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

1. 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

2. 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

3. 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

4. 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

5. 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

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

8. 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

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

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

11. 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

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

13. 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

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

15. 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

16. 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

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

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

19. 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

20. 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

21. 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

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

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

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

25. “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

26. “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

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

28. “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

29. “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

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

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

32. “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

33. “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

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

35. 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

36. 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

37. 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

38. 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

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

40. 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

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

42. 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
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43. 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

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

45. 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

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

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

48. 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

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

50. 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

51. 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