Uni t 3: Di sa ste r M e di ca l O pe rat i o ns
Unit 3: Disaster Medical Operations
•
•
•
•
•
•
Injuries Commonly Seen
Treatment of Injuries
Rescue Lifts and Carries
Medical Treatment Areas
Triage
Size-Up
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
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.
Disaster Medical Operations
Injuries Commonly Seen
The “3 Killers”
1. Airway obstruction
2. Excessive bleeding
3. 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
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
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.
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
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
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.
Disaster Medical Operations
Treatment of Injuries
Controlling Bleeding
Brachial Pressure Point
Femoral Pressure Point
EXERCISE
Disaster Medical Operations
Treatment of Injuries
Nose Bleeding
 Control bleeding by:
• Leaning slightly forward
• Pinching at the nasal septum
• Placing ice pack behind neck
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?”
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
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?”
1. Head
2. Face
3. Neck
4. Shoulders
5. Arms and hands
6. Chest
7. Abdomen
8. Pelvis
9. Legs and feet
10.Back
* Reverse for children
DEMO
Disaster Medical Operations
Treatment of Injuries
Splinting
Objective: Immobilize injury site
and both adjacent joints.
Check the distal pulse BEFORE
and AFTER splinting!
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
Disaster Medical Operations
Treatment of Injuries
Burns
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.
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.
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.
Disaster Medical Operations
Rescue Lifts and Carries
We’ve found them…now we need to move them to
our treatment area…
Disaster Medical Operations
Rescue Lifts and Carries
One person
pack strap
One person arm
carry
Two person chair
carry
EXERCISE
Disaster Medical Operations
Rescue Lifts and Carries
Two person carry
Two person seat
carry
EXERCISE
Disaster Medical Operations
Rescue Lifts and Carries
Long axis drag
Long axis blanket drag
Disaster Medical Operations
Rescue Lifts and Carries
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.
Disaster Medical Operations
Medical Treatment Areas
Disaster Medical Operations
Medical Treatment Areas
Treatment Areas
Immediate
Command Post
Delayed
Incident Site
Triage
Communications
Morgue
Transportation
Treatment Area Layout
“I” and “D” should be close together for worker
communication, sharing supplies, and transferring
patients.
Disaster Medical Operations
Medical Treatment Areas
A Leader Should be Assigned to Treatment Areas
•Orderly patient placement.
•Head-to-toe assessments.
•Patient treatments.
•Patient documentation and
treatment area records.
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.
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.
Disaster Medical Operations
Triage
 Use Simple Triage And Rapid Treatment
to quickly evaluate and prioritize victims for
treatment.
1. Most effective use of limited resources.
2. Who to treat.
3. “Sorting it out”: Walking Wounded,
Immediate, Delayed, Deceased.
 RPM
• Respiration (breathing)
• Perfusion (blood circulation)
• Mental Status (alertness, consciousness)
Disaster Medical Operations
Triage
Think 30 - 2 - CAN DO
Disaster Medical Operations
Triage
Conducting Triage
1.
2.
3.
4.
5.
6.
7.
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.
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…
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.
Disaster Medical Operations
Triage
Triage Tag
Samples
Disaster Medical Operations
Triage Video
Disaster Medical Operations
Exercise
Exercise: Time for Triage
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.
Disaster Medical Operations
Size-Up
Size-Up
1. Gather facts.
2. Assess the scene.
3. Identify your resources.
4. Establish your medical priorities.
5. Develop a medical plan.
6. Conduct medical treatment.
7. Evaluate your progress.
Disaster Medical Operations
Size-Up
Biohazard in Disaster Medicine
1. Contain all soiled items.
2. Avoid contact with infectious materials
• Blood
• Body fluids
3. Set up area to contain biohazard waist
• Used bandages
• Gloves
• Face mask
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.
Disaster Medical Operations
Triage
Exercise: Time for Triage