Unit 3: Disaster Medical Operations

1. Unit 3: Disaster Medical Operations

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

3. Disaster Medical Operations Injuries Commonly Seen • Crush injuries (internal injuries) • Open wounds • Abrasions • Lacerations • Avulsions • Puncture wounds, impaled objects • Burns • Spinal cord injuries • Other types of injuries

4. Disaster Medical Operations Injuries Commonly Seen Closed-Head, Neck and Spinal Injuries Indications: • 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.

5. Disaster Medical Operations Injuries Commonly Seen • The “3 Killers” • Airway obstruction • Excessive bleeding • 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

6. Disaster Medical Operations Injuries Commonly Seen Shock Shock is defined as inadequate organ perfusion and tissue oxygenation. Cells die i Tissues die i Organs die i Systems die i People die

7. Disaster Medical Operations Treatment of Injuries Primary Survey • Check Airways. • Is it open? • Look, listen and feel • Is Breathing adequate? • Check Circulation. • Is there a pulse? • Check mental status.

8. Disaster Medical Operations Treatment of Injuries 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. *If a c-spine injury suspected, use the jaw-thrust method DEMO

9. Disaster Medical Operations Treatment of Injuries Controlling Bleeding • Control bleeding with: • Direct pressure • Elevation • Pressure points **Direct pressure with elevation for 5-7 min. DEMO

10. Disaster Medical Operations Treatment of Injuries Controlling Bleeding • Rules of Dressing: • If there is active bleeding, redress over existing dressing and maintain pressure and elevation.

11. Disaster Medical Operations Treatment of Injuries Controlling Bleeding Brachial Pressure Point Femoral Pressure Point EXERCISE

12. Disaster Medical Operations Treatment of Injuries • Control bleeding by: • Leaning slightly forward • Pinching at the nasal septum • Placing ice pack behind neck Nose Bleeding

13. Disaster Medical Operations Treatment of Injuries Tourniquets • Tourniquets 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?”

14. Disaster Medical Operations Treatment of Injuries 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

15. Disaster Medical Operations Treatment of Injuries Secondary Survey • Head-to-toe Patient Assessment: • “Hi, my name is Sally Joe, I’m a CERT member, may I help you?” Head Face Neck Shoulders Arms and hands Chest Abdomen Pelvis Legs and feet Back * Reverse for children DEMO

16. Disaster Medical Operations Treatment of Injuries Splinting Objective: Immobilize injury site and both adjacent joints. Check the distal pulse BEFORE and AFTER splinting!

17. Disaster Medical Operations Treatment of Injuries 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

18. Disaster Medical Operations Treatment of Injuries Burns

19. Disaster Medical Operations Treatment of Injuries Special Wound Situations • Eye 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.

20. Disaster Medical Operations Treatment of Injuries Special Wound Situations • Impaled 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.

21. Disaster Medical Operations Treatment of Injuries 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.

22. Disaster Medical Operations Rescue Lifts and Carries We’ve found them…now we need to move them to our treatment area…

23. Disaster Medical Operations Rescue Lifts and Carries One person pack strap One person arm carry Two person chair carry EXERCISE

24. Disaster Medical Operations Rescue Lifts and Carries Two person carry Two person seat carry EXERCISE

25. Disaster Medical Operations Rescue Lifts and Carries Long axis drag Long axis blanket drag

26. Disaster Medical Operations Rescue Lifts and Carries

27. Disaster Medical Operations Medical 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.

28. Disaster Medical Operations Medical Treatment Areas

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

30. Disaster Medical Operations Medical Treatment Areas A LeaderShould be Assigned to Treatment Areas • Orderly patient placement. • Head-to-toe assessments. • Patient treatments. • Patient documentation and treatment area records.

31. Disaster Medical Operations Medical Treatment Areas Thoroughly Document Patients in 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.

32. Disaster Medical Operations Triage • 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.

33. Disaster Medical Operations Triage • Use Simple Triage And Rapid Treatment • to quickly evaluate and prioritize victims for treatment. • Most effective use of limited resources. • Who to treat. • “Sorting it out”: Walking Wounded, • Immediate, Delayed, Deceased. • RPM • Respiration (breathing) • Perfusion (blood circulation) • Mental Status (alertness, consciousness)

34. Disaster Medical Operations Triage Think 30 - 2 - CAN DO

35. Disaster Medical Operations Triage Conducting Triage Stop, look, listen, and think. Determine the walking wounded. Conduct voice triage. Start where you stand and follow a systematic route. Evaluate each victim and tag them. Treat “I” victims immediately. Document triage results.

36. Disaster Medical Operations Triage Challenges with Triage • No organization. • Inadequate scene size-up. • Inadequate medical assessment. • Too much medical assessment. • Getting caught up treating injuries. Practice, practice, practice…

37. Disaster Medical Operations Triage • 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.

38. Disaster Medical Operations Triage Triage Tag Samples

39. Disaster Medical Operations Triage Video

40. Disaster Medical Operations Exercise Exercise: Time for Triage

41. Disaster Medical Operations Size-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.

42. Disaster Medical Operations Size-Up Size-Up Gather facts. Assess the scene. Identify your resources. Establish your medical priorities. Develop a medical plan. Conduct medical treatment. Evaluate your progress.

43. Disaster Medical Operations Size-Up Biohazard in Disaster Medicine • Contain all soiled items. • Avoid contact with infectious materials • Blood • Body fluids • Set up area to contain biohazard waist • Used bandages • Gloves • Face mask

44. Disaster Medical Operations Review • 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.

45. Disaster Medical Operations Triage Exercise: Time for Triage