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

Unit 3: Disaster Medical Operations — Part 1 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 1

Unit 3: Disaster Medical Operations — Part 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 CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 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 These phases of death underlie why disaster medical operations are conducted. Identify those with most serious injuries as soon as possible. Victims in the second and third phase can be saved by simple medical care. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

Unit 3: Disaster Medical Operations — Part 1 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 Because there may be more victims than rescuers during a disaster, CERT personal are trained to be part of disaster medical operations to provide….. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

Unit 3: Disaster Medical Operations — Part 1 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

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

Unit 3: Disaster Medical Operations — Part 1 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

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 permission to treat, if possible (“implied consent”) Respect cultural differences CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

Unit 3: Disaster Medical Operations — Part 1 Open the Airway Wear your protective gear CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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

Head-Tilt/Chin-Lift Method If unsuccessful try one more tome. Clear airway. Maintain by placing something under shoulders. Elevate CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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

Unit 3: Disaster Medical Operations — Part 1 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 13

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

Unit 3: Disaster Medical Operations — Part 1 Control Bleeding 3 main methods for controlling bleeding: Direct pressure Elevation Pressure points Also: “Stop the Bleed” CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 15

Unit 3: Disaster Medical Operations — Part 1 Bandaging 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 CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 16

Unit 3: Disaster Medical Operations — Part 1 Pressure Points Talk about tourniquets CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 17

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

Unit 3: Disaster Medical Operations — Part 1 Shock Result of ineffective circulation of blood Remaining in shock will lead to death of: Cells Tissues Entire organs When the body is not getting enough blood flow, oxygen and other nutrients are not carried to tissues and organs. Blood vessels begin to close and organs are damaged and if left untreated will shut down completely. Shock can worsen very rapidly. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

Unit 3 Disaster Medical Operations — Part 1 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! Demonstrate these with class participants. Also radial pulse. Raise feet above heart level and do not provide food or drink. CERT Basic Training Unit 3 Disaster Medical Operations — Part 1 20

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

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

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

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

“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

“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

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

“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

“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

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

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

“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

“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

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

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

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

Unit 3: Disaster Medical Operations — Part 1 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 Triage is french word for to sort. Remember there are many more victims than rescuers, there are limited resources and time is critical CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

Unit 3: Disaster Medical Operations — Part 1 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

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

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

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

Unit 3: Disaster Medical Operations — Part 1 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 History has proven that 40% of disaster victims can be saved with …… START is based on the premise that a simple assessment and rapid treatment will yield positive, often lifesaving results Explain the difference between disaster medical and regular CPR and first aid. CERT Basic Training Unit 3: Disaster Medical Operations — Part 1 42

Unit 3: Disaster Medical Operations — Part 1 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

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

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

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

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

Unit 3: Disaster Medical Operations — Part 1 Triage Overview Chris’ Overview Bus Crash Example Hard drive CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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

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

Unit 3: Disaster Medical Operations — Part 1 Homework Assignment Read Unit 4 Bring your PPE and gear Wear loose, comfortable clothing Supplies: Amazon, VitalityMedical.com, BuyEMP.com, AtlanticMedSupply.com, BoundTree.com, + many others CERT Basic Training Unit 3: Disaster Medical Operations — Part 1