Disaster Medical

Operations

“Introduction”

Objectives

1. Identify the 3 Killers.

2. Describe how to and perform:

a. Treatment procedures for the 3 Killers;

b. Splinting procedures;

c. Head-to-Toe Assessment procedures’

d. Triage

In a Disaster there are

3 Phases of Trauma Death:

Phase 1: Death in Minutes

Phase 2: Death in Hours

Phase 3: Death in Days to Weeks

Phases of Trauma Deaths

Peter Safer’s Research:

40 percent of disaster victims in the

second and third phases of death from

trauma could be saved by providing

simple medical care.

Phases of Trauma Deaths

Do the GREATEST GOOD for the GREATEST NUMBER of people!

Medical Operations Philosophy

The 3 “Killers”:

Airway obstruction

Excessive Bleeding

Control Shock

Life-threatening conditions mustreceive immediate treatment!

The 3 Killers

Disaster Medical

Operations

“Opening the Airway”

Respiratory System

Nasopharynx Oropharynx Tongue

Epiglottis

Trachea

Esophagus

Upper Airway

Critical Nature

Airway Obstruction

Head-Tilt / Chin-Lift

Head-Tilt / Chin-Lift

Step Action

1At an arm’s distance, shake the victim by touching the shoulder and shout, “Can you hear me?”

2If the victim does not or cannot respond, place the palm of one hand on the forehead.

3Place two fingers of the other hand under the chin and tilt the jaw upward while tilting the head back slightly.

4Place your ear over the victim’s mouth, looking toward the victim’s feet, and place a hand on the victim’s abdomen.

5 Look for chest rise.

6 Listen for air exchange.

7 Feel for abdominal movement.

Action Steps

1. Check for Responsiveness

Action Steps

2. Head-Tilt / Chin-Lift

Action Steps

3. Look, Listen, Feel

Action Steps

Purpose: This exercise allows you to practice using the Head-Tilt / Chin-Lift method on each other.

Instructions:1. Work in pairs with your buddy – one person will be the

victim and the other person the rescuer.2. Victims should lie on the floor on their backs and close

their eyes.3. The rescuer should use the Head-Tilt / Chin-Lift method

on the victim to open the airway.

After the rescuer has made two or three attempts at using the Head-Tilt / Chin-Lift method, the victim and the rescuer should change roles.

“Opening the Airway” Exercise

“Opening the Airway”

Questions

Disaster Medical

Operations

“Bleeding Control”

The average adult has between 5-6 liters of blood in their body.

Losing one liter can result in death.

Anatomy / Physiology

There are 3 types of blood loss:

Capillary Venous Arterial

Blood Loss

There are 3 methods to control blood loss:

1. Direct Pressure

2. Elevation

3. Pressure Points

Controlling Blood Loss

Direct Pressure

Placing pressure directly over the wound, using a clean dressing.

Followed by a pressure bandage.

Controlling Blood Loss

Elevation

Placing the wound above the level of the heart.

It can take 5-7 minutes to stop the bleeding using Direct Pressure and Elevation.

Controlling Blood Loss

Pressure Points

A pulse point for a major artery.

- Brachial point

- Femoral point

Put pressure with your hand at the proximal pressure point.

Controlling Blood Loss

Tourniquet

A “Last Resort”

Leave in plain sight

Mark the patient’s forehead with “T” and time it was applied

Only a physician should remove

Controlling Blood Loss

Applying a Tourniquet – A “LAST RESORT”

Controlling Blood Loss

Control bleedingTreat for shockSave tissue parts,

wrapped in clean clothKeep tissue coolKeep tissue with the

victim

Treating Amputations

Impaled Objects:

Immobilize.

Don’t move or

remove.

Control bleeding.

Clean and dress

wound.

Wrap.

Treating Impaled Objects

Special Circumstances – Head Wound

Controlling Blood Loss

Special Circumstances – Nose Bleed

Controlling Blood Loss

Special Circumstances – Won’t Stop

Controlling Blood Loss

Purpose: This exercise allows you to practice the techniques for controlling bleeding.

Instructions:1. Work in pairs with your buddy – victims lie on the floor

with their eyes closed.2. The rescuer should use direct pressure to control

bleeding from a simulated wound on the right forearm just below the elbow. The rescuer should:

- apply a pressure bandage- elevate the arm

After the rescuer has made one attempt to control bleeding, the victim and the rescuer should change roles. Complete two attempts each, the second one for speed.

