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Broward County Public Schools Revised: August 2007
Health Science Core Chapter 8
Disaster: Preparedness, Hazards, and PreventionBroward County Triage
Broward County Incident Command
Broward County Public Schools Revised: August 2007
Chapter 18: Disasters: Preparedness
Broward County Public Schools Revised: August 2007
Disaster
An unexpected event that causes great damage and depletes or exhausts currently available resources
• Earthquakes• Hurricanes• Floods• Tornadoes• Airplane accident• Hazardous waste
accident
Broward County Public Schools Revised: August 2007
Triaging Terms
• Triage - To sort or prioritize care for a group of patients
• Assessment – evaluation of the patient• Objective – Information obtained from observing
the patient• Subjective – Information obtained from the
patient• The goal of triage – Prompt and efficient patient
care
Broward County Public Schools Revised: August 2007
Disaster Preparedness
1. Disaster preparedness has become a recognized specialty which requires cooperation of many agencies.
2. Proper preparation takes:• Foresight• Thought• Planning• Experience is the best teacher
Broward County Public Schools Revised: August 2007
Disaster Basic Guidelines
• Remain calm• Know who the designated person in charge of
you• Keep agency telephone lines clear for official
business• Communicate and cooperate with other workers• Always speak in a firm voice but a caring tone
Broward County Public Schools Revised: August 2007
Occupational Safety
• OSHA – Occupational Safety and Health Administration – agency that develops safety standards and establishes maximum levels of exposure to many hazardous material.
• NIOSH – National Institute for Occupational Safety and Health – Investigates requests of unsafe working conditions and how they relate to employee illnesses.
Broward County Public Schools Revised: August 2007
Hospital Hazards
• Anesthesia – gases used to cause loss of sensation and/or consciousness caused by the administration of drugs
• Radiation and chemotherapy – toxic substances that can have a high risk of developing tissue damage
• Asbestos – fireproofing material in old construction
• Always read the label and mixing instructions before using any chemicals
Broward County Public Schools Revised: August 2007
Hazard Communication / HazCom
Program that protects employees from the dangers of
chemicals and medical gases.
1. Employee training
2. Written program
3. Material Safety Data Sheets
4. Warning Labels
Broward County Public Schools Revised: August 2007
Mass Casualty Incidents Uniform Pre-hospital MCI Procedure
Broward County Public Schools Revised: August 2007
What is an MCI ?
Any Incident Which Overwhelms the Capabilities of the First Arriving Unit (s).
Broward County Public Schools Revised: August 2007
Predetermined Response
• Amount of resources that will automatically be issued based on the number of patients
• First responding unit will notify dispatch center the MCI Level
• There are 5 Levels of response
Broward County Public Schools Revised: August 2007
MCI Level 1 Response (5-10 Victims)
•
• 4 ALS Transport Units • 2 Suppression units• 1 Shift Supervisor
• 1 EMS Supervisor
Broward County Public Schools Revised: August 2007
MCI Level 2 Response (11-20 Victims)
• 6 ALS Rescue Units• 3 Suppression Units• 2 Shift Supervisors• 2 EMS Supervisors
Broward County Public Schools Revised: August 2007
MCI Level 3 Responses(21-100 Victims)
• 8 ALS Transport Units• 4 Suppression Units• 3 Shift Supervisors• 3 EMS Supervisors• 1 Operations Chief• 1 Command Vehicle• 1 Supply Trailer
Broward County Public Schools Revised: August 2007
MCI LEVEL 4 Response(101-1000 Victims)
• 5 MCI Task Forces (25 units)• 2 ALS Transport Unit Strike Teams (10 units)• 1 Suppression Unit Strike Team (5 units)• 2 BLS Transport Unit Strike Teams (10 units)• 2 Mass Transit Buses• 5 Shift Supervisors• 3 EMS Supervisors• 1 EMS Chief• 1 Operations Chief• 1 Command Vehicle• 2 Supply Trailers• 1 Communications Trailer
Broward County Public Schools Revised: August 2007
MCI LEVEL 5 Response(Over 1000 victims)
• 10 MCI Task Forces (50 units)• 4 ALS Transport Unit Strike Teams (20 units)• 2 Suppression Unit Strike Teams (10units)• 4 BLS Transport Unit Strike Teams (20 units)• 4 Mass Transit Buses• 10 Shift Supervisors• 6 EMS Supervisors• 2 EMS Chiefs• 2 Operations Chief • 2 Command Vehicles• 4 Supply Trailers• 1 Communication Trailers
Broward County Public Schools Revised: August 2007
First Arriving Unit Procedure
Broward County Public Schools Revised: August 2007
First Arriving
A. Unit Officer will establish “COMMAND”
1. Size-up and estimate number of victims
2. Request MCI level response
3. Identify a Staging Area
Broward County Public Schools Revised: August 2007
First Arriving
4. Initiate triage with crew members and initial crewsa. Perform START or JumpSTART Triageb. Prioritize victims
• REDRED (Immediate) (Immediate)• YELLOWYELLOW (Delayed) (Delayed)• GREENGREEN (Minor)(Minor)• BLACK BLACK (Non-salvageable)(Non-salvageable)
5. Direct walking wounded to one location
Broward County Public Schools Revised: August 2007
Mass Casualty Operational Structure
Broward County Public Schools Revised: August 2007
Operational Groups
1. Triage
