Contra Costa County CERT Program Unit 3 – Emergency Medical Operations Part 1

1. Contra Costa County CERT ProgramUnit 3 – Emergency Medical Operations Part 1 Released: 6 September 2011

2. 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. Unit Objectives • Identify the “killers” • Apply techniques for opening airways, controlling bleeding, and treating for shock • Conduct triage under simulated emergency conditions

4. Death from Trauma • Overwhelming and irreversible damage to vital organs, death within minutes • Excessive bleeding, death within minutes • Infection or multiple organ failure, death in several days or weeks 40% could be saved! 90% of disaster victims are rescued by other victims!

5. Life-Threatening Conditions The “Killers”: • Airway obstruction • Excessive bleeding • Shock Life-threatening conditions must receive immediate treatment!

6. How to Approach a Victim • Size-up: Check scene for safety • Be sure victim can see you • Identify yourself • Your name, training and name of your organization • Request permission to evaluate and treat • Respect cultural differences

7. Checking For Breathing • Tap and shout • Open airway…palm on forehead, 2 fingers under chin and tilt the jaw upward while tilting the head backwards slightly • Ear over victims mouth while looking at the chest • look - for chest rise • listen - for air exchange • feel – abdominal movement • Evaluate and repeat if necessary once more

8. Opening The Airway

9. Opening The Airway Head Tilt/Chin Lift

10. Arterial…spurting Venous…flowing Capillary…oozing Bleeding Losing one liter can be life threatening

11. Bleeding Control • Direct pressure • Elevation • Pressure points No tourniquets!

12. Shock • Result of ineffective circulation of blood • Remaining in shock will lead to death of: • Cells • Tissues • Entire organs

13. Shock - Signs • Weak, restless or irritable • Rapid and weak pulse • Rapid shallow breathing • Pale, cool, moist skin • Blue lips or fingernails • Nausea and vomiting • Dizzy, drowsy or unconscious • Very low blood pressure Treat anyone unconscious for SHOCK

14. Shock - Treatment • Control major bleeding • Place in Recovery Position • Maintain body temperature • Loosen restrictive clothing Recovery Position

15. Multi-Casualty Incident Definition A Multi-Casualty Incident (MCI) is any situation that overwhelms the normal emergency response capability An MCI is also known as a Mass Casualty Incident or a Mass Casualty Event

16. Typical Multi-Casualty Incidents • Earthquakes • Urban Wild Lands Fires • Motor Vehicle Accidents • Floods • Tornados • Hurricanes • Explosions • Train derailments • Hazmat

17. CERT Size-up • Gather Facts • Assess Damage • Consider Probabilities • Assess Your Situation • Establish Priorities • Make Decisions • Develop Plan of Action • Take Action • Evaluate Progress

18. Triage TRIAGE – French term meaning “to sort ” • During triage, victims are evaluated and prioritized according to the urgency of treatment needed • Spending a lot of time trying to save one life may prevent a number of other patients from receiving the treatment they need • Triage is a Perishable Skill and must be practiced regularly

19. Triage Steps • Size-up • Conduct voice triage • Follow a systematic route • Start where you stand • Evaluate each victim and tag them • Document Triage results “Immediates”…airway, bleeding, recovery position Transfer “Immediates” to medical group immediately!

20. The START Triage System SimpleTriageAndRapidTreatment

21. START Video

22. Triage Pitfalls • No team plan, organization, or goal • Indecisive leadership • Too much focus on one injury • Treatment (rather than triage) performed

23. Patient Assessment…RPM Three things to check… • Respirations • Perfusion • Mental Status Anyone who is unconscious is an “Immediate” by definition!

24. RPM…Respirations Range…Adults under 30 breaths a minute Children to 12 years: 15-45 breaths/min • No breathing • Position airway, if still not breathing try it again • If still no breathing tag as DECEASED and move on to next person • Out of range for breaths per minute • Tag as IMMEDIATE and move on to next person • Within range for breaths per minute • Go to the next step…Perfusion

25. RPM…Perfusion…Blanch Test Goal…perfusion in under 2 seconds • More than 2 seconds • Tag asIMMEDIATEand move on to next person • Less than 2 seconds • Go to next step… Mental Status

26. RPM…Mental Status Goal…follow simple command • Can not follow directions • Tag asIMMEDIATEand move on to next person • Can follow directions • Tag asDELAYEDand move on to next person

27. S.T.A.R.T. Categories • MINOR • IMMEDIATE • DELAYED • DECEASED

28. “ MINOR ” • Walking wounded • Do not require immediate care • “Screamers” • Use as helpers to care for others

29. “ IMMEDIATE ” • Life Threatening Injury • Victim needs immediate care • Fails R – P – M check Adult >30 respirations per minute • Child outside 15-45 respirations/m • Breathing normal, no radial pulse • Capillary refill > 2 seconds • Mental check

30. “ DELAYED ” • Serious Non Life Threatening Injury • Did not walk out of scene • R-P-M within in acceptable limits • May have broken bones • May be extrication problem • May have chest pain, etc.

31. “ DECEASED ” • New term: MORGUE • Considered Non-Salvageable • Obviously dead • Pulseless • Non-breathers who fail to breathe after airway has been cleared • Mortal injuries

32. Triage Operations Review • Size Up … What’s happening? • Check the scene • Stop, look, listen and think • Assess your situation … What could happen? • Develop a plan of action … What will we do? • Conduct voice triage, get walking wounded out • Start where you stand • Follow a systematic route • Use RPM to evaluate and tag each victim • Transfer“Immediates”to medical group immediately! • Document Triage results Help or Document and Report

33. Triage Exercises • Head Tilt / Chin Lift • Bleeding Control • Triage Exercise RPM

34. Unit Summary • The Killers • Approaching a Victim • Open Airway • Control Bleeding • Treat Shock • Size-up and Triage • RPM