim and tag ●Step 5: Treat “I” victims immediately ●Step 6: Document triage results

33. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-32 Triage Evaluation ●Check airway and breathing ●Check circulation and bleeding ●Check mental status

34. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-33 Triage Pitfalls ●No team plan, organization, or goal ●Indecisive leadership ●Too much focus on one injury ●Treatment (rather than triage) performed

35. Triage Practice

36. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-35 Unit Summary ●You should now be able to:  Identify 3 “killers”  Apply techniques for opening the airway, controlling bleeding, and treating for shock  Conduct triage under simulated disaster conditions

37. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 3-36 Homework Assignment 1.Read unit to be covered in next session 2.Bring necessary supplies for the next session 3.Wear appropriate clothes for the next session