First National Course on Public Health Emergency Management

Mass Casualty Management

First National Course on Public Health Emergency Management

12 – 23 March 2011. Muscat, Oman

Learning Objectives

At the end of the session the participants will be able to:

• Explain the concept of Mass Casualty

• Define Mass Casualty Management System

• Describe Field Management

• Elaborate the management of victims

• Elucidate the concept of transfer organization

• Be familiarized with the concept of Surge Capacity



Overview of Mass Casualty

Mass Casualty Incident

• Produces several patients

• As few as six or as many as several hundred

• Affects local hospitals

• Patients are greater than resources of the initial responders



3


Preparation for Mass Casualty

• Pre-planning and training are critical

• Establish guidelines and procedures

• Early implementation of Incident Command

• First five minutes will determine next five hours



4


Response Categories for Mass

Casualties

• Mass Casualties can occur in a variety of ways

• Effect on emergency response and community impact

• Include transportation, violent crimes and building collapse



5


Response Categories of Mass Casualties

• Hazardous materials incidents

• Civil disturbances

• Natural disasters

• Major fires

• Terrorist attacks



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Problems in Mass Casualty Incidents

Most common being:

• Who is in command of the incident

• Location of the Command Post

• Lack of communication between agencies leading to conflicting priorities and orders



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Problems in Mass Casualty Incidents

• Perimeter establishment delayed or not done at all

• Large crowds of people

• Media involvement

• Political involvement

• Inadequate resources



8

Establishing Mass Casualty

Management System



9

Establishing a Mass Casualty Management System

Mass Casualty Incident

 Any event resulting in a number of victims large enough to disrupt the normal course of emergency and health care services



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Mass Casualty Management

• Management of victim of a mass casualty event

• Objective is to minimize loss of life and disabilities



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Mass Casualty Management System

The group of Units, Organizations, Sectors which work jointly during a mass casualty event

Based on:

- Pre-established procedures

- Maximization of use of existing resources

- Multi-sectoral preparation and response

- Strong pre-planned and tested coordination



12


Different Approaches to MCI

1.

“Scoop and Run”

2.

Classical Approach

3. Mass Casualty Management System



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Scoop and Run

• Most common

• Does not require specific technical ability from rescuers

• Justified for small numbers occurring near a hospital

• May just transfer problem to the hospital



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Classical Approach

• First responders are trained (basic triage and field care)

• Disregard the receiving hospitals from the field

• Quickly result to chaos



15


Mass Casualty Management Approach

• Most sophisticated approach includes preestablished procedures for: a. resource mobilization b. field management c. hospital reception



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Mass Casualty Management Approach

• Training of various level of responders

• Incorporates links between field and health care facilities

• Command Post

• Multi-sectoral Response

• Dependent on the availability of large amounts of human & material resources



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Problems in Developing MCM

• Limited human resources

• limited material resources

– facility

– transport

– communication

• Poor communication

– topography

• Political

– isolation




Activities at various levels of responses:

‘E’/Disaster

Site/Scene alerting process initial assessment command / control / coordinate manage information search/rescue field care-mostly health activities transport/traffic control facility reception at ER / A&ED hospital mass casualty mgt. & command system




Field Management

Definition:

Encompass procedures used to organize the disaster area in order to facilitate the management of victims

Components

Search and Rescue

Alerting Process

Field Care

Pre-identification of

Field Areas

Evacuation

Safety/ Security

(EMC) Emergency

Management Center

Command Post




Impact Zone

RESCUE CHAIN---SECTORAL

Command Post

*SEARCH*

*RESCUE*

*First Aid*

Triage

Stabilization

Evacuation

CP / AMP

Traffic Control

Regulation of Evacuation

ER or

A&ED

Pre-Hospital Organization Hospital Organization



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Field Organization

Alerting Process

Definition: Sequence of activities implemented to achieve the efficient mobilization of adequate resources

Aim:

- Confirm the initial warning

- Evaluate the extent of the problems

- Ensure that appropriate resources are informed and mobilized



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Field Organization

Alerting Process

Dispatch Center:

• Core of the Alerting Process

(Operation/Communication Center)

• Functions:

