Contra Costa County CERT - Unit 3 4/26/2017 Contra Costa County CERT Program Unit 3 – Emergency Medical Operations Part 1 Released: 10 January 2016 Rev. 6 September 2011

Community Emergency Response Team Contra Costa County CERT - Unit 3 4/26/2017 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 Rev. 6 September 2011

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

Contra Costa County CERT - Unit 3 4/26/2017 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! More than 90% of disaster victims are rescued by other victims! Rev. 6 September 2011

Life-Threatening Conditions Contra Costa County CERT - Unit 3 4/26/2017 Life-Threatening Conditions The “Killers”: Airway obstruction Excessive bleeding Shock Life-threatening conditions must receive immediate treatment! Rev. 6 September 2011

How to Approach a Victim Contra Costa County CERT - Unit 3 4/26/2017 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 Rev. 6 September 2011

Checking For Breathing Contra Costa County CERT - Unit 3 4/26/2017 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 Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 Opening The Airway Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 Opening The Airway Head Tilt/Chin Lift Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 Bleeding Arterial…spurting Venous…flowing Capillary…oozing Losing one liter can be life threatening Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 Bleeding Control Direct pressure Elevation Pressure points No tourniquets! Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 Shock Result of ineffective circulation of blood Remaining in shock will lead to death of: Cells Tissues Entire organs Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 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 Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 Shock - Treatment Control major bleeding Place in Recovery Position Maintain body temperature Loosen restrictive clothing Recovery Position Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 Multi-Casualty Incident Definition A Multi-Casualty Incident (MCI) is any situation that overwhelms the normal emergency response capability Examples – More victims than rescuers – 1 rescuer / 2 patients An MCI is also known as a Mass Casualty Incident or a Mass Casualty Event Rev. 6 September 2011

Typical Multi-Casualty Incidents Contra Costa County CERT - Unit 3 4/26/2017 Typical Multi-Casualty Incidents Earthquakes Terrorist Events Urban Wild Lands Fires Motor Vehicle Accidents Floods Tornados Hurricanes Explosions Train derailments Hazmat Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 CERT Size-up Gather Facts Assess Damage Consider Probabilities Assess Your Situation Establish Priorities Make Decisions Develop Plan of Action Take Action Evaluate Progress Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 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 Rev. 6 September 2011

“Immediates”…airway, bleeding, recovery position 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!

Contra Costa County CERT - Unit 3 4/26/2017 The START Triage System Simple Triage And Rapid Treatment Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 START Video Rev. 6 September 2011

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

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

Contra Costa County CERT - Unit 3 4/26/2017 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 Rev. 6 September 2011

RPM…Perfusion…Blanch Test Contra Costa County CERT - Unit 3 4/26/2017 RPM…Perfusion…Blanch Test Goal…perfusion in under 2 seconds More than 2 seconds Tag as IMMEDIATE and move on to next person Less than 2 seconds Go to next step… Mental Status Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 RPM…Mental Status Goal…follow simple command Can not follow directions Tag as IMMEDIATE and move on to next person Can follow directions Tag as DELAYED and move on to next person Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 S.T.A.R.T. Categories MINOR IMMEDIATE DELAYED DECEASED Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 “ MINOR ” Walking wounded Do not require immediate care “Screamers” Use as helpers to care for others Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 “ 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 Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 “ 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. Rev. 6 September 2011

Contra Costa County CERT - Unit 3 4/26/2017 “ DECEASED ” New term: MORGUE Considered Non-Salvageable Obviously dead Pulseless Non-breathers who fail to breathe after airway has been cleared Mortal injuries Rev. 6 September 2011

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

Contra Costa County CERT - Unit 3 4/26/2017 Triage Exercises Head Tilt / Chin Lift Bleeding Control Triage Exercise RPM Rev. 6 September 2011

Unit Summary The Killers Approaching a Victim Open Airway Control Bleeding Treat Shock Size-up and Triage RPM Written START Triage Exercise