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CERT EMERGENCY MEDICAL OPERATIONS

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CERT EMERGENCY MEDICAL OPERATIONS Part 1 Whatcom County Division of Emergency Management OBJECTIVES Identify killers Apply techniques for opening airways ... – PowerPoint PPT presentation

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Title: CERT EMERGENCY MEDICAL OPERATIONS


1
CERTEMERGENCY MEDICAL OPERATIONS
  • Part 1
  • Whatcom County Division of Emergency Management

2
OBJECTIVES
  1. Identify killers
  2. Apply techniques for opening airways, controlling
    serious bleeding, and treating shock
  3. Conduct triage under simulated disaster conditions

3
DISASTER MEDICAL OPERATIONSAssumptions
  • The number of victims will exceed local capacity
    for treatment
  • Survivors will assist others

4
PHASES OF DEATH FROM TRAUMA
  • Phase 1 Death within minutes
  • Phase 2 Death within several hours
  • Phase 3 Death after several days or weeks

5
  • Experts agree that over 40 of disaster victims
    in the second and third phases of death could be
    saved by providing simple medical care
  • CERT members aim to Do the greatest good for the
    greatest number

6
CERT REMINDER!
  • CERT members MUST take care of themselves before
    caring for others
  • Gloves
  • Mask
  • Goggles
  • Pocket Mask

7
THE KILLERS
  • Airway Obstruction
  • Bleeding
  • Shock

8
AIRWAY
9
OBSTRUCTED AIRWAY
  • 4-6 minutes until brain death
  • Heimlich
  • Conscious
  • Unconscious
  • Most common obstruction is the tongue

10
HEAD-TILT/CHIN-LIFT
  • Step 1 Can you hear me?
  • Step 2 One hand on forehead
  • Other hand under chin
  • Step 3 Lift the jaw while tilting
  • the head backwards slightly
  • Step 4 Look, Listen, Feel for signs of
  • breathing (Chest Rise, Air
  • Exchange, Abdominal Movement)

11
Pad under shoulders to maintain an open airway
12
WHAT IF. . .
  • The person doesnt breath after opening the
    airway?
  • Try one more time then move on.
  • Remember the CERT Mission.
  • The person does start breathing but you need to
    move on to other patients?
  • Walking wounded.
  • Recovery position - consider neck injury.

13
PRACTICE TIME
  • IC break class into teams.
  • Medical Group Leader make victim and rescuer
    assignments.
  • Patient to breathe normally.
  • Rescuer to assess breathing.
  • Practice Head-Tilt/Chin-Lift.
  • Position patient in recovery position.

14
BLEEDING
  • Uncontrolled Bleeding is a Killer!
  • Three types
  • Arterial high pressure, spurts
  • Venous low pressure, flows
  • Capillary low pressure, oozes

15
BLEEDING CONTROL
  • Direct Pressure
  • Brachial
  • Femoral
  • Elevation
  • Local pressure combined with elevation will
    address 95 of bleeding.
  • Can take 5-7 minutes to work.
  • Get help from the patient, walking wounded,
    pressure bandage.

16
BLEEDING CONTROL
  • Pressure Dressing
  • Pressure Points
  • May be combined.
  • Not a tourniquet.

17
TOURNIQUET
  • Rarely necessary except
  • Crushing injury
  • Partial amputation
  • Use when willing to sacrifice a limb to save a
    life
  • Leave it in plain sight - no bandage
  • Time/Day written on patients forehead

18
CERT REMINDER!
  • One CERT function is to collect and record
    information. Pencils, markers, and tape are
    important items for the disaster preparedness
    kit.
  • The marker can be used for non-traditional
    purposes, such as marking a forehead.

19
PRACTICE TIME
  • IC break class into teams
  • Medical Group Leader assign victims/rescuers
  • Practice making a pressure dressing
  • Practice slipping a square knot
  • Additional Skills
  • Vital Signs (BP, HR, RR)
  • EpiPens

20
SHOCK - THE SILENT KILLER
  • Ineffective circulation of blood (which carries
    oxygen)
  • Will lead to the death of cells, tissues and
    entire organs
  • Adults compensate differently from children
  • Early recognition is essential

21
Earliest Signs of Shock
  • Slightly increased rate of breathing - Breaths
    may be shallow
  • Slightly increased pulse - pale and cool skin -
    Capillary refill of gt2 seconds
  • Restlessness, anxiety, irritability,
    apprehension, inability to follow simple commands