– receives all warning messages (radio/phone)

– mobilize a small assessment team (Flying Team) from police, fire or ambulance services



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Initial Assessment

• Precise location of the event

• Time & type of the event

• Estimated number of casualties

• Added potential risk

• Exposed population

• Resources needed



24


Pre-Identification of Field Areas

• Impact Zone

• Command Post

• Collecting Area in unstable location

• Advance Medical Post Area (3-T Principle)

• Evacuation Area

• VIP & Press Area (Information Officer)

• Access Roads (geographical presentations if available)

• Check point for resources (Staging Area)



25


Safety

• Best practice technique to protect victims, responders

& exposed population: immediate/potential risk

• Measures:

Direct action:

- risk reduction - fire fighting

- contain hazardous material

- evacuation of exposed population

Preventive actions: establish field areas

primary- impact zone

- secondary- rescue/ICP/AMP

- tertiary-“buffer zone”; tri-media



26


Safety

• Personnel: fire services; specialized units hazardous materials & explosives (bio-nuclear and radioactive materials) experts, etc., airport manager, chemical plant expert



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Security Measures

• Non-interference of external elements:

- crowd/traffic control

• Contribute to safety:

– protect workers from external influence; additional stress

– free flow: victims/resources

– protect general public from risk exposure

• ensured by police officers / special units (security: airport/building/hospital/establishments, etc..)



28


Command Post ( CP / or ICP)

Multi-sectoral control unit to:

• Coordinate sectors involved in field/scene management

• Linked w/ back-up system: provide information & mobilization resources

• Supervise victim management

REQUISITE: radio communication network: main criterion to be effective

Purpose: coordination / communication hub of people who don’t work routinely (pre-hospital setting)

Location: external boundary of restricted area (impact zone) close to AMP/ Evacuation Area/ accessible/easily identified

* should accommodate: com./visuals/maps/boards



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Personnel

• High ranking officer (government police, fire, health, defense)

- plant manager/ airport manager/ chief security, etc…

- fire officer / police officer skilled in ICS / MCM

• Identified by name/position, coordinator / commander

• May depend on what type of incident

• Must be familiar with each other’s roles during previous meetings/ drills/ simulation exercises (policy)

• This core group cooperate with volunteer organizations



30


METHOD

• The communication / coordination hub of the prehospital organization. By constant re-assessment,

CP will identify needs to increase / decrease resources: o organize timely rotation of rescue workers exposed to stressful/exhausting conditions in close coordination w/ back-up system o ensure adequate supply of equipment / manpower o ensure welfare / comfort of rescue workers o provide info to back-up system, other officials, and tri-media thru an Information Officer o release as soon as situation allows “E” staff and reestablish normal operations o determine termination of field operations



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MANAGEMENT OF VICTIMS

• Search & Rescue

locate victims

- remove victims from unsafe locations – collecting area

- assess victim’s status (on-site triage)

- provide first aid , if necessary (no CPR on-site in MC Event)

- transfer victims to AMP thru entry triage (medical triage)

- under supervision of the CP/ IC/ or Commander/Coordinator

- may in special situation, require medical personnel (trained)

- to stabilize/resuscitate/amputate (trapped) victim before extrication.



32


Management of Victims

• Field Care

- Pre-established capabilities / inventory: pre-planning

- Integrated community plan: practiced w/ policy support

The “Golden Hour” Principle



33


Recent progress in pre-hospital emergency / disaster medicine

Establish AMP with specially skilled /trained ----

“disaster field medical teams”

- good triage / stabilization capacity

- specifically trained / up-skilled medical teams

- good (radio) communications between the field scene & medical facility

“ Don’t transfer chaos in the scene, to the hospital……”



34


TRIAGE

Basis: urgency (victim’s status) survival (chance or likelihood) care resource availability and capability

Objectives:

Quick identification for immediate stabilization for life-saving (measures) and surgery

Levels:

On-site–----- ‘

Medical -----

Evacuation --where they lie’ at Advance Medical Post transport



35


On-site T:

Medical T:

Acute

Non-acute

Red

Yellow

Green

Black

Evacuation T - transport:

Red : transferred as soon as possible to tertiary facilities in an equipped ambulance with medical escort

Yellow : after evacuation of Red, without life-threatening problem

Red

Yellow

Green : ‘walking wounded’-to

AS/OPD

Black : to morgue Forensic Services

Public Health & Psycho-Social interventions to relatives/kin

Green

Black



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First Aid

Personnel:

– volunteers, fire, police staff, special units, EMT’s, and medical personnel

Location:

– on-site, before moving victim

– at collecting point/ area in an unstable environment.

