CERT EMERGENCY MEDICAL OPERATIONS

1. CERTEMERGENCY MEDICAL OPERATIONS Part 1 Whatcom County Division of Emergency Management

2. OBJECTIVES • Identify “killers” • Apply techniques for opening airways, controlling serious bleeding, and treating shock • Conduct triage under simulated disaster conditions

3. DISASTER MEDICAL OPERATIONSAssumptions • The number of victims will exceed local capacity for treatment • Survivors will assist others

4. PHASES OF DEATH FROM TRAUMA Phase 1: Death within minutes Phase 2: Death within several hours Phase 3: Death after several days or weeks

5. Experts agree that over 40% of disaster victims in the second and third phases of death could be saved by providing simple medical care CERT members aim to “Do the greatest good for the greatest number”

6. CERT REMINDER! CERT members MUST take care of themselves before caring for others • Gloves • Mask • Goggles • Pocket Mask

7. THE “KILLERS” • Airway Obstruction • Bleeding • Shock

8. AIRWAY

9. OBSTRUCTED AIRWAY • 4-6 minutes until brain death • Heimlich • Conscious • Unconscious • Most common obstruction is the tongue

10. HEAD-TILT/CHIN-LIFT • Step 1 Can you hear me? • Step 2 One hand on forehead Other hand under chin • Step 3 Lift the jaw while tilting the head backwards slightly • Step 4 Look, Listen, Feel for signs of breathing (Chest Rise, Air Exchange, Abdominal Movement)

11. Pad under shoulders to maintain an open airway

12. WHAT IF. . . • The person doesn’t breath after opening the airway? • Try one more time then move on. • Remember the CERT Mission. • The person does start breathing but you need to move on to other patients? • Walking wounded. • Recovery position - consider neck injury.

13. PRACTICE TIME • IC break class into teams. • Medical Group Leader make victim and rescuer assignments. • Patient to breathe normally. • Rescuer to assess breathing. • Practice Head-Tilt/Chin-Lift. • Position patient in recovery position.

14. BLEEDING • Uncontrolled Bleeding is a “Killer”! • Three types • Arterial high pressure, spurts • Venous low pressure, flows • Capillary low pressure, oozes

15. BLEEDING CONTROL • Direct Pressure • Brachial • Femoral • Elevation • Local pressure combined with elevation will address 95% of bleeding. • Can take 5-7 minutes to work. • Get help from the patient, walking wounded, pressure bandage.

16. BLEEDING CONTROL • Pressure Dressing • Pressure Points • May be combined. • Not a tourniquet.

17. TOURNIQUET • Rarely necessary except • Crushing injury • Partial amputation • Use when willing to “sacrifice a limb to save a life” • Leave it in plain sight - no bandage • Time/Day written on patient’s forehead

18. CERT REMINDER! • One CERT function is to collect and record information. Pencils, markers, and tape are important items for the disaster preparedness kit. • The marker can be used for non-traditional purposes, such as marking a forehead.

19. PRACTICE TIME • IC break class into teams • Medical Group Leader assign victims/rescuers • Practice making a pressure dressing • Practice slipping a square knot • Additional Skills • Vital Signs (BP, HR, RR) • EpiPens

20. SHOCK - THE SILENT KILLER • Ineffective circulation of blood (which carries oxygen) • Will lead to the death of cells, tissues and entire organs • Adults compensate differently from children • Early recognition is essential

21. Earliest Signs of Shock • Slightly increased rate of breathing - Breaths may be shallow • Slightly increased pulse - pale and cool skin - Capillary refill of >2 seconds • Restlessness, anxiety, irritability, apprehension, inability to follow simple commands Compensatory Stage

22. CERT GOAL:Watch for subtle signs of early shock • Slightly increased rate of breathing • Slightly increased pulse - pale and cool skin • Restlessness, anxiety, irritability, apprehension Compensatory Stage

23. Increased, irregular, shallow breaths • Increased, irregular, weak pulse • Cool, moist, blue or pale skin • Dilated pupils • Listlessness, apathy Progressive Stage (uncompensated)

24. This patient will die! • We must do what we can to prevent the condition from progressing to this point! IrreversibleStage

25. SHOCK ASSESSMENT • R Rapid and shallow breathing - (Respirations/airway) • P Capillary refill of greater than 2 seconds - (Pulse) • M Follow simple commands, such as “Squeeze my hand” - (Mentation)

26. CERT TREATMENT Face Pale - Raise Tail Face Red - Raise Head • Elevate feet 6-10 inches - Watch the airway • Control bleeding • Maintain body temperature • Avoid rough or excess handling • Give nothing to eat or drink - Expect the patient in shock to be nauseous or thirsty

27. DISASTER MEDICAL OPERATIONSOrganization

28. TRIAGE • French for “to sort” • Evaluated and sorted by the immediacy of treatment needed • Used when • Rescuer(s) are overwhelmed. • There are limited resources. • Time is critical.