“Bleeding Control” Exercise I

Purpose: This exercise allows you to practice the techniques for controlling bleeding.

Instructions:1. Work in pairs with your buddy – victims lie on the floor

with their eyes closed.2. Complete different bleeding control exercises to stop

head wounds, lower extremity wounds, etc…

After the rescuer has made one attempt to control bleeding, the victim and the rescuer should change roles. Complete two attempts each, the second one for speed.

“Bleeding Control” Exercise II

“Bleeding Control”

Questions

Disaster Medical

Operations

“Recognizing & Treating for Shock”

• Shock is a disorder from ineffective circulation of blood.

• In a disaster situation, this ineffective circulation of blood usually results from uncontrolled bleeding.

Definition of Shock

• The loss of blood volume will ultimately lead to the death of cells, tissue, & entire

organs.

Definition of Shock

• Rapid, shallow breathing

• Capillary refill >2 sec.

• Unable to follow simple commands

• Skin color & temperature

Signs of Shock

Capillary Refill

• Lay victim on his back

• Elevate feet 6 – 10”

• Control obvious bleeding

• Maintain body temperature

• Avoid rough handling

Action Steps for Treating Shock

Purpose: This exercise allows you to practice the steps for treating shock.

Instructions:1. Work in pairs with your buddy – victims lie on the floor

with their eyes closed.2. The rescuer should treat the victim based on the

scenario given by the instructor.

The rescuer and the victim should switch roles.

“Treating for Shock” Exercise

“Recognizing & Treating Shock”

Questions

Disaster Medical

Operations

“Triage”

French Term meaning – “to sort”

Victims are sorted by

the urgency of their

need for treatment.

Definition of Triage

Effective Strategy used when:

Mass Casualty IncidentLimited ResourcesTime is Critical

Military Tested

V

TRIAGE EXERCISE

Triage

Functions of Disaster Med. Ops.

Incident Location Triage Medical Treatment

Delayed Care Area

ImmediateCare Area

Morgue

Search & Rescue

Medical Treatment Site

Hazard

Treatment Site

WIND

SELECTION PROCESS:

1. Safe Area free of debris & hazards2. Close to the hazard but upwind & uphill3. Accessible4. Expandable

Categorization

Triage is done as quickly as possible!

Victims are sorted

into 1 of 4 colored

categories.IMMEDIATEDELAYEDWALKING WOUNDED

DEAD

Triage Procedures

1. Stop, Look, Listen, Think!

2. Conduct voice Triage

3. Start where you stand

4. Evaluate each victim

5. Treat “IMMEDIATE” victims pronto!

Triage System

S.T.A.R.T.

1. Airway

2. Respirations

3. Pulse

4. Level of Consciousness

POST - TRIAGE EXERCISE

Triage

MALE – 2 YEARS OLD

Whimpering: “I want my mommy.”Cries vigorously and draws back when you touch his

left arm.

Radial Pulse: PresentRespirations: 44

1

1

MALE – APPROX30 YEARS OLD

Conscious but disorientedHolding left arm; grimaces when you touch it.Laceration to forehead

Radial Pulse: PresentRespirations: 32

2

2

FEMALE – APPROX60 YEARS OLD

Disoriented / ConfusedCuts and abrasions to face and arms.Rigid, swollen abdomen

Radial Pulse: PresentRespirations: 34

3

3

FEMALE – APPROX20 YEARS OLD

Conscious / Alert to person, place, & time.Complains of pain to left leg.Compound fracture to upper left leg.Cuts to face and arms.

Radial Pulse: PresentRespirations: 20

4

4

MALE – APPROX55 YEARS OLD

Disoriented, wants to wander away.Open head wound.Pain to right arm, swollen right elbow.

Radial Pulse: PresentRespirations: 28

5

5

FEMALE – APPROX30 YEARS OLD

Unconscious / UnresponsiveOpen wound to abdomen, penetrating trauma.Laceration to forehead.

Radial Pulse: AbsentRespirations: 0

6

6

FEMALE – APPROX45 YEARS OLD

Unconscious / UnresponsiveOpen wound to abdomen, penetrating trauma.Laceration to forehead.