– “Green Area” of “AMP”

– ambulance in transit to facility

Action:

– primarily to transfer with consideration of the

ABC’s order of priority



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Advance Medical Post (AMP)

Purpose:

• reduce loss of life & limb - save as many as possible in the context of existing & available resources/ situation

• victim’s status; chance of survival; resources

Location:

• 50-100 meters from Impact Zone (walking distance )

• direct access to: Evacuation Road. / Command Post

• Clear Radio-Com Zone… and SAFE (Upwind)

• tent / bldg / open / mobile field hospital..??



38


Advance Medical Post (AMP)

Role:

• Provide “entry” medical triage

• Effective stabilization for victims of a MCI/Situation

– intubation, tracheostomy, chest drainage,

– shock mgt , analgesia , fracture immobilization

– fasciotomy, control external bleed & dressing

• Convert red to yellow category as maybe possible

• Organize patient transfer to designated care facility/ties

• AMP 3-T principle: Tag – Treat – Transfer….

Personnel:

•

• ER (A&ED), physicians/ nurses etc.

(trained & skilled) support : Anesthetists / Surgeons / EMT’s / Nurses / Aiders,



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AMP

NON-ACUTE

TRIAGE

Black Green

NON ACUTE

C evacuation

P

ACUTE

Red Yellow

ACUTE

C P– Collecting Point



40


COLLECTION AREA

(in unstable condition)

COMMAND POST

TRIAGE AREA

(color tagging of victims)

TREATMENT AREA

(management and stabilization)

1st

3rd

2nd

PRIORITY III PRIORITY II

T R A N S P O R T A R E A

PRIORITY I



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Field Management Plan: Diagram

Working

Area

Triage

AMP

Evacuation f a r

T i f c l r o t n

C o

Impact Zone

Command Post

Strictly Restricted

Restricted

Traffic

Access Route



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Transfer Organization

• Procedures used to ensure that victims of a MC situation is safely, quickly, and efficiently transferred by appropriate vehicles to the appropriate and prepared facility

• Preparation for Evacuation:

1. Single Reception Facility

2. Multiple Reception Facilities

* type of vehicle required

* type of escort required

* destination



43



• Preparation for Transport

Evacuation Officer reporting to ATM:

• assess patient’s status: vital signs, ventilation / hemostasis

• check security of equipment / & accessories

• ensuring efficiency of immobilization measures

• ensure triage tags: secure/& clearly visible

• Evacuation Procedures: Regulation

Principles

not to overwhelm care facility

- avoid spontaneous evacuation of unstable patients.



44



• Evacuation Procedures: Regulation

Rules:

- victim is in most possible stable condition

- victim is adequately equipped for transfer

- receiving facility correctly informed and ready

- the best possible vehicle and escort– available

Victim Flow

- “Noria” Principle, Spanish word from Arabic--… ”wheel”

WW I Battle of Chemin de Dames, Verdun, France first aid to the most



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Victim Flow : “ Conveyor Belt ” Management Diagram

Triage Treatment

Triage

3-T

Tag

Treat

Evacuation and

Transfer

Impact

Zone

Collecting

Point

AMP TRANSFER

Victims Flow

HOSPITAL

Transport Resource Flow



46


Victim Flow

- Ambulance Traffic Control

Radio Links:

*Transport Officer at AMP

*Hospital Admission / ER Department

*Command Post

*Ambulance Headquarters

Responsibility of Ambulance Driver

*takes order from the Transport Officer



47


Victim Flow

Road Control:

