Disaster Medical Operations — Part 1

1. Disaster Medical Operations —Part 1 CERT Basic Training Unit 3 2017-c Edition

2. Review of Unit 2 • PPE & gear • Electric & gas shutoff • Hazmat • Fire triangle • Sizeup (FAPAR) • Buddy system and PASS CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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

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

5. CERT Training • Treatment for life-threatening conditions • Airway obstruction, bleeding, shock • Treatment for other, less urgent conditions • Minor cut, bruise, broken bone, burn Provide greatest good for greatest number by conducting Simple Triage And Rapid Treatment CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

6. Unit Objectives • Identify the “Three Killers” • Apply techniques for opening airway, controlling bleeding, and treating for shock • Conduct triage under simulated disaster conditions • Remember: “Greatest Good for the Greatest Number” CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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

8. Three “Killers” • Emergency medicine “killers” • Airway obstruction • Bleeding • Shock • First priority of medical operations: • Open airway (breathing) • Control excessive bleeding (bleeding) • Treat for shock (blood pressure) CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

9. How to Approach a Victim • Be sure victim can see you • Point headlamp down, not in their eyes • Identify yourself • Your name and name of your organization • Request permissionto treat, if possible(“implied consent”) • Respect cultural differences CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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

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

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

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

14. Types of Bleeding • Arterial bleeding • Bleeding from artery spurts • Venous bleeding • Bleeding from vein flows • Capillary bleeding • Bleeding from capillaries oozes CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

15. Types of Bleeding CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

16. 3 main methods for controlling bleeding: Direct pressure Elevation Pressure points Also: “Stop the Bleed” Control Bleeding CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

17. Dressing: The absorbent material placed on the wound Bandage: Holds dressing in place, provides direct pressure over wound Helps reduce swelling Can make bandages out of any clean cloth Bandaging CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

18. Pressure Points CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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

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

21. Recognizing Shock • Main signs of shock • Rapid and shallow breathing (>30/min) • Rapid and shallow pulse (>100/min) • Capillary refill of greater than 2 seconds(blanche test) • Altered mental status • Failure to follow simple commands • Symptoms of shock are easily missed… pay careful attention to your patient! CERT Basic Training Unit 3 Disaster Medical Operations — Part 1

22. Proceedures for Controlling Shock Maintain an open airway Control obvious bleeding Maintain body temperature Avoid rough or excessive handling Do not provide food or drink CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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

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

25. “Stop the Bleed” New program: “Stop the Bleed” CERT Basic Training: Orem/Provo Extra Unit 3: Disaster Medical Operations—Part 1

26. “Stop the Bleed” Background • Bleeding #1 cause of preventable trauma death • By presidential directive, first responders, military, and doctors met to determine best methods to decrease mass casualty deaths • Program focuses on educating citizens and first responders to apply immediate, aggressive treatment to stop profuse bleeding • Methods can be painful to victim but preserve life • bleedingcontrol.org and dhs.gov/stopthebleed CERT Basic Training: Orem/Provo Extra Unit 3: Disaster Medical Operations—Part 1

27. “Stop the Bleed” Procedure Prepare: • Ensure own safety. • Call 911 or tell someone to. • Find injury. Remove clothing if necessary. Act: • Cover w/dressing, apply direct pressure • Pack wound with gauze (esp. clotting gauze) • Apply tourniquet (if available, and if on limb) CERT Basic Training: Orem/Provo Extra Unit 3: Disaster Medical Operations—Part 1

28. “Stop the Bleed” Simplified CERT Basic Training: Orem/Provo Extra Unit 3: Disaster Medical Operations—Part 1

29. “Stop the Bleed” Pressure • Find wound; remove clothing, if necessary • Cover with clean cloth/dressing • If wound is large and deep, pack with cloth/dressing • Apply pressure with both hands CERT Basic Training: Orem/Provo Extra Unit 3: Disaster Medical Operations—Part 1

30. “Stop the Bleed” Pack • Use if wound is large and deep, not on torso • Wipe away pooled (but not clotted) blood • Pack wound with clotting “combat” gauze (preferred), plain gauze, or clean cloth/bandage CERT Basic Training: Orem/Provo Extra Unit 3: Disaster Medical Operations—Part 1

31. “Stop the Bleed” Tourniquet CERT Basic Training: Orem/Provo Extra Unit 3: Disaster Medical Operations—Part 1

32. “Stop the Bleed” Tourniquet Applying a Tourniquet CERT Basic Training: Orem/Provo Extra Unit 3: Disaster Medical Operations—Part 1

33. “Stop the Bleed” Tourniquet • Use only on limbs (not trunk or head/neck) • Tighten strap 2 or 3" above wound, not on joint • Twist windlass until bleeding stops • Secure windlass • Note time tourniquet was applied CERT Basic Training: Orem/Provo Extra Unit 3: Disaster Medical Operations—Part 1

34. “Stop the Bleed” Exercises Exercise 1: Packing a wound Exercise 2: Applying a tourniquet CERT Basic Training: Orem/Provo Extra Unit 3: Disaster Medical Operations—Part 1

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

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

37. CERT Sizeup (simplified) • Facts (Gather facts) • Anticipate (Consider facts, guess future) • Plan (“Direction before velocity”) • Act (Less talking, more doing) • Review (Continuously re-evaluate) CERT Basic Training: Orem/Provo Extra Unit 2: Fire Safety and Utility Controls

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

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

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

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

42. Exercise Let’s get a little messy (or not) CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

43. What Is START? • STart = Simple Triage • Victims marked based on priority of treatment (includes “voice triage”) • stART = And Rapid Treatment • Rapid treatment of “Three Killer” injuries CERTs triage and treat at the same time CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

44. START 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” (red) victims immediately • Step 6: Document triage results CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

45. Triage Decision Flowchart CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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

47. Triage Overview CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

48. Triage Overview CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

49. Triage Overview Chris’ Overview Bus Crash Example Harddrive CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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