Contra Costa County CERT Program

Unit 4 – Emergency Medical Operations Part 2Released: 18 August 2011Released: 18 August 2011

Visual 4.2

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 4.3

Unit Objectives

Personal Protection Take appropriate

sanitation measures to help protect public health

Perform head-to-toe patient assessments

Establish Treatment Areas Treating injuries

(Warning: some graphic pictures)

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Public Health Considerations

Maintain proper hygiene

Maintain proper sanitation

Purify water (if necessary)

Prevent spread of disease

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Steps to Maintain Hygiene

Wash hands frequently using soap and water for at least 12 to 15 seconds use alcohol based sanitizer if soap and water not available

Wear non-latex gloves; change or disinfect after each patient 1 part bleach to 10 parts water for 30 seconds

Wear N95 mask and goggles

Keep dressings sterile

Avoid contact with body fluids

If it’s wet or sticky and it’s not yours

DON’T TOUCH IT!

Visual 4.6

Maintaining Sanitation

Control disposal of bacterial sources by putting waste products in plastic bags Tie off and mark as medical waste

Bury or bag human waste

Visual 4.7

Water Purification

Boil for 1 minute or

Use Water Purification Tablets or

Use ⅛ tsp of bleach per gallon of clear water Use ¼ tsp of bleach per gallon of cloudy water

no soaps or scents in bleach 4% to 6% sodium hypochlorite

Let solution stand for 30 minutes

If that solution does not smell or taste of bleach, add another ⅛ tsp of bleach and let solution stand for another 15 minutes before using

Visual 4.8

Disaster Medical Operations

Triage

Transport

Treatment

Morgue

Supply

Functions:

Visual 4.9

Disaster Medical Operations

Select site and set up treatment area as soon as injured victims are confirmed

When determining best location(s) for treatment area, consider:

Safety of rescuers and victims

Most effective use of resources

Visual 4.10

In a safe area

Close to but upwind, upstream and uphill from the hazard zones

Accessible by transportation vehicles

Expandable

Establishing Treatment Areas

Site selected should be:

TREATMENT SITE

Hazard

Wind

Visual 4.11

Establishing Treatment Areas

“Immediates” need immediate attention Transport “Immediates” to a higher level of

medical care if possible

Assign treatment leader to each treatment area

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Documentation in Treatment Areas

Available identifying information name, phone number, address, etc……..

Description age, sex, body build, approximate height and

weight clothing

Injuries the victim sustained

Treatment and actions taken

Transfer location

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Head-to-Toe Assessment

Respirations – Airway obstruction

Perfusion – Circulation, excessive bleeding

Mental Status – Signs of shock

Look for “The Killers”

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Indicators of Injury

Bruising

Swelling

Severe pain

Disfigurement

Provide immediate treatment

for life-threatening injuries!

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Types of Injury

Deformities

Contusions

Abrasions

Punctures

Burns

Tenderness

Lacerations

Swelling

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Conducting Head-To-Toe Assessment

Get permission to conduct assessment

Determine the extent of injuries and treatment Look for “The Killers”

Determine the type of treatment needed

Document injuries and actions taken

Be aware of “mechanism of injury”

Visual 4.17

Head-to-Toe Assessment

Look for medical identification

Conduct on all victims, even those who seem to be alright

Children are assessed Toe-to-Head

Everyone gets a tag

Verbal assessment

Hands-on assessment look, listen and feel for anything unusual

Victim has the right to refuse treatment

Visual 4.18

Head to Toe Assessment

1. Head2. Neck3. Shoulders4. Chest5. Arms6. Abdomen7. Pelvis8. Legs9. Back

Anyone unconscious or with injuries to the head, neck, trunk or upper legs are “Immediates”

Let them know what you are doing. Communicate!

Visual 4.19

Symptoms

Change in consciousness

Inability to move one or more body parts

Severe pain or pressure in the head, neck or back

Tingling or numbness in extremities

Difficulty breathing or seeing

Heavy bleeding, bruising or deformity of the head or spine

Blood or fluid in the nose or ears

Bruising behind the ears “Raccoon” eyes (bruising

around the eyes) “Uneven” pupils Seizures Nausea or vomiting Victim found under collapsed

building materials or heavy debris

Signs of a closed-head, neck or spinal injury

Minimize movement of head, neck and spine

Visual 4.20

Layers of Skin

Epidermis - First Degree

Dermis - Second Degree

Subcutaneous layer - Third Degree

Visual 4.21

Treating Burns

Remove victim from burning source

Cool the burned area no more than 15% or approximately one arm at

a time

Cover with sterile cloth to reduce infection risk

Elevate burned extremity higher than heart

No ice, antiseptics, ointments, butter, etc…

Extra caution with infants, young children or elderly

Visual 4.22

Treating Chemical Burns

Remove cause of burn & affected clothing/jewelry

If irritant is dry, gently brush away as much as possible Always brush away from eyes, victim, and you

Flush with lots of cool running water

Apply cool, wet compress to relieve pain

Cover wound loosely with dry, sterile or clean dressing

Treat for shock if appropriate

Visual 4.23

Inhalation Burns

Sudden loss of consciousness

Evidence of respiratory distress or upper airway obstruction

Soot around mouth or nose

Singed facial hair

Burns around face or neck

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Wound Care

Control bleeding Prevent secondary infection

Objective of wound care:

