Section 4: Disaster Medical Operations, Part 2

1. 1 Disaster Medical Operations —

   Part 2

2. 2 Slide 2

   • 3 “Killers”
     • Airway obstruction
     • Excessive bleeding
     • Shock

3. 3 CERT Sizeup REMEMBER: CERT SIZEUP IS A CONTINUAL PROCESS

   • 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 Part 2

4. 4 Unit Objectives

   • Take appropriate sanitation measures to help protect public health
   • Perform head-to-toe patient assessments
   • Establish a treatment area
   • Apply splints to suspected fractures and sprains
   • Employ basic treatments for other injuries

5. 5 Unit Topics

   • Public Health Considerations
   • Functions of Disaster Medical Operations
   • Establishing Medical Treatment Areas
   • Conducting Headto-Toe Assessments
   • Treating Burns
   • Wound Care
   • Treating Fractures, Dislocations, Sprains, and Strains
   • Nasal Injuries
   • Treating Cold- Related Injuries
   • Treating Heat- Related Injuries
   • Bites and Stings CERT Basic Training

6. 6 Public Health Considerations

   • Maintaining proper hygiene
   • Maintaining proper sanitation
   • Purifying water (if necessary)
   • Preventing spread of disease

7. 7 Maintaining Hygiene

   • Wash hands frequently
     • Or use alcohol-based hand sanitizer
   • Wear non-latex exam gloves
   • Wear N95 mask and goggles
   • Keep dressings sterile
   • Avoid contact with body fluids
     • “If it is warm, wet, and not yours, don’t touch it!”

8. 8 Maintain Sanitation

   • Control disposal of bacterial sources
   • Put waste products in plastic bags
     • Tie off bags and mark them as medical waste
   • Bury human waste

9. 9 Water Sanitation Methods

   • Boil water for 1 minute
   • Water purification tablets
   • Non-perfumed liquid bleach
     • 8 drops/gal of water
     • 16 drops/gal if water is cloudy
     • Let stand for 30 minutes before use

10. 10 Functions of Disaster Medical Operations

    • Triage
    • Treatment
    • Transport
    • Morgue
    • Supply

11. 11 Establish a Medical Treatment Area

    • Select site and set up treatment area as soon as injured survivors are confirmed
    • When determining best location(s) for treatment area, consider:
      • Safety of rescuers and survivors
      • Most effective use of resources

12. 12 Treatment Area Site Selection

    • The site selected should be:
      • In a safe area, free of hazards and debris
      • Upwind, uphill, and upstream (if possible) from hazard zone(s)
      • Accessible by transportation vehicles
      • Expandable

13. 13 Most Effective Use of CERT Resources

    • To help meet the challenge of limited resources, CERT may need to establish:
      • Decentralized medical treatment location (more than one location)
      • Centralized medical treatment location (one location)

14. 14 Treatment Area Layout

    • Four treatment areas:
      • “I” for Immediate care
      • “D” for Delayed care
      • “M” for Minor injuries/walking wounded
      • “DEAD” for the morgue

15. 15 Treatment Area Layout

16. 16 Treatment Area Organization

    • Assign treatment leader to each treatment area
    • Document thoroughly
      • Available identifying information
      • Description (age, sex, body build, estimated height)
      • Clothing
      • Injuries
      • Treatment
      • Transfer location

17. 17 Head-to-Toe Assessment

    • Objectives of head-to-toe assessment:
      • Determine extent of injuries
      • Determine type of treatment needed
      • Document injuries

18. 18 DCAP-BTLS

    • Deformities
    • Contusions
    • Abrasions
    • Punctures
    • Burns
    • Tenderness
    • Lacerations
    • Swelling

19. 19 Where and When

    • Light damage: assess in place
    • Moderate damage: move to treatment area first
    • Assess and tag everyone
    • Both verbal and hands on

20. 20 Conducting Head-to-Toe Assessment

    • Pay careful attention
    • Look, listen, and feel
    • Check own hands for patient bleeding
    • If you suspect a spinal injury in unconscious survivors, treat accordingly
    • Check PMS in all extremities
    • Look for medical identification