Compensatory Stage
22
CERT GOALWatch for subtle signs of early shock
  • Slightly increased rate of breathing
  • Slightly increased pulse - pale and cool skin
  • Restlessness, anxiety, irritability, apprehension

Compensatory Stage
23
  • Increased, irregular, shallow breaths
  • Increased, irregular, weak pulse
  • Cool, moist, blue or pale skin
  • Dilated pupils
  • Listlessness, apathy

Progressive Stage (uncompensated)
24
  • This patient will die!
  • We must do what we can to prevent the condition
    from progressing to this point!

Irreversible Stage
25
SHOCK ASSESSMENT
  • R Rapid and shallow breathing -
  • (Respirations/airway)
  • P Capillary refill of greater than 2
  • seconds - (Pulse)
  • M Follow simple commands, such as Squeeze my
    hand -
  • (Mentation)

26
CERT TREATMENT
  • Face Pale - Raise Tail
  • Face Red - Raise Head
  • Elevate feet 6-10 inches - Watch the airway
  • Control bleeding
  • Maintain body temperature
  • Avoid rough or excess handling
  • Give nothing to eat or drink - Expect the patient
    in shock to be nauseous or thirsty

27
DISASTER MEDICAL OPERATIONSOrganization
28
TRIAGE
  • French for to sort
  • Evaluated and sorted by the immediacy of
    treatment needed
  • Used when
  • Rescuer(s) are overwhelmed.
  • There are limited resources.
  • Time is critical.

29
TRIAGE PRIORITIZATION
  • GREEN - Minor/Walking Wounded
  • Patient may require professional care.
  • Life not jeopardized by delay in treatment.
  • RED - Immediate
  • Life-threatening injuries demand immediate
    attention.
  • Treatment may save a life.
  • YELLOW - Delayed
  • Needs care as soon as people and materials are
    available.
  • Treatment is essential.
  • BLACK - Dead
  • Not breathing after two tries to open the airway.
  • Massive trauma or major medical condition which
    exceeds available resources.

30
BEFORE CHARGING IN . . .
  • 1ST - Stop, Look, Listen, Smell, Think
  • Dangers to CERT?
  • Where to set up staging/supply/treatment and
    morgue areas?
  • Voice Triage - Identify walking wounded
  • Whistle.
  • If you can walk, come to my voice.
  • Label as GREEN - Reassess later.
  • Get information from them
  • Stage them with a CERT member
  • Use as needed.

31
PERFORMING TRIAGE
Begin with the first patient located
  • R Respirations/Airway
  • Position.
  • Look, Listen, Feel.
  • Greater than 30 Immediate/Red.
  • Treat for shock and move on.
  • Not breathing after 2 attempts Dead/Black
  • EXCEPTION Give children 15 breaths and
  • reassess before placing them in the Black
    category

32
Step 1
33
PERFORMING TRIAGE
  • P Pulse/Bleeding
  • Capillary refill greater than 2 sec.
    Immediate/Red.
  • Control bleeding, treat for shock, and move on.

Triage quickly move to the next patient. Only
immediate life-saving treatment is given during
triage.
34
Step 2
35
PERFORMING TRIAGE
  • M Mental Status
  • Ask the victim to follow a simple command, such
    as squeezing your hand.
  • No response or inappropriate response
    Immediate/Red.
  • Treat for shock and move on.

36
Step 3
37
PRACTICE TIME
  • Turn to your neighbor and perform a shock
    assessment. Look for normal
  • R Respirations
  • P Pulse/Capillary Refill
  • M Mentation

38
TRIAGE - DETAILS
  • Everyone gets a tag
  • Keep a count of numbers in each color
  • Triage is sorting - transportation does not start
    until triage is completed
  • Time is critical in a disaster

39
AFTER TRIAGE - THEN TRANSPORT TO TREATMENT
  • Immediate - RED
  • Delayed- YELLOW
  • Most qualified rescuers.
  • Majority of medical equipment.
  • Minor - GREEN
  • Walking wounded may already be in the treatment
    area.
  • May be able to help with Red and Yellow patients.
  • Record keepers.
  • Dead - BLACK
  • A different location - morgue.
  • Consider sanitation/safety issues.