Treatment of wounds: Clean wounds – don’t scrub Apply dressing to wound Apply bandage to hold

dressing in placeNo tourniquetsNo Hydrogen Peroxide

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Rules of Dressing

In the absence of active bleeding, remove dressing and flush, check wound at least every 4-6 hours, redress as necessary

If there is active bleeding, redress over existing dressing and maintain pressure and elevation

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Signs of Infection

Swelling around wound site

Discoloration

Discharge from wound

Red striations from wound site

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Treating Amputations

Control bleeding and elevate part

Treat for shock if present

Save tissue parts, wrapped in clean cloth

Place in baggy w/ patient’s name, date, and time

Keep tissue cool, not frozen

Keep tissue with the victim Duct tape to body

Visual 4.28

Treating Impaled Objects

Immobilize

Don’t move or remove

Control bleeding

Clean and dress wound

Wrap

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Fractures, Dislocations, Sprains, Strains

Symptoms:

Tenderness at injury site

Swelling and/or bruising

Restricted use or loss of use

Objective:

Immobilize the injury and joints above and below the injury and elevate

If questionable, treat as a fracture

Improvise items to use as splints

Visual 4.30

Guidelines for Splinting

Support the injured area

Assess color, warmth and sensation

Splint injury in the position that you find it

Don’t try to realign bones

Immobilize above and below the injury

After splinting, recheck for color, warmth, and sensation below the injury site

All fracture & suspected fractures require splinting

Visual 4.31

Dislocations

Dislocation is injury to ligaments around joint So severe that it permits separation of

bone from its normal position in joint

Treatment Immobilize; do NOT relocate Check PMS before and after splinting/

immobilization

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Signs of Sprain

Tenderness at site

Swelling and bruising

Restricted useor loss of use

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Types of Fractures

Open Closed Nondisplaced

Closed Displaced

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Treating an Open FractureDO:

Cover wound Splint fracture without disturbing

wound Place a moist 4" x 4" dressing over

bone end to prevent dryingDO NOT:

Draw exposed bones back into tissue

Irrigate wound

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Nasal Bleeding

Causes: blunt force, skull fracture, non-trauma related conditions

Blood loss can lead to shock

Victims may become nauseated and vomit if they swallow blood

Treating Nasal Bleeding

Pinch the nostrils together, lean forward

Put pressure on the upper lip just under the nose

Visual 4.36

Bites and Stings

If bite or sting is suspected, and situation is non-emergency: Remove stinger if still present by scraping

edge of credit card or other stiff, straight-edged object across stinger

Wash site thoroughly with soap and water Place ice on site for 10 minutes on and 10

minutes off

Visual 4.37

Anaphylaxis

Check airway and breathing

Calm individual

Remove constrictive clothing and jewelry

Find and help administer victim’s Epi-pen

Watch for signs of shock and treat appropriately

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Symptoms of HypOthermia

Primary signs and symptoms: A body temperature of 95o Fahrenheit

(35o Celsius) or less Redness or blueness of the skin Numbness accompanied by shivering

Later stages of Hypothermia:

Slurred speech

Unpredictable behavior

Listlessness and confusion

Visual 4.39

Treating HypOthermia

Remove wet clothing

Wrap victim in a blanket or sleeping bag and cover head and neck or

Place victim in warm bath

Protect victim from weather

Provide warm fluids to conscious victims No alcohol, caffeine or soda

Place unconscious victim in recovery position

Even mild degrees of hypothermia can have serious consequences

Visual 4.40

Symptoms of Frostbite

Skin discoloration

Burning or tingling sensation

Partial or complete numbness

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Treatment of Frostbite

Immerse injured area in warm (NOT hot) water Warm slowly!

Do NOT allow part to re-freeze

Do NOT attempt to use massage

Wrap affected body parts in dry, sterile dressing

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Symptoms of HypERthermia

Heat Exhaustion Heat StrokeHeavy sweating Body Temperature over 103˚FPaleness Red, hot, dry skin (no

sweating)Muscle cramps Rapid, strong pulseWeakness Throbbing headacheTiredness DizzinessDizziness or headache NauseaNausea or vomiting ConfusionFainting Unconsciousness

Heat Stroke is the most severe form of hyperthermia and is a life-threatening emergency!

Visual 4.43

Treating HypERthermia

Get victim to a cool place / air conditioned if you can

Cool victim as rapidly as possible Immerse in cool water / shower / garden hose In low humidity, wrap in wet sheet and fan the

victim vigorously

Monitor body temperature until it drops to 101-102˚F

Give exhaustion victim fluids to drink unless nauseated, cramping or losing consciousness (no caffeine, alcohol or soda).

No fluids for stroke victims!

Transport Immediately!

Visual 4.44

Unit Summary

Public health concerns

Organization of disaster medical operations

Conducting head-to-toe assessments

Bandaging and splinting

Treating other injuries and conditions

Written START Triage Exercise

Visual 4.45

Exercise

Anyone with an injury to the head, neck, trunk or upper legs are “Immediates”