Radial Pulse: PresentRespirations: 24

7

7

MALE – APPROX20 YEARS OLD

Unconscious / Responsive to painLeft knee & ankle dislocated.Abrasions & bruising to left side of face .Fractured ribs, left side of chest.

Radial Pulse: PresentRespirations: 22

8

8

MALE – APPROX30 YEARS OLD

Unconscious / unresponsive Left knee & ankle dislocated.Abrasions & bruising to left side of face .Fractured ribs, left side of chest.

Radial Pulse: AbsentRespirations: 4

9

99

FEMALE – APPROX5 YEARS OLD

Conscious, Alert & Oriented Laceration to left arm and face.Complains of pain to abdomen & left arm.

Radial Pulse: PresentRespirations: 40

10

10

“Triage”

Questions

Disaster Medical

Operations

“Patient Assessment”

Should follow the completion of Triage and Treatment.

Looking for:

Bruising, Swelling, Pain, Disfigurement

Patient Assessment Objectives

Three Objectives of Patient Assessment:

1. Determine the extent of the injuries.

2. Determine what additional treatment is needed.

3. Document injuries.

Patient Assessment Objectives

1. A Head-to-Toe Assessment is to be completed on all victims.

2. Talk to your patients.a. Ask for permission

b. Ask questions

3. Hands-on approach.

4. Step by Step process.

Procedure

Orderly procedure – Starting with:

Head→Neck→Shoulders→Chest→Arms→

Abdomen→Pelvis→Legs→Back

Step by Step Procedure

Orderly procedure – Starting with:

Step by Step Procedure

HEAD

Step by Step Procedure

HEAD

Step by Step Procedure

Neck

Step by Step Procedure

Shoulders

Step by Step Procedure

Chest

Step by Step Procedure

Arms

Step by Step Procedure

Abdomen

Step by Step Procedure

Pelvis

Step by Step Procedure

Legs

Step by Step Procedure

Back

Step by Step Procedure

Purpose: This exercise allows you to practice conducting head-to-toe assessments.

Instructions:1. Work in pairs with your buddy – one person will be the

victim and the other person the rescuer.2. Victims should lie on the floor on their backs and close

their eyes.3. The rescuer should conduct a head-to-toe assessment

on the victim following the procedure demonstrated earlier.

After the rescuer has made one assessment, the victim and the rescuer should change roles. Compete two assessments each.

“Head-to-Toe Assessment” Exercise

“Patient Assessment”

Questions

Disaster Medical

Operations

“Splinting”

Treating Fractures, Dislocations, Sprains, and Strains

Immobilize the injury and joints above and below the injury site.

If questionable, treat as a fracture.

ObjectivesObjectives

Treating Fractures, Dislocations, Sprains, and Strains

A CLOSED FRACTURE is a broken bone with no associated wound.

First aid treatment for closed fractures may require only splinting.

Fractures

An OPEN FRACTURE is a broken bone with some kind of wound that allows contaminants to enter into or around the fracture site.

Fractures

Open fractures are more dangerous because of the risk

of severe bleeding and infection. Therefore, they are a higher priority and need to be checked more frequently.

Treating an Open Fractures

DO:

Cover wound.

Splint fracture

without disturbing wound.

Place a moist 4" x 4" dressing over bone end to prevent drying.

DO NOT:

Do not draw

exposed bones back into tissue.

Do not irrigate wound

Displaced Fractures

DISPLACED

fractures in which the fractured bones are no

longer aligned.

Non-Displaced Fractures

NON-DISPLACED

fractures in which the fractured bone remains aligned.

Dislocations

DISLOCATION:

an injury to the ligaments around a joint that permits a separation of the bone from its normal position in a joint.

Dislocations

Signs of a dislocation are similar to those of a fracture….

A suspected dislocation should be treated like a fracture.

Dislocations

Never try to relocate a suspected dislocation.

Immobilize the joint until professional medical help is available.

Sprains

A sprain involves a stretching or tearing of ligaments at a joint

Is usually caused by stretching or extending the joint beyond its normal limits.

Signs of Sprain

Tenderness at injury site

Swelling and/or bruising

Restricted use or loss of use

Immobilize and elevate.

Strains

Stretching and/or tearing of muscles or tendons.

Most often involves the muscles in the neck, back, thigh, or calf.