40
CERT REMINDER!
  • Triage Pitfalls
  • Inadequate medical size-up.
  • No team plan, organization or goal.
  • Indecisive leadership.
  • Too much focus on one injury.
  • Treatment rather than triage.

41
PRACTICE TIME
  • You are at the scene where a bus has been
    overturned as the result of an earthquake. No
    other emergency services will be able to reach
    your location for several hours, at least, and
    likely much longer.
  • Use the worksheet to identify the category you
    will triage each of the following patients into.
    You will have 15 seconds to read the information
    and make a decision.

42
Whats your call? 1
  • A young school aged boy is found lying on the
    roadway 10 ft from the vehicle.
  • Respiratory Rate 10/min.
  • Capillary Refill is 2 seconds.
  • Groans to painful stimuli.

43
Whats your call? 1
  • A young school aged boy is found lying on the
    roadway 10 ft from the vehicle.
  • Respiratory Rate 10/min.
  • Capillary Refill is 10 seconds.
  • Groans to painful stimuli.
  • R- Slow for a child
  • P- OK
  • M- Unable to follow command

44
Whats your call? 2
  • An adult kneels at the side of the road, shaking
    his head. He says hes too dizzy to walk.
  • Respiratory Rate is 20.
  • Capillary Refill is 2 sec.
  • Obeys commands.

45
Whats your call? 2
  • An adult kneels at the side of the road, shaking
    his head. Says hes too dizzy to walk.
  • Respiratory Rate is 20.
  • Capillary Refill is 2 sec.
  • Obeys commands.
  • R - OK
  • P - OK
  • M - OK - but couldnt walk

46
Whats your call? 3
  • A school aged girl crawls out of the wreckage.
    Shes able to stand and walk toward you crying.
  • Jacket and shirt torn.
  • No obvious bleeding.

47
Whats your call? 3
  • A school aged girl crawls out of the wreckage.
    Shes able to stand and walk toward you crying.
  • Jacket and shirt are torn.
  • No obvious bleeding.
  • R - Crying
  • P - No obvious bleeding
  • M - Able to obey command

48
Whats your call? 4
  • A toddler lies with his lower body trapped under
    the vehicle.
  • Not breathing with modified jaw thrust and after
    15 ventilations.

49
Whats your call? 4
  • A toddler lies with his lower body trapped under
    the vehicle.
  • Not breathing with modified jaw thrust and after
    15 ventilations.
  • R - no
  • P - no
  • M - no

50
Whats your call? 5
  • Adult female driver, trapped by her lower legs
    under caved-in dash.
  • Respiratory Rate 24.
  • Capillary refill 4 sec.
  • Moans with verbal stimulus.

51
Whats your call? 5
  • Adult female driver, trapped by her lower legs
    under caved-in dash.
  • Respiratory Rate 24.
  • Capillary refill 4 sec.
  • Moans with verbal stimulus.
  • R - fast
  • P - slow
  • M - no

52
Whats your call? 6
  • A toddler lies among the wreckage.
  • Respiratory Rate 50.
  • Capillary refill gt 2 seconds.
  • Withdraws when touched.

53
Whats your call? 6
  • A toddler lies among the wreckage.
  • Respiratory Rate 50.
  • Capillary Refill gt 2 seconds.
  • Withdraws when touched.
  • R - fast
  • P - delayed
  • M - inappropriate

54
Whats your call? 7
  • A woman is carrying a crying infant. She is able
    to walk.
  • Respiratory Rate 20.
  • Capillary Refill 2 sec.
  • Obeys commands.

55
Whats your call? 7
  • A woman is carrying a crying infant. She is able
    to walk. Obeys commands.
  • Respiratory Rate 20.
  • Capillary Refill 2 sec.
  • R - ok
  • P - ok
  • M - ok

56
Whats your call? 8
  • An infant is carried by mother.
  • Hes screaming but the woman quiets him. He
    focuses on mom.
  • Respiratory Rate of 34.
  • Capillary refill lt 2 seconds.
  • No obvious significant external injuries.

57
Whats your call? 8
  • An infant is carried by mother.
  • Hes screaming but the woman quiets him. He
    focuses on mom. Respiratory Rate of 34.
  • Capillary refill lt 2 seconds.
  • No obvious significant external injuries.
  • R - ok
  • P - ok
  • M - ok

58
Whats your call? 9
  • School aged boy props himself up.
  • Respiratory Rate 28.
  • Capillary refill in hands and feet lt 2 sec.
  • Answers question and commands.
  • Obvious deformity of both lower legs.

