Contra Costa County CERT Program

Unit 3 – Emergency Medical Operations Part 1Released: 18 August 2011Released: 18 August 2011

Visual 3.2

Community Emergency Response Team

Personal safety is ALWAYS the number one priority Work as a team Wear personal protective equipment…gloves, helmet,

goggles, N95 mask and boots

The CERT goal is to do the

Greatest Good for the Greatest Number Hope for the best but plan for the worst

Visual 3.3

Unit Objectives

Identify the “killers”

Apply techniques for opening airways, controlling bleeding, and treating for shock

Conduct triage under simulated emergency conditions

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Death from Trauma

Overwhelming and irreversible damage to vital organs, death within minutes

Excessive bleeding, death within minutes

Infection or multiple organ failure, death in several days or weeks

40% could be saved!

90% of disaster victims are rescued by other victims!

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Life-Threatening Conditions

The “Killers”:

Airway obstruction

Excessive bleeding

Shock

Life-threatening conditions must receive

immediate treatment!

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How to Approach a Victim

Size-up: Check scene for safety

Be sure victim can see you

Identify yourself Your name, training and name of your organization

Request permission to evaluate and treat

Respect cultural differences

Visual 3.7

Checking For Breathing

Tap and shout

Open airway…palm on forehead, 2 fingers under chin and tilt the jaw upward while tilting the head backwards slightly

Ear over victims mouth while looking at the chest look - for chest rise listen - for air exchange feel – abdominal movement

Evaluate and repeat if necessary once more

Visual 3.8

Opening The Airway

Visual 3.9

Opening The Airway

Head Tilt/Chin Lift

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Bleeding

Arterial…spurting

Venous…flowing

Capillary…oozing

Losing one liter can be life threatening

Visual 3.11

Bleeding Control

Direct pressure

Elevation

Pressure points

No tourniquets!

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Shock

Result of ineffective circulation of blood Remaining in shock will lead to death of:

CellsTissuesEntire organs

Visual 3.13

Shock - Signs

Weak, restless or irritable

Rapid and weak pulse

Rapid shallow breathing

Pale, cool, moist skin

Blue lips or fingernails

Nausea and vomiting

Dizzy, drowsy or unconscious

Very low blood pressure

Treat anyone unconscious for SHOCK

Visual 3.14

Shock - Treatment

Control major bleeding

Place in Recovery Position

Maintain body temperature

Loosen restrictive clothing

Recovery Position

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A Multi-Casualty Incident (MCI) is any situation that overwhelms the normal emergency response capability

Multi-Casualty Incident Definition

An MCI is also known as a Mass Casualty Incident or a Mass Casualty Event

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Typical Multi-Casualty Incidents

Earthquakes Urban Wild Lands Fires Motor Vehicle Accidents Floods Tornados Hurricanes Explosions Train derailments Hazmat

Visual 3.17

CERT Size-up

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

Visual 3.18

Triage

During triage, victims are evaluated and prioritized according to the urgency of treatment needed

Spending a lot of time trying to save one life may prevent a number of other patients from receiving the treatment they need

TRIAGE – French term meaning “to sort ”

Visual 3.19

Triage Steps

1. Size-up

2. Conduct voice triage

3. Follow a systematic route

4. Start where you stand

5. Evaluate each victim and tag them

6. Document Triage results

“Immediates”…airway, bleeding, recovery position

Transfer “Immediates” to medical group immediately!

Visual 3.20

The START Triage System

SimpleTriage

AndRapid

Treatment

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START Video

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Triage Pitfalls

No team plan, organization, or goal

Indecisive leadership

Too much focus on one injury

Treatment (rather than triage) performed

Visual 3.23

Patient Assessment…RPM

Respirations

Perfusion

Mental Status

Three things to check…

Anyone who is unconscious is an “Immediate” by definition!

Visual 3.24

RPM…Respirations

No breathing Position airway, if still not breathing try it again If still no breathing tag as LIFELESS and move

on to next person

Out of range for breaths per minute Tag as IMMEDIATE and move on to next

person

Within range for breaths per minute Go to the next step… Perfusion

Range…Adults under 30 breaths a minute Children to 12 years: 15-45 breaths/min

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More than 2 seconds Tag as IMMEDIATE and move on to next

person

Less than 2 seconds Go to next step… Mental Status

RPM…Perfusion…Blanch Test

Goal…perfusion in under 2 seconds

Visual 3.26

Can not follow directions Tag as IMMEDIATE and move on to next

person

Can follow directions Tag as DELAYED and move on to next

person

RPM…Mental Status

Goal…follow simple command

Visual 3.27

S.T.A.R.T. Categories

MINORMINOR IMMEDIATEIMMEDIATE DELAYEDDELAYED LIFELESSLIFELESS

Visual 3.28

“ “ MINOR ”MINOR ”

Walking wounded

Do not require immediate care

“Screamers” Use as helpers to care for others

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“ “ IMMEDIATE ”IMMEDIATE ”

Victim needs immediate care

Fails R – P – M check

Adult >30 respirations per minute

Child outside 15-45 respirations/m

Breathing normal, no radial pulse

Capillary refill > 2 seconds

Mental check

Visual 3.30

“ “ DELAYED ”DELAYED ”

Did not walk out of scene R-P-M within in acceptable limits May have broken bones May be extrication problem May have chest pain, etc.

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“ “ LIFELESS LIFELESS ””

Considered Non-SalvageableObviously deadNon-breathers who fail to breathe after

airway has been clearedMortal injuries

Visual 3.32

Triage Operations Review

Size Up … What’s happening? Check the scene Stop, look, listen and think

Assess your situation … What could happen?

Develop a plan of action … What will we do? Conduct voice triage, get walking wounded out Start where you stand Follow a systematic route Use RPM to evaluate and tag each victim Transfer “Immediates” to medical group immediately!

Document Triage results

Help or Document and Report

Visual 3.33

Triage Exercises

Head Tilt / Chin Lift

Bleeding Control

Triage Exercise RPM

Visual 3.34

Unit Summary

The Killers Approaching a Victim Open Airway Control Bleeding Treat Shock Size-up and Triage RPM