May be difficult to distinguish from sprains or fractures.

Strains

When uncertain whether an injury is a strain, sprain, or fracture, treat the injury as if it is a fracture.

Splinting

Splinting is the most

common procedure

for immobilizing an

injury.

Cardboard is the material typically used for “makeshift” splints but a variety of

materials can be used, including:

Splinting

Splinting using a towel, in which the towel is rolled up and wrapped around the limb, then tied in place.

SOFT MATERIALS: Towels or blankets tied with

bandaging materials or soft cloths.

Splinting

Pillow splint, in which the pillow is

wrapped around the limb and tied.

SOFT MATERIALS: Pillows tied with bandaging

materials or soft cloths.

RIGID MATERIALS:

Using a board, metal strip, folded magazine or newspaper, or other rigid item.

Splinting

ANATOMICAL SPLINTS:

Created by securing a fractured bone to an adjacent un-fractured bone.

Splinting using a blanket in which the victim’s legs are

immobilized by tying blankets at intervals from

mid-thigh to feet.

Splinting

Guidelines for Splinting

Support the injured area above and below the site of the injury,including the joints.

If possible, splint the injury in the position that you find it.

Don’t try to realign bones or joints.

Guidelines for Splinting

After splinting, check for proper circulation (warmth, feeling, and color).

Immobilize above and below the injury.

“Splinting”

Questions

Disaster Medical

Operations

“Burns & Hypothermia”

4 Major Sub-functions

TRIAGE: The initial assessment and sorting of victims for treatment based on the

severity of their injuries.

TREATMENT: The area in which disaster medical services are provided to victims.

TRANSPORT: The movement of victims from the Triage area to the Treatment area.

MORGUE: The temporary holding area for victims who have died as a result of their injuries.

Treating Burns

Two Objectives:

1. Cool the burned area

2. Cover with sterile cloth to reduce the risk of infection

Treating Burns

Severity of a Burn depends on:

1. Temperature of the Burning agent

2. Length of exposure

3. Area of body affected

4. Size of the area Burned

5. Depth of the Burn

Classification of Burns

Epidermis

Dermis

Subcutaneous

Layers of Skin

Classification of Burns

11stst Degree 2 Degree 2ndnd Degree 3 Degree 3rdrd Degree Degree

Classification of Burns

11stst Degree Degree

Classification of Burns

22ndnd Degree Degree

33rdrd Degree Degree

Classification of Burns

Electrical Burns

Electrical Burns

Entrance Wound Exit Eound

Treatment of Burns

Remove the victim from the hazard.Remove the victim from the hazard. Cool with water for no more than Cool with water for no more than

1 minute. 1 minute. Cover with loosely dry, sterile dressings.Cover with loosely dry, sterile dressings. Elevate the wound site.Elevate the wound site. Do not use ice.Do not use ice. Do not apply antiseptics or ointments.Do not apply antiseptics or ointments. Do not remove items from the wound Do not remove items from the wound

site. site.

Hypothermia – Definition

HHYPOTHERMIAYPOTHERMIA is a condition that occurs is a condition that occurs when the body’s temperature drops when the body’s temperature drops below normal.below normal.

HHYPOTHERMIAYPOTHERMIA may be caused by exposure may be caused by exposure to cold air or water or by inadequate to cold air or water or by inadequate food combined with inadequate clothing food combined with inadequate clothing and/or heat, especially in older people.and/or heat, especially in older people.

Hypothermia – Signs & Symptoms

A body temperature of 95° Fahrenheit or less.A body temperature of 95° Fahrenheit or less. Redness or blueness of the skin.Redness or blueness of the skin. Numbness accompanied by shivering.Numbness accompanied by shivering.

IINN L LATERATER S STAGESTAGES::

Slurred speech.Slurred speech. Unpredictable behavior.Unpredictable behavior. Listlessness.Listlessness.

Hypothermia – Treatment Remove wet clothingRemove wet clothing

Wrap the victim in Wrap the victim in warm blanketswarm blankets

Remove from the Remove from the ElementsElements

Do not give alcoholDo not give alcohol

Do not massage cold extremitiesDo not massage cold extremities

Place unconscious victims in recovery Place unconscious victims in recovery positionposition

Disaster Medical

Operations

Questions / Comments