2. Treatment
3. Transport
4. Staging
Broward County Public Schools Revised: August 2007
Basic Command Structure for Mass Casualty Incidents
Incident Commander /
Medical Branch Officer
Triage Group Treatment Group Staging GroupTransport Group
Broward County Public Schools Revised: August 2007
Other Possible Operational Groups
1. Medical Branch
2. Landing Zone
3. Extrication
4. Hazmat
5. Rehabilitation
6. Safety
7. PIO
8. Medical Intelligence
Broward County Public Schools Revised: August 2007
Complex Command Structure for Mass Casualty Incidents
Medical Branch
Triage Group Treatment Group Transport Group
Medical Supply
Triage Unit
Litter Bearers Unit
Medical Examiner Unit
Red unit
Yellow Unit
Green Unit
Staging
Aid
Medical Communication
Coordinator
Aid
Broward County Public Schools Revised: August 2007
START Triage
Broward County Public Schools Revised: August 2007
Initial Triage
• Locate and direct all walking wounded
• Assign someone to keep green group together
• Assess non-ambulatory• Use colored ribbons tied to
upper extremity• Borderline use higher priority
tag
Broward County Public Schools Revised: August 2007
• Perform during Treatment phase
• Use DMS All Risk Triage Tag
• Trauma criteria will apply
Secondary Triage Procedure
Broward County Public Schools Revised: August 2007
Respirations
Perfusion
Mental
Adult START TriageRPM
Broward County Public Schools Revised: August 2007
• Less Than 30/minute – Go To Perfusion• Over 30/Minutes – RED Tag• No Respirations – Open Airway:
– Breathing – RED Tag
– Not Breathing – BLACK Tag
Respirations
Broward County Public Schools Revised: August 2007
• Radial Pulse present or Capillary Refill is < 2 seconds -
Go To Mental Status
• No Radial Pulse or Capillary Refill > 2 Seconds – RED Tag
Perfusion
Broward County Public Schools Revised: August 2007
• Follows Simple Commands & AAOX3 – GREEN
• Does not follow commands, not AAOX3 or is Unconscious – RED Tag
• Depending on Injuries – YELLOW Tag
Mental Status
Broward County Public Schools Revised: August 2007
START Flow Chart
Broward County Public Schools Revised: August 2007
Pediatrics Jump START Triage
Broward County Public Schools Revised: August 2007
JumpSTART Triage
Triage system adapted for pediatrics < 8 years old, which use a modify version of
evaluating:
• Respiration• Perfusion• Mental Status
Broward County Public Schools Revised: August 2007
Respiration
• Rate between 15 and 45 BPM –
Go to Perfusion• Rate over 45 BPM or under 15 BPM – RED Tag • No Respiration –
• Open Airway and remove any obstruction• Still no breathing, than check radial or pedal pulse• No pulse - BLACK Tag• Pulse present Give 5 respirations –
• Breathing begins – RED Tag• No breathing – BLACK Tag
Broward County Public Schools Revised: August 2007
Perfusion
• Peripheral pulse present –
Go to Mental Status• Peripheral pulse absent –
RED Tag
Broward County Public Schools Revised: August 2007
Mental Status
Assess child with AVPU Scale
(Alert, Verbal, Painful, or Unconscious)• If unconscious or only responds to
painful stimuli –
RED Tag• If child is alert or responds to verbal
stimuli assess for further injuries -
YELLOW Tag or GREEN Tag
Broward County Public Schools Revised: August 2007
JumpSTART Flow Chart
Broward County Public Schools Revised: August 2007
Secondary Triage with All Risk Triage Tag
Broward County Public Schools Revised: August 2007
All Risk Triage Tags
Broward County Public Schools Revised: August 2007
Contaminated Section
• Must remove if patient is not contaminated
• If strip is not remove patient is considered contaminated.
Broward County Public Schools Revised: August 2007
Contaminated Section
• When the patient’s cloths are removed, the strip should be placed in the bag for evidence
Broward County Public Schools Revised: August 2007
Back
Front
1 watch, 2 rings, and 1 wallet
Personal Property Receipt
• Patient valuables in plastic bag
Broward County Public Schools Revised: August 2007
Personal Property Receipt
Broward County Public Schools Revised: August 2007
Front
Back
HMWR19
John Smith
Patient Ground Transport Tracking Tag
• Removed by Transport Officer for patient tracking
Broward County Public Schools Revised: August 2007
Chemical Exposure Symptoms and Treatment
• Salivation• Lacrimation• Urination• Defecation• G.I. Distress• Emesis• Miosis
X X
Mark 1
X
Broward County Public Schools Revised: August 2007
Patient Assessment
• Decontamination
• Area of injury
• WMD type
X
28
X
XX
Broward County Public Schools Revised: August 2007
Vital Signs
• Documenting B/P, Pulse, Respiration, and IV solution
11:30 180/78 120 14
11:30 Normal Saline KVO
Broward County Public Schools Revised: August 2007
Triage Category
• Remove all of the tags distal to desires color and half of the color.
• Above is Yellow Tag
Broward County Public Schools Revised: August 2007
START Triage Method
X XX
X
Broward County Public Schools Revised: August 2007
Personal Information
John Smith
14801 SW 27 Street
Miramar FL 33027
Broward County Public Schools Revised: August 2007
References
• Stevens, Kay, and Garber, Debra. Introduction to Clinical Allied Healthcare. 2nd ed. Clifton Park, New York: Thomson Delmar Learning, 1996.
• Jones and Bartlett Publishers. (2004). Florida Regional Common EMS Protocols, Sudbury, MA: Jones and Bartlett.