21. 21 Order of Assessment

    • 1. Head
    • 2. Neck
    • 3. Shoulders
    • 4. Chest
    • 5. Arms
    • 6. Abdomen
    • 7. Pelvis
    • 8. Legs

22. 22 Closed-Head, Neck, Spinal Injuries

    • Do no harm
      • Minimize movement of head and neck
    • Keep spine in straight line
    • Stabilize head

23. 23 Treating Burns

    • Conduct thorough sizeup
    • Treat with first aid
      • Cool burned area
      • Cover with sterile cloth to reduce risk of infection

24. 24 Burn Severity

    • Factors that affect burn severity:
      • Temperature of burning agent
      • Period of time survivor exposed
      • Area of body affected
      • Size of area burned
      • Depth of burn

25. 25 Burn Classifications

    • Superficial: epidermis
    • Partial Thickness: dermis and epidermis
    • Full Thickness: subcutaneous layer and all layers above

26. 26 Burn Treatment: DOs

    • When treating a burn survivor, DO:
      • Cool skin or clothing if they are still hot
      • Cover burn loosely with dry, sterile dressings to keep air out, reduce pain, and prevent infection
      • Elevate burned extremities

27. 27 Burn Treatment: DON’Ts

    • When treating a burn survivor, DO NOT:
      • Use ice
      • Apply antiseptics, ointments, or other remedies
      • Remove shreds of tissue, break blisters, or remove adhered particles of clothing

28. 28 Treatment for Chemical Burns

    • Remove cause of burn + affected clothing/jewelry
    • If irritant is dry, gently brush away as much as possible
      • Always brush away from eyes, survivor, and you
    • Flush with lots of cool running water
    • Apply cool, wet compress to relieve pain
    • Cover wound loosely with dry, sterile or clean dressing
    • Treat for shock if appropriate

29. 29 Inhalation Burns Signs and Symptoms

    • Sudden loss of consciousness
    • Evidence of respiratory distress or upper airway obstruction
    • Soot around mouth or nose
    • Singed facial hair
    • Burns around face or neck

30. 30 Wound Care

    • Control bleeding
    • Clean wound
    • Apply dressing and bandage

31. 31 Cleaning and Bandaging Wounds

    • Clean by irrigating with clean, room temperature water
      • NEVER use hydrogen peroxide
      • Irrigate but do not scrub
    • Apply dressing and bandage
      • Dressing applied directly to wound
      • Bandage holds dressing in place

32. 32 Rules of Dressing

    • If active bleeding:
      • Redress OVER existing dressing
    • If no active bleeding:
      • Remove bandage and dressing to flush wound
      • Check for infection every 4-6 hours

33. 33 Signs of Infection

    • Signs of possible infection
      • Swelling around wound site
      • Discoloration
      • Discharge from wound
      • Red striations from wound site

34. 34 Amputations

    • Control bleeding; treat shock
    • If amputated body part is found:
      • Save tissue parts, wrapped in clean material and placed in plastic bag
      • Keep tissue parts cool, but NOT directly on ice
      • Keep severed part with survivor

35. 35 Impaled Objects

    • When foreign object is impaled in patient’s body:
      • Immobilize affected body part
      • Do not attempt to move or remove
      • Try to control bleeding at entrance wound
      • Clean and dress wound, making sure to stabilize impaled object

36. 36 Fractures, Dislocations, Sprains, Strains

    • Immobilize injury and joints immediately above and below injury site
    • If uncertain of injury type, treat as fracture

37. 37 Types of Fractures

38. 38 Treating Open Fractures

    • Do not draw exposed bone ends back into tissue
    • Do not irrigate wound
    • Cover wound with sterile dressing
    • Splint fracture without disturbing wound
    • Place moist dressing over bone end

39. 39 Displaced and Nondisplaced Fractures

40. 40 Dislocations

    • Dislocation is injury to ligaments around joint
      • So severe that it permits separation of bone from its normal position in joint
    • Treatment
      • Immobilize; do NOT relocate
      • Check PMS before and after splinting/ immobilization

41. 41 Signs of Sprain

    • Tenderness at site
    • Swelling and bruising
    • Restricted use or loss of use

