Contra Costa County CERT Program
Unit 3 – Emergency Medical Operations
Part 1
Released: 6 September 2011
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 3.1
Unit Objectives
 Identify the “killers”
 Apply techniques for opening airways,
controlling bleeding, and treating for shock
 Conduct triage under simulated emergency
conditions
Visual 3.2
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!
Visual 3.3
Life-Threatening Conditions
The “Killers”:
 Airway obstruction
 Excessive bleeding
 Shock
Life-threatening
conditions must receive
immediate treatment!
Visual 3.4
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 3.5
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 3.6
Opening The Airway
Visual 3.7
Opening The Airway
Head Tilt/Chin Lift
Visual 3.8
Bleeding
 Arterial…spurting
 Venous…flowing
 Capillary…oozing
Losing one liter can be life threatening
Visual 3.9
Bleeding Control
 Direct pressure
 Elevation
 Pressure points
No tourniquets!
Visual 3.10
Shock
 Result of ineffective circulation of blood
 Remaining in shock will lead to death of:
 Cells
 Tissues
 Entire organs
Visual 3.11
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 3.12
Shock - Treatment
 Control major bleeding
 Place in Recovery Position
 Maintain body temperature
 Loosen restrictive clothing
Visual 3.13
Recovery Position
Multi-Casualty Incident Definition
A Multi-Casualty Incident (MCI) is any situation that
overwhelms the normal emergency response capability
An MCI is also known as a Mass Casualty Incident
or a Mass Casualty Event
Visual 3.14
Typical Multi-Casualty Incidents






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
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Earthquakes
Urban Wild Lands Fires
Motor Vehicle Accidents
Floods
Tornados
Hurricanes
Explosions
Train derailments
Hazmat
Visual 3.15
CERT Size-up
1.
2.
3.
4.
5.
6.
7.
8.
9.
Gather Facts
Assess Damage
Consider Probabilities
Assess Your Situation
Establish Priorities
Make Decisions
Develop Plan of Action
Take Action
Evaluate Progress
Visual 3.16
Triage
TRIAGE – French term meaning “to sort ”
 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 is a Perishable Skill and must
be practiced regularly
Visual 3.17
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 3.18
The START Triage System
Simple
Triage
And
Rapid
Treatment
Visual 3.19
START Video
Visual 3.20
Triage Pitfalls
 No team plan, organization, or goal
 Indecisive leadership
 Too much focus on one injury
 Treatment (rather than triage) performed
Visual 3.21
Patient Assessment…RPM
Three things to check…
 Respirations
 Perfusion
 Mental Status
Anyone who is unconscious is an
“Immediate” by definition!
Visual 3.22
RPM…Respirations
Range…Adults under 30 breaths a minute
Children to 12 years: 15-45 breaths/min
 No breathing
Position airway, if still not breathing try it again
If still no breathing tag as DECEASED 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
Visual 3.23
RPM…Perfusion…Blanch Test
Goal…perfusion in under 2 seconds
 More than 2 seconds
Tag as IMMEDIATE and move on to next
person
 Less than 2 seconds
Go to next step… Mental Status
Visual 3.24
RPM…Mental Status
Goal…follow simple command
 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
Visual 3.25
S.T.A.R.T. Categories


MINOR
IMMEDIATE
DELAYED
 DECEASED

Visual 3.26
“ MINOR ”

Walking wounded

Do not require immediate care

“Screamers”
Use as helpers to care for
others

Visual 3.27
“ IMMEDIATE ”

Life Threatening Injury

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 3.28
“ DELAYED ”
Serious Non Life Threatening
Injury
 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.

Visual 3.29
“ DECEASED
New term: MORGUE
 Considered Non-Salvageable
 Obviously dead
 Pulseless
 Non-breathers who fail to breathe after
airway has been cleared
 Mortal injuries

Visual 3.30
”
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 3.31
Triage Exercises
 Head Tilt / Chin Lift
 Bleeding Control
 Triage Exercise RPM
Visual 3.32
Unit Summary
 The Killers
 Approaching a Victim
 Open Airway
 Control Bleeding
 Treat Shock
 Size-up and Triage
 RPM
Visual 3.33