Police Officers ----- crowd and traffic control

• Evacuation of Non-Acute Victims

- use available mass transport

- as much as possible, to primary care centre



48


Field Organization Checklist

 Situation Assessment

 Report to Central Level

 Work Areas Pre-identification

 Safety

 Primary Area: Impact Zone

 Secondary Area Units: CP/AMP/EVAC/TRANSFER

 Radio Communications

 Crowd & Traffic Control

 Search and Rescue

 Triage & Stabilization

 Controlled Evacuation



49

Fallacy

“IT CAN’T HAPPEN

TO US”



50

Thank you



Incident Command

System



Performance Objectives

• Discuss the advantages of using the Incident

Command System

• Discuss the two types of command

• Discuss the Incident Command Process

• Discuss Incident Priorities



53


• Discuss the components of the Incident Command

System

• Discuss the Incident Command System organization

• Discuss the use of the Incident Command checklist



54

Incident Command System

• Developed in the 1970’s during the California wildfires

• Business management practices of planning, directing, organizing, coordinating, delegating, communicating and evaluating



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• Framework necessary to manage resources, personnel and equipment

• Designed to be flexible and can be used in large or small incidents

• Creates a safe environment for all involved



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Benefits of Incident Command

• Common terminology

• Position titles and Chain of Command for decision making

• Responder accountability



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Basic Command Types

• Single Command

• Unified Command



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Single Command

• Based on first arriving emergency units

• Initial Incident Commander begins assessment of incident

• Rescue, Triage, Treatment, Transport



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Basic Command Structure

Single Command

RESCUE/

EXTRICATION

INCIDENT

COMMANDER

TRIAGE TREATMENT TRANSPORT



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Unified Command

• Incidents that involve jurisdictions or agencies involved in the decision making and planning process

• Ensures plan is communicated and supported by all resources assembled



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INCIDENT COMMAND SYSTEM

SAFETY OFFICER

INCIDENT

COMMAND

LIAISON OFFICER

PUBLIC INFORMATION

OFFICER

OPERATIONS OFFICER

FIELD MEDICAL COMMANDER

PLANNING OFFICER LOGISTICS OFFICER

STAGING OFFICER MEDICAL GROUP

SUPERVISOR

TRANSPORT GROUP

SUPERVISOR

RESOURCES SERVICE SUPPORT

SITUATION

TREATMENT TEAM

LEADER

TRIAGE TEAM

LEADER

GROUND AMBULANCE COMMUNICATIONS SUPPLY

DOCUMENTATION

AIR AMBULANCE MEDICAL FACILITIES

TREATMENT MEMBERS

IMMEDIATE

TREATMENT MEMBERS

DELAYED

TREATMENT MEMBERS

MINOR

TRIAGE MEMBERS

MORGUE MANAGER

DEMOBILIZATION

FOOD GROUND SUPPORT



ADMINISTRATIVE OFFICER

TIME

PROCUREMENT

COMPENSATION

COST

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Overview of Incident Command Process

Process is based on:

• Size up

• Setting Incident Priorities

• Predicting incident course and harm

• Strategic goals and tactical objectives



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Size Up

• Rapid mental evaluation of factors influencing an incident

• Must continue throughout incident with ongoing evaluation

• Incident situation, incident cause and incident status



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Incident Situation

May be one or combination of:

• Biological

• Nuclear

• Fire

• Chemical

• Explosion or natural event

• Natural disaster with MCI



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Incident Cause

• Incident Cause is important because additional or specialized resources may be needed

• The Incident Commander must determine if the incident was accidental or intentional



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Incident Status

Is the incident:

• In a somewhat controlled state or

• Does it remain uncontrolled



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Setting Incident Priorities

• After size up of the incident a course of action is determined

• High priority is life safety for the public and responders

• Incident stabilization

• Protection of critical systems



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Estimating Potential Incident Course and Harm

• Responder is making a prediction on what will likely occur during the incident

• Based on available information

• Responder’s experience



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Strategic Goals

• Broad general statements of desired outcome of the incident

• Example: mass casualty overturned school bus

- extrication, triage, treatment, transport



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Organization

• Comprised of two major categories which assist in organizing functions into an effective design:

- Command Staff

- General Staff



Command Staff

Consists of the :

