Section 3: Disaster Medical Operations, Part 1

1. 1 Disaster Medical Operations

   — Part 1

2. 2 CERT Training

   • Treatment for life-threatening conditions
     • Airway obstruction, bleeding, shock
   • Treatment for other, less urgent conditions Provide greatest good for greatest number by conducting simple triage and rapid treatment

3. 3 START

   • STart = Simple Triage
     • Survivors sorted based on priority of treatment
   • stART = And Rapid Treatment
     • Rapid treatment of injuries assessed and prioritized in first phase

4. 4 Unit Objectives

   • Identify “killers”
   • Apply techniques for opening airway, controlling bleeding, and treating for shock
   • Conduct triage under simulated disaster conditions

5. 5 Unit Topics

   • Treating life threatening injuries
   • Triage

6. 6 Three “Killers”

   • Emergency medicine “killers”
     • Airway obstruction
     • Bleeding
     • Shock
   • First priority of medical operations:
     • Open airway
     • Control excessive bleeding
     • Treat for shock

7. 7 How to Approach a Survivor

   • Be sure survivor can see you
   • Identify yourself
     • Your name and name of your organization
   • Request permission to treat, if possible
   • Respect cultural differences

8. 8 Open the Airway

9. 9 Open vs. Obstructed Airway

10. 10 Head-Tilt/Chin-Lift Method

11. 11 Types of Bleeding - 1

    • Arterial bleeding
      • Bleeding from artery spurts
    • Venous bleeding
      • Bleeding from vein flows
    • Capillary bleeding
      • Bleeding from capillaries oozes

12. 12 Types of Bleeding - 2

13. 13 Control Bleeding

    • 3 main methods for controlling bleeding:
      • Direct pressure
      • Elevation
      • Pressure points

14. 14 Pressure Points

15. 15 Shock

    • Result of ineffective circulation of blood
    • Remaining in shock will lead to death of:
      • Cells
      • Tissues
      • Entire organs

16. 16 Recognizing Shock

    • Main signs of shock
      • Rapid and shallow breathing
      • Capillary refill of greater than 2 seconds
      • Failure to follow simple commands, such as “Squeeze my hand”
    • Symptoms of shock are easily missed… pay careful attention to your patient!

17. 17 Responding to Mass Casualty Event

    • Have a plan
    • Follow that plan
    • Document your actions throughout

18. 18 CERT Sizeup

    • 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 REMEMBER: CERT SIZEUP IS A CONTINUAL PROCESS

19. 19 What Is Triage?

    • Process for managing mass casualty event
    • 1. Survivors are evaluated
    • 2. Survivors are sorted by urgency of treatment needed
    • 3. Survivors are set up for immediate or delayed treatment

20. 20 Triage

    • Immediate (I): Survivor has lifethreatening injuries (airway, bleeding, or shock)
    • Delayed (D): Injuries do not jeopardize survivor’s life; treatment can be delayed
    • Minor (M): Walking wounded and generally ambulatory
    • Dead (DEAD): No respiration after two attempts to open airway

21. 21 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

22. 22 Triage 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 survivor and tag
    • Step 5: Treat “I” survivors immediately
    • Step 6: Document triage results

23. 23 Step 4: Triage Evaluation Step 4: Triage Evaluation

    • Check airway and breathing
    • Check circulation and bleeding
    • Check mental status

24. 24 Triage Pitfalls

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

25. 25 Unit Summary 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

26. 26 Homework Assignment

    • 1. Read unit to be covered in next session
    • 2. Bring necessary supplies for the next session
    • 3. Wear appropriate clothes for the next session

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