29. TRIAGE PRIORITIZATION • GREEN - Minor/Walking Wounded • Patient may require professional care. • Life not jeopardized by delay in treatment. • RED - Immediate • Life-threatening injuries demand immediate attention. • Treatment may save a life. • YELLOW - Delayed • Needs care as soon as people and materials are available. • Treatment is essential. • BLACK - Dead • Not breathing after two tries to open the airway. • Massive trauma or major medical condition which exceeds available resources.

30. BEFORE CHARGING IN . . . • 1ST - Stop, Look, Listen, Smell, Think • Dangers to CERT? • Where to set up staging/supply/treatment and morgue areas? • Voice Triage - Identify “walking wounded” • Whistle. • “If you can walk, come to my voice.” • Label as GREEN - Reassess later. • Get information from them • Stage them with a CERT member • Use as needed.

31. PERFORMING TRIAGE RRespirations/Airway • Position. • Look, Listen, Feel. • Greater than 30 = Immediate/Red. • Treat for shock and move on. • Not breathing after 2 attempts = Dead/Black EXCEPTION: Give children 15 breaths and reassess before placing them in the Black category Begin with the first patient located

32. Step 1

33. PERFORMING TRIAGE P Pulse/Bleeding • Capillary refill greater than 2 sec. = Immediate/Red. • Control bleeding, treat for shock, and move on. Triage & quickly move to the next patient. Only immediate life-saving treatment is given during triage.

34. Step 2

35. PERFORMING TRIAGE M Mental Status • Ask the victim to follow a simple command, such as squeezing your hand. • No response or inappropriate response = Immediate/Red. • Treat for shock and move on.

36. Step 3

37. PRACTICE TIME Turn to your neighbor and perform a “shock assessment”. Look for normal R Respirations P Pulse/Capillary Refill M Mentation

38. TRIAGE - DETAILS • Everyone gets a tag • Keep a count of numbers in each color • Triage is sorting - transportation does not start until triage is completed • Time is critical in a disaster

39. AFTER TRIAGE - THEN TRANSPORT TO TREATMENT • Immediate - RED • Delayed- YELLOW • Most qualified rescuers. • Majority of medical equipment. • Minor - GREEN • Walking wounded may already be in the treatment area. • May be able to help with Red and Yellow patients. • Record keepers. • Dead - BLACK • A different location - morgue. • Consider sanitation/safety issues.

40. CERT REMINDER! • Triage Pitfalls • Inadequate medical size-up. • No team plan, organization or goal. • Indecisive leadership. • Too much focus on one injury. • Treatment rather than triage.

41. PRACTICE TIME You are at the scene where a bus has been overturned as the result of an earthquake. No other emergency services will be able to reach your location for several hours, at least, and likely much longer. Use the worksheet to identify the category you will triage each of the following patients into. You will have 15 seconds to read the information and make a decision.

42. What’s your call? 1 • A young school aged boy is found lying on the roadway 10 ft from the vehicle. • Respiratory Rate 10/min. • Capillary Refill is 2 seconds. • Groans to painful stimuli.

43. What’s your call? 1 • A young school aged boy is found lying on the roadway 10 ft from the vehicle. • Respiratory Rate 10/min. • Capillary Refill is 10 seconds. • Groans to painful stimuli. R- Slow for a child P- OK M- Unable to follow command

44. What’s your call? 2 • An adult kneels at the side of the road, shaking his head. He says he’s too dizzy to walk. • Respiratory Rate is 20. • Capillary Refill is 2 sec. • Obeys commands.

45. What’s your call? 2 • An adult kneels at the side of the road, shaking his head. Says he’s too dizzy to walk. • Respiratory Rate is 20. • Capillary Refill is 2 sec. • Obeys commands. R - OK P - OK M - OK - but couldn’t walk

46. What’s your call? 3 • A school aged girl crawls out of the wreckage. She’s able to stand and walk toward you crying. • Jacket and shirt torn. • No obvious bleeding.

47. What’s your call? 3 • A school aged girl crawls out of the wreckage. She’s able to stand and walk toward you crying. • Jacket and shirt are torn. • No obvious bleeding. • R - Crying • P - No obvious bleeding • M - Able to obey command

48. What’s your call? 4 • A toddler lies with his lower body trapped under the vehicle. • Not breathing with modified jaw thrust and after 15 ventilations.

49. What’s your call? 4 • A toddler lies with his lower body trapped under the vehicle. • Not breathing with modified jaw thrust and after 15 ventilations. R - no P - no M - no

50. What’s your call? 5 • Adult female driver, trapped by her lower legs under caved-in dash. • Respiratory Rate 24. • Capillary refill 4 sec. • Moans with verbal stimulus.