42. 42 Splinting

43. 43 Splinting Guidelines

    • 1. Support injured area above and below injury
    • 2. Assess PMS in extremity
    • 3. Splint injury in position that you find it
    • 4. Don’t try to realign bones or joints
    • 5. Fill voids to stabilize and immobilize
    • 6. Immobilize above and below injury
    • 7. After splinting, reassess PMS

44. 44 Nasal Injuries

    • Causes
      • Blunt force to nose
      • Skull fracture
      • Nontrauma conditions, e.g., sinus infections, high blood pressure, and bleeding disorders
    • Cautions
      • Large blood loss from nosebleed can lead to shock
      • Actual blood loss may not be evident because survivor will swallow some amount of blood

45. 45 Treatment of Nasal Injuries

    • Control nasal bleeding:
      • Pinch nostrils or put pressure on upper lip under nose
      • Have survivor sit with head forward, NOT back
    • Ensure that airway remains open
    • Keep survivor calm

46. 46 Cold-Related Injuries

    • Hypothermia:
      • Occurs when body’s temperature drops below normal
    • Frostbite:
      • Occurs when extreme cold shuts down blood flow to extremities, causing tissue death

47. 47 Symptoms of Hypothermia

    • Body temperature of 95° F or lower
    • Redness or blueness of skin
    • Numbness and shivering
    • Slurred speech
    • Unpredictable behavior
    • Listlessness

48. 48 Hypothermia Treatment

    • Remove wet clothing
    • Wrap survivor in blanket
    • Protect survivor from weather
    • Provide food and drink to conscious survivors
    • Do not attempt to massage to warm body
    • Place unconscious survivor in recovery position
    • Place survivor in warm bath

49. 49 Symptoms of Frostbite

    • Skin discoloration
    • Burning or tingling sensation
    • Partial or complete numbness

50. 50 Frostbite Treatment

    • Immerse injured area in warm (NOT hot) water
      • Warm slowly!
    • Do NOT allow part to re-freeze
    • Do NOT attempt to use massage
    • Wrap affected body parts in dry, sterile dressing

51. 51 Heat-Related Injuries

    • Heat cramps:
      • Muscle spasms brought on by over-exertion in extreme heat
    • Heat exhaustion:
      • Occurs when exercising or working in extreme heat results in loss of body fluids
    • Heat stroke:
      • Survivor’s temperature control system shuts down
      • Body temperature rises so high that brain damage and death may result

52. 52 Symptoms of Heat Exhaustion

    • Cool, moist, pale or flushed skin
    • Heavy sweating
    • Headache
    • Nausea or vomiting
    • Dizziness
    • Exhaustion

53. 53 Symptoms of Heat Stroke

    • Hot, red skin
    • Lack of perspiration
    • Changes in consciousness
    • Rapid, weak pulse and rapid, shallow breathing

54. 54 Treatment of Heat-Related Injuries

    • Remove from heat to cool environment
    • Cool body slowly
    • Have the survivor drink water, SLOWLY
    • No food or drink if survivor is experiencing vomiting, cramping, or is losing consciousness

55. 55 Treatment for Bites/Stings

    • If bite or sting is suspected, and situation is non-emergency:
      • Remove stinger if still present by scraping edge of credit card or other stiff, straightedged object across stinger
      • Wash site thoroughly with soap and water
      • Place ice on site for 10 minutes on and 10 minutes off

56. 56 Anaphylaxis

    • Check airway and breathing
    • Calm individual
    • Remove constrictive clothing and jewelry
    • Find and help administer survivor’s Epi-pen
    • Watch for signs of shock and treat appropriately

57. 57 Unit Summary

    • Public health concerns related to sanitation, hygiene, and water purification
    • Organization of disaster medical operations
    • Establishing treatment areas
    • Conducting head-to-toe assessments
    • Treating wounds, fractures, sprains, and other common injuries

58. 58 Homework Assignment

    • Read unit to be covered in next session
    • Bring necessary supplies for next session
    • Wear appropriate clothes for next session
    • Practice complete head-to-toe assessment on friend or family member

Course material: FEMA's CERT Basic Training (2019), in the public domain. For study only, not medical advice: in an emergency, call 911.