59
Whats your call? 9
  • School aged boy props himself up.
  • Respiratory Rate 28.
  • Capillary refill in hands and feet lt 2 sec.
  • Answers question and commands.
  • Obvious deformity of both lower legs.
  • R - ok
  • P - ok
  • M - ok

60
Whats your call? 10
  • A school aged girl lies among the wreckage.
  • Respiratory Rate 40.
  • Capillary Refill is 5 seconds.
  • Pushes rescuers away.

61
Whats your call? 10
  • A school aged girl lies among the wreckage.
    Pushes rescuers away.
  • Respiratory Rate 40.
  • Capillary Refill is 5 seconds.
  • R - fast
  • P - delayed
  • M - questionable

62
Whats your call? 11
  • A screaming infant is found among the bushes at
    the side of the road. Partial amputation of the
    foot without active bleeding. Reaches for you.
  • Respiratory Rate 38.
  • Capillary Refill lt 2 seconds.

63
Whats your call? 11
  • A screaming infant is found among the bushes at
    the side of the road. Partial amputation of the
    foot without active bleeding. Reaches for you.
  • Respiratory Rate 38.
  • Capillary Refill lt 2 seconds.
  • R - ok
  • P - ok
  • M - ok

64
Whats your call? 12
  • An adult male lies at the waters edge.
  • No Breathing.
  • Continues to not breath with jaw thrust.

65
Whats your call? 12
  • An adult male lies at the waters edge.
  • No Breathing.
  • Continues to not breath with jaw thrust.
  • R - no
  • P - no
  • M - no

66
Whats your call? 13
  • A youngster is up and walking around but is
    limping.
  • Alert, crying hysterically for his mother.
  • Capillary Refill is immediate.

67
Whats your call? 13
  • A youngster is up and walking around but is
    limping.
  • Alert, crying hysterically for his mother.
  • Capillary Refill is immediate.
  • R - Crying
  • P - ok
  • M - ok

68
Whats your call? 14
  • A school aged boy lies close to the road.
  • Respiratory Rate 36.
  • Capillary refill is 2 seconds.
  • Slowly looks at you when you talk to him.

69
Whats your call? 14
  • A school aged boy lies close to the road.
  • Respiratory Rate 36.
  • Capillary refill is 2 seconds.
  • Slowly looks at you when you talk to him.
  • R - fast
  • P - ok
  • M - delayed

70
Whats your call? 15
  • Teen girl lies next to vehicle, crying for
    someone to help her. A man with her says she
    needs her wheelchair. Minor cuts and bruises.
    Alert.
  • Respiratory Rate 22.
  • Capillary Refill is 1 second.

71
Whats your call? 15
  • Teen girl lies next to vehicle, crying for
    someone to help her. A man with her says she
    needs her wheelchair. Minor cuts and bruises.
    Alert.
  • Respiratory Rate 22.
  • Capillary Refill is 1 second.
  • R - ok
  • P - ok
  • M - ok

72
Whats your call? 16
  • An adult male lies on the ground.
  • Respiratory Rate 20.
  • Capillary refill is 2 seconds.
  • Obeys commands but cries that he cant move his
    legs.

73
Whats your call? 16
  • An adult male lies on the ground.
  • Respiratory Rate 20.
  • Capillary refill is 2 seconds.
  • Obeys commands but cries that he cant move his
    legs.
  • R - ok
  • P - ok
  • M - ok

OR
74
Whats your call? 17
  • An older school aged child is found lying against
    a tree. Groggy, confused but slowly follows
    commands.
  • Respiratory Rate 28.
  • Capillary refill is 2 seconds.

75
Whats your call? 17
  • An older school aged child is found lying against
    a tree. Groggy, confused but slowly follows
    commands.
  • Respiratory Rate 28.
  • Capillary refill is 2 seconds.
  • R - ok
  • P - ok
  • M - slow

76
It can be confusing - but its ok to change your
mind the second time through.
77
Next Class
  • Search Rescue

78
Next Class
  • Public Health Considerations
  • Disaster Medical Operations
  • Establishing Treatment Areas
  • More Indepth Patient Evaluations
  • Bandaging
  • Splinting
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