unit 3: disaster medical operations

Unit 3: Disaster Medical Operations

Unit 3: Disaster Medical Operations• Injuries Commonly Seen• Treatment of Injuries• Rescue Lifts and Carries• Medical Treatment Areas• Triage• Size-Up

Disaster Medical OperationsInjuries Commonly Seen

Crush injuries (internal injuries) Open wounds

• Abrasions• Lacerations• Avulsions

Puncture wounds,impaled objects

Burns Spinal cord injuries Other types of injuries


Change in consciousness. Inability to move one or more parts of the body. Tingling, numbness in extremities. Difficulty breathing or seeing. Bleeding, bruising, deformity of the head or spine. Blood or fluid from ears or nose. Bruising behind ears, around eyes. Uneven pupils, seizure, nausea, vomiting.

Closed-Head, Neck and Spinal Injuries Indications:


The “3 Killers”1. Airway obstruction2. Excessive bleeding3. Shock

It is estimated that 40% of deaths could have been saved if rescuers had performed the following techniques:

• Opened airway• Controlled bleeding• Treated for shock


Shock is defined as inadequate organ perfusion and tissue oxygenation.

Shock

Cells diei

Tissues diei

Organs diei

Systems diei

People die

Disaster Medical OperationsTreatment of Injuries

Primary SurveyCheck Airways.• Is it open?• Look, listen and feel

Is Breathing adequate?Check Circulation.• Is there a pulse?

Check mental status.


*If a c-spine injury suspected, use the jaw-thrust method

Airway Management The most common airway obstruction is the tongue.When an airway obstruction is suspected, try to open

the airway using the head-tilt / chin-lift method.

DEMO


Controlling BleedingControl bleeding with:

• Direct pressure• Elevation• Pressure points

**Direct pressure with elevation for 5-7 min.

DEMO

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Controlling Bleeding

Rules of Dressing: If there is active bleeding, redress

over existing dressing and maintain

pressure and elevation.


Controlling Bleeding

Brachial Pressure Point Femoral Pressure PointEXERCISE


Control bleeding by:• Leaning slightly forward• Pinching at the nasal septum• Placing ice pack behind neck

Nose Bleeding


TourniquetsTourniquets will only be used as a last resort to stop bleeding.

Tourniquets are a device twisted around an extremity to stop uncontrolled bleeding.

They are rarely, if ever, necessary. Partial or complete traumatic amputations

Major arteries are severed.

If using a tourniquet: write in a highly visible location that patient has tourniquet and the time it was applied.

“Is this a situation of life or limb?”


Treatment of Shock Lay the victim on their back. Elevate feet 6-10” above the level of the heart (if no neck

injury is expected). Maintain an open airway. Control obvious bleeding. Maintain body temperature (cover the ground and the

victim with a blanket if necessary). Avoid rough or excessive handling unless the rescuer and

victim are in immediate danger. Do not give any fluids or foods as vomiting will often occur

and can lead to aspiration problems.DEMO


Secondary Survey Head-to-toe Patient Assessment:“Hi, my name is Sally Joe, I’m a CERT member, may I help you?”

1. Head2. Face3. Neck4. Shoulders5. Arms and hands6. Chest7. Abdomen8. Pelvis9. Legs and feet10.Back

* Reverse for children

DEMO


SplintingObjective: Immobilize injury site and both adjacent joints.

Check the distal pulse BEFORE and AFTER splinting!


Splinting Types of splints:• Swathe, cardboard, plywood,

magazine, other limb (buddy splint). How to splint:• Hold with gauze rollers, triangle

bandages or tape.• Pad limb inside splint as needed to

improve comfort.• Leave opening to check skin color or

pulse at end of limb.

EXERCISE


Burns


Special Wound SituationsEye injury:

Do NOT remove objects or debris from injured eye. Do NOT apply dressing or bandage directly on injured

eye.• Requires use of “donut” bandage made with

triangle bandage. Bandage should completely cover both eyes• Patient should not be able to see with good eye.


Special Wound SituationsImpaled objects:

Immobilize object. DO NOT move or remove.• Cut off excess part of the object if possible.