• Incident Commander

• Safety Officer

• Liaison Officer

• Public Information Officer



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Incident Commander

INCIDENT

COMMANDER



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• First person on the scene with communications capability

• Remains in command until transferred or incident is terminated

• Complete authority and responsibility



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• Must assume and announce command, rapidly evaluate incident, identify resources on hand, request additional resources and establish incident action plan

• Fill command staff and functional areas

• Must approve all information releases to the media



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Transfer of Command

• Based on the initial responders experience and comfort level

• Higher ranking officer does not need to assume command

• Transfer procedures should be predetermined

• Detailed briefing is required

• Face to Face is best method

• Include: current status, strategies and tactics employed, progress, safety, accountability and resources assigned or needed



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General Staff

Consists of:

• Operations (includes staging)

• Planning

• Logistics

• Administrative/Finance



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Operations Section

INCIDENT

COMMANDER

OPERATIONS



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Operations Section

• Operations officer functions under direction of the

Incident Commander

• Deploys tactics to control and resolve the incident

• Responsible for execution of the incident action plan

• Makes recommendations for changes to plan based on incident status

• Oversees and is in direct contact with the staging manager

• Task supervisors report to Operations not Incident

Command



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Planning Section

INCIDENT

COMMANDER

OPERATIONS PLANNING



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Planning Section

• Responsible for collection, evaluation, distribution and use of information about the incident

• Forecast and develop plans to contain and resolve incident

• Communicates with logistics section



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Logistics Section

OPERATIONS

INCIDENT

COMMAND

PLANNING LOGISTICS



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Logistics Section

• Responsible for providing facilities, services and materials in support of incident

• Includes equipment, personnel and associated materials and tools

• Support branch and Services branch



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Administrative / Finance Section

OPERATIONS

INCIDENT

COMMANDER

PLANNING LOGISTICS ADMINISTRATIVE

FINANCE



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Administrative/Finance Section

• Generally not located at incident site

• Responsible for financial, administrative and cost analysis

• Divided into four units: time, procurement, compensation/claims and cost



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Summary

• Incident Command created to deal with any incident in an organized manner

• Manages resources, personnel and equipment to mitigate the incident

• Builds from first responder

• Expandable to manage hundreds

• Implementation is critical for safe and effective operation

• Allows for multi-agency operations and response based on incident type



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86

Thank you



CRITICAL INCIDENT

MANAGEMENT


12 – 23 March 2011. Muscat, Oman 88 88


• Discuss critical incident stages

• Discuss decision making in a critical incident



Critical Incident Management

Characteristics

• Demands a coordinated response to prevent incident from getting worse

• This includes unresolved element of danger such as additional bomb, a threat to citizens and responders or an unusual incident

• Often random in nature and disrupt normal life

• Terrorist organizations use opportunity as a tool for civil disturbance

• A mass casualty is a critical incident



Mass Casualty Incident Overview

• Produces several patients

• As few as six or as many as several hundred

• Affects local hospitals

• Patients are greater than resources of the initial responders



Preparation For Mass Casualty

• Pre-planning and training are critical

• Establish guidelines and procedures

• Early implementation of Incident Command

• First five minutes will determine next five hours



Functional Systems Approach

• Three levels of function: strategic, tactical and task

(operation)

• Management is strategic

• Team leaders are tactical

• Resources not involved in supervision are task



Critical Incident Stages

They consist of:

• Initial Response

• Incident Control using the Six Step Response

• Recovery Stage



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Initial Response Stage

• Ability to establish command and control

• Faced with confusion and panic

• Crucial to develop a team and place a plan in action

• Protecting citizens and rescue of victims

• Limit incident growth

• Protect arriving responders

• Identify ingress and egress routes



Initial Response Objectives

As soon as possible:

• Gain control of the scene

• Restore order

• Prevent target opportunities



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Incident Control Using The Six-Step

Response

The Six-Step response is based on the Incident Command

System. It includes:

1. Assume Command,

2. Situation Assessment,

3. Identify and Set Perimeters,

4. establish Command Post,

5. assign Safety Officer and

6. establish Staging Area and assign a Staging Officer



# 1 – Assume Command

• Must advise incoming responders of incident location

• Secure tactical frequency

• Request supervisory support



# 2 – Situation Assessment

• Size up of the incident that includes the type of threat, approximate number of injured, size of threatened area and possibility of secondary event.



