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Contra Costa County CERT Program
Unit 3 – Emergency Medical Operations Part 1Released: 18 August 2011Released: 18 August 2011
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Visual 3.2
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
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Visual 3.3
Unit Objectives
Identify the “killers”
Apply techniques for opening airways, controlling bleeding, and treating for shock
Conduct triage under simulated emergency conditions
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Visual 3.4
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!
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Visual 3.5
Life-Threatening Conditions
The “Killers”:
Airway obstruction
Excessive bleeding
Shock
Life-threatening conditions must receive
immediate treatment!
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Visual 3.6
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
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Visual 3.7
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
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Visual 3.8
Opening The Airway
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Visual 3.9
Opening The Airway
Head Tilt/Chin Lift
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Visual 3.10
Bleeding
Arterial…spurting
Venous…flowing
Capillary…oozing
Losing one liter can be life threatening
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Visual 3.11
Bleeding Control
Direct pressure
Elevation
Pressure points
No tourniquets!
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Visual 3.12
Shock
Result of ineffective circulation of blood Remaining in shock will lead to death of:
CellsTissuesEntire organs
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Visual 3.13
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
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Visual 3.14
Shock - Treatment
Control major bleeding
Place in Recovery Position
Maintain body temperature
Loosen restrictive clothing
Recovery Position
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Visual 3.15
A Multi-Casualty Incident (MCI) is any situation that overwhelms the normal emergency response capability
Multi-Casualty Incident Definition
An MCI is also known as a Mass Casualty Incident or a Mass Casualty Event
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Visual 3.16
Typical Multi-Casualty Incidents
Earthquakes Urban Wild Lands Fires Motor Vehicle Accidents Floods Tornados Hurricanes Explosions Train derailments Hazmat
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Visual 3.17
CERT Size-up
1. Gather Facts
2. Assess Damage
3. Consider Probabilities
4. Assess Your Situation
5. Establish Priorities
6. Make Decisions
7. Develop Plan of Action
8. Take Action
9. Evaluate Progress
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Visual 3.18
Triage
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 – French term meaning “to sort ”
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Visual 3.19
Triage Steps
1. Size-up
2. Conduct voice triage
3. Follow a systematic route
4. Start where you stand
5. Evaluate each victim and tag them
6. Document Triage results
“Immediates”…airway, bleeding, recovery position
Transfer “Immediates” to medical group immediately!
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Visual 3.20
The START Triage System
SimpleTriage
AndRapid
Treatment
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Visual 3.21
START Video
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Visual 3.22
Triage Pitfalls
No team plan, organization, or goal
Indecisive leadership
Too much focus on one injury
Treatment (rather than triage) performed
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Visual 3.23
Patient Assessment…RPM
Respirations
Perfusion
Mental Status
Three things to check…
Anyone who is unconscious is an “Immediate” by definition!
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Visual 3.24
RPM…Respirations
No breathing Position airway, if still not breathing try it again If still no breathing tag as LIFELESS 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
Range…Adults under 30 breaths a minute Children to 12 years: 15-45 breaths/min
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Visual 3.25
More than 2 seconds Tag as IMMEDIATE and move on to next
person
Less than 2 seconds Go to next step… Mental Status
RPM…Perfusion…Blanch Test
Goal…perfusion in under 2 seconds
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Visual 3.26
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
RPM…Mental Status
Goal…follow simple command
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Visual 3.27
S.T.A.R.T. Categories
MINORMINOR IMMEDIATEIMMEDIATE DELAYEDDELAYED LIFELESSLIFELESS
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Visual 3.28
“ “ MINOR ”MINOR ”
Walking wounded
Do not require immediate care
“Screamers” Use as helpers to care for others
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Visual 3.29
“ “ IMMEDIATE ”IMMEDIATE ”
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
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Visual 3.30
“ “ DELAYED ”DELAYED ”
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.
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Visual 3.31
“ “ LIFELESS LIFELESS ””
Considered Non-SalvageableObviously deadNon-breathers who fail to breathe after
airway has been clearedMortal injuries
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Visual 3.32
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
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Visual 3.33
Triage Exercises
Head Tilt / Chin Lift
Bleeding Control
Triage Exercise RPM
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Visual 3.34
Unit Summary
The Killers Approaching a Victim Open Airway Control Bleeding Treat Shock Size-up and Triage RPM