If possible, use “donut” to isolate object. Control bleeding. Wrap / brace the object to keep it from moving. Clean and dress wound.


Things to remember… Most valuable tool in a disaster: your brain. Use common sense. Avoid tunnel vision. Follow your training and guidelines. Communicate with your team members. Stay flexible. Be creative.

Disaster Medical OperationsRescue Lifts and Carries

We’ve found them…now we need to move them to our treatment area…


One person pack strap

One person arm carry

Two person chair carry

EXERCISE


Two person seat carry

Two person carry

EXERCISE


Long axis drag

Long axis blanket drag

Disaster Medical OperationsMedical Treatment Areas

The site selected should be• In a safe area.• Close to (but upwind and uphill from) the

hazard.• Accessible by transportation vehicles.• Expandable.• Clearly identifiable.


Transportation

Communications

Treatment Areas

Immediate Delayed

Triage

Incident Site

Command Post

Morgue

Transportation

Communications

Treatment Areas

Immediate Delayed

Triage

Incident Site

Command Post

Morgue

Treatment Area Layout“I” and “D” should be close together for worker communication, sharing supplies, and transferring patients.


• Orderly patient placement.• Head-to-toe assessments.• Patient treatments.• Patient documentation and

treatment area records.

A Leader Should be Assigned to Treatment Areas


• Available identifying information.• Clothing descriptions.• Description of injuries.• Treatments received – include rescuers names

and times for all triage, assessments and treatments.• Transfer locations – to and from.

Thoroughly Document Patients in Treatment Areas

Disaster Medical OperationsTriage

Be safe! Work within your resources. Treatment for life-threatening conditions:• Airway obstruction• Bleeding• Shock

Treatment for less urgent conditions. To do the greatest good for the greatest number

of victims-S.T.A.R.T. Triage.Simple Triage And Rapid Treatment.


Use Simple Triage And Rapid Treatmentto quickly evaluate and prioritize victims for treatment.1. Most effective use of limited resources.2. Who to treat.3. “Sorting it out”: Walking Wounded,

Immediate, Delayed, Deceased. RPM• Respiration (breathing)• Perfusion (blood circulation)• Mental Status (alertness, consciousness)


Think 30 - 2 - CAN DO


Conducting Triage1. Stop, look, listen, and think.2. Determine the walking wounded.3. Conduct voice triage.4. Start where you stand and follow a systematic route.5. Evaluate each victim and tag them.6. Treat “I” victims immediately.7. Document triage results.


Challenges with TriageNo organization. Inadequate scene size-up. Inadequate medical assessment. Too much medical assessment.Getting caught up treating injuries.

Practice, practice, practice…


Dealing with Death• Cover the body; treat it with respect.• Have one family member look at the body and

decide if the rest of the family should see it.• Allow family members to hold or spend time with

the deceased.• Let the family grieve.


Triage TagSamples

Disaster Medical OperationsTriage Video

Disaster Medical OperationsExercise

Exercise: Time for Triage

Disaster Medical OperationsSize-Up

Size-Up Your personal protection comes first! Got Personal Protection Equipment? Work with a buddy. Demo: Safe removal of PPE to not

contaminate yourself.

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Size-Up1. Gather facts.2. Assess the scene.3. Identify your resources.4. Establish your medical priorities.5. Develop a medical plan.6. Conduct medical treatment.7. Evaluate your progress.


Biohazard in Disaster Medicine1. Contain all soiled items.2. Avoid contact with infectious materials• Blood• Body fluids

3. Set up area to contain biohazard waist• Used bandages• Gloves• Face mask

Disaster Medical OperationsReview

Disaster Medical Operations Review• Scene safety / scene size-up.• Injuries seen in a disaster• ABCs and “The 3 Killers”.• Triage. RPM 30-2-CAN DO.• Lifting techniques.• Establishing a medical treatment area.• Documentation.• Acting within your scope of practice.• The most valuable tool in a disaster…your brain.


Exercise: Time for Triage

unit 3: disaster medical operations

Documents

active bleeding

uncontrolled bleeding

control obvious bleeding

open airway

common airway obstruction

spinal injuries indications

neck injury

cspine injury