# 2 – Situation Assessment

In simple terms the assessment describes:

• What do you have

• What are you doing

• What do you need



# 3 - Identify and Set Perimeters

• Divide the incident into manageable divisions

(geographical areas)

• Allows command to provide resources where they are needed

• Critical incidents have three standard perimeters. All perimeters are divisions

• Expand perimeters based on weather

• Perimeters are the hot zone, inner perimeter and outer perimeter



The Hot Zone

• Area in which the incident has occurred

• May be a street corner or spread over a large area

• Secured by placing responders in positions of controlling ingress and egress



Inner Perimeter

• Protects responders in hot zone

• Uniformed personnel only

• Used as decontamination area, treatment area and evacuation area for walking wounded

Outer Perimeter

• Provides last line of defense from internal incident acceleration

• Provides first line of defense from external acceleration

• Secure area for command post, resources and control of the media



Perimeter Placement Illustration



# 4 – Establish Command Post

• Typically begins at first responders vehicle

• Incident dynamics will require Incident Commander to shift to a fixed command post

• Must be away from hot zone

• The command post will ensure support for field personnel, create a controlled environment and improve communications



# 5 - Establish Safety Officer

• Should be filled as soon as possible

• Officer selected on operational experience and ability to recognize acceptable and unacceptable risk

• Operations can be stopped or modified

# 6 - Establish Staging Area

• Effective tool in correct and safe deployment of resources

• Staging Supervisor must track, rotate and relieve resources as appropriate

• Area established within inner or outer perimeter. Avoid congestion



Inter Agency Planning

• Failure to include all agencies during planning process may compromise responders

• Identify and establish liaisons with all agencies and coordinate tactical operations

Secondary Incidents

• May be more destructive and damaging than initial incident

• World Trade Center crashes were primary incident with collapse of the towers as secondary incidents claiming more lives



Recovery Stage

• Begun when aggressive threats of incident are neutralized

• Incident is not over when last patient is transported

• Recovery must be managed aggressively

• Planning Section of incident command is responsible for initial recovery

• Typically the longest and most poorly managed part of the incident

• May require months to years


12 – 23 March 2011. Muscat, Oman 108

108

Goals in the Recovery Stage

• Most important goal is document collection

• Information can assist in Post Incident Analysis, cost recovery and tracking responder injuries or deaths

• Provide critical incident stress management for responders

• Collect and properly dispose of used medical supplies and biohazard waste from the incident



Post Incident Analysis

Critical for operational review. Benefits include:

• Operational performance

• Organizational needs

• Procedure modification

• Additional training



Summary

• Critical Incident Management can place a heavy burden on responders

• Requires a coordinated response from all agencies involved

• Mass casualty incident is a critical incident, terrorist related or not

• Identifying critical stages will give the responder a better chance of dealing with the incident

• Six – Step response is a tool for incident management

• Humanitarian Assistance



9-11-01

9-11-01



TRIAGE



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113

Description

• This lesson provides participants with methods of prioritizing care delivery in mass casualty situations.

• The decision- making process is explored with the goal being the maximum positive effect for the greatest number of patients.



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2

QUESTION 1

What is the meaning of Triage ?

What is the basis of triage ?



115

QUESTION 2

In the MCMS, how many times do you triage and where ?



116

Objectives

• Describe the basic concepts of sorting and allocating

•

Describe the basic concepts of sorting and allocating treatment to patients in a triage

•

• situation determining priority of care

Demonstrate the decision-making process in determining priority of care



117

3

3

What is Triage ?

• French word meaning to “Sort”

• Utilized to identify treatment priorities

• Process by which a decision is made on which victim receives treatment and which does not

• Four basic priorities of patient treatment and transport



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Priorities

Highest Priority

• Patients that require immediate care and transportation

• Patients receive treatment at the scene for life threatening injuries

• First to be sent to available medical facilities

Intermediate Priority

• Patient treatment and transport can be delayed



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Priorities

Delayed or Low Priority

• Referred to as “walking wounded”

• Injuries require medical care at some point

• Treatment and transport can be delayed

• Monitor patients and reassess

Lowest Priority

• Patients have either died or are near death

• If still alive they have suffered severe or serious injuries with little chance of survival

• When resources are limited, patients must be ignored



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Initial Triage Officer

• Must size up situation

• Ensure safe approach and scene survey

• Activate additional resources o Number of victims o Size of the incident o Better off requesting more equipment and personnel than not enough



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Simple Triage and Rapid Transport System

This system focuses on three areas :

1. Respirations

2. Pulse Rate and Quality

3. Mental Status

System requires first responders to have tags, ribbons or tape in four colors

Priority One (Highest Priority )

Red – Immediate care : Life threatening injuries



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Priority Two (Intermediate Priority)

 Yellow – Urgent care: delay treatment and transport up to one hour

Priority Three (Delayed or Low Priority)

 Green – Walking wounded: delay treatment and transport up to three hours



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Priority Four (Lowest Priority)

• Black – No care required: patient is dead or near death

• Hardest priority to deal with emotionally

• Necessary for others to survive



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• First Step is to make an announcement for all people able to get up and walk to specific area

• Allows responder to focus on injured

• People who successfully move should be tagged

“Green”

• Tell people to look out for each other and notify responders of any significant changes



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• Second step is to conduct an orderly survey of remaining victims

• Decide how to move through area

• Perform quick assessment on each person and label or tag

• No more than 10 seconds per patient



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• Correct life threatening : airway or breathing problem and profuse bleeding

• The objective is to: locate, identify and tag priority one patients who require immediate care and transportation



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Patient Assessment

Respiration

Assess breathing rate

• Greater than 30 per minute, patient is priority one and tagged red

• Less than 30 per minute, move on to assessing pulse and mental status



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Not Breathing

•

•

•

Quickly make sure mouth is clear

Open airway with head tilt method

During mass casualty incident, cervical spine immobilization may not be able to be done

• Open patients airway and position so it remains open

• If patient does not start to breath with simple airway maneuvers, tag priority four - black



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Pulse Rate and Quality

•

•

•

Check radial pulse

No more than 5 second check

Pulse is weak or irregular - Red Tag Priority One

•

•

If pulse is strong, move on to assess mental status

If there is NO pulse, Black tag priority four



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Mental Status

•

•

Breathing and pulse should have already been checked

Have patient respond to simple commands such as

“open your eyes” or “squeeze my hand”

•

If patient can perform this function, is breathing and has a pulse, yellow tag priority two

•

If patient is unresponsive and cannot follow simple commands, red tag priority one



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all walking wounded

MINOR

START TRIAGE

RESPIRATION

YES over under

30/min 30/min

NO

Position Airway

YES NO

IMMEDIATE DECEASED

IMMEDIATE

PERFUSION

Radial Pulse Present

Radial Pulse Absent

Capillary Refill

Control

Bleeding

Over Under

2 2

Secs Secs

MENTAL STATUS

IMMEDIATE

Can ’t Follow Can Follow

Simple Commands Simple Commands

Respirations 30/min

Perfusion 2 secs

Mental Status can do

IMMEDIATE DELAYED



132



Thank You



134

First National Course on Public Health Emergency Management

Mass Casualty Management

Learning Objectives

Establishing Mass Casualty

Management System

Fallacy

“IT CAN’T HAPPEN

TO US”

Thank you

Incident Command

System

Performance Objectives

Performance Objectives

Incident Command System

Thank you

CRITICAL INCIDENT

MANAGEMENT

Summary

TRIAGE

Objectives

Thank You

Related documents

Products

Support

First National Course on Public Health Emergency Management

Mass Casualty Management

Learning Objectives

Establishing Mass Casualty

Management System

Fallacy

“IT CAN’T HAPPEN

TO US”

Thank you

Incident Command

System

Performance Objectives

Performance Objectives

Incident Command System

Thank you

CRITICAL INCIDENT

MANAGEMENT

Summary

TRIAGE

Objectives

Thank You

Related documents

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