Mass Casualty Management First National Course on Public Health Emergency Management 12 – 23 March...

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


• 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

Overview of Mass Casualty

Mass Casualty Incident

3


• Pre-planning and training are critical

• Establish guidelines and procedures

• Early implementation of Incident Command

• First five minutes will determine next five hours


Preparation for Mass Casualty

4


• Mass Casualties can occur in a variety of ways

• Effect on emergency response and community impact

• Include transportation, violent crimes and building collapse


Response Categories for Mass Casualties

5


• Hazardous materials incidents

• Civil disturbances• Natural disasters• Major fires• Terrorist attacks


Response Categories of Mass Casualties

6


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


Problems in Mass Casualty Incidents

7


• Perimeter establishment delayed or not done at all

• Large crowds of people

• Media involvement

• Political involvement

• Inadequate resources


Problems in Mass Casualty Incidents

8


Establishing Mass Casualty Management

System

9


Any event resulting in a number of victims large

enough to disrupt the normal course of emergency and health care services

Establishing a Mass Casualty Management System

Mass Casualty Incident

10


• Management of victim of a mass casualty event

• Objective is to minimize loss of life and disabilities

Mass Casualty Management


11



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

13



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

14



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 pre-established procedures for:

a. resource mobilizationb. field managementc. hospital reception

16



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

17



Problems in Developing MCM• Limited human resources• limited material resources

– facility– transport– communication

• Poor communication– topography– isolation

• Political


Activities at various levels of responses:

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

‘E’/Disaster Site/Scene




Field Management Definition:

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

Components

Alerting Process

Pre-identification ofField Areas

Safety/ Security

Command Post

Search and Rescue

Field Care

Evacuation

(EMC) Emergency Management Center


RESCUE CHAIN---SECTORAL

*SEARCH*

*RESCUE*

*First Aid*

Impact Zone

Command Post

Triage

Stabilization

Evacuation

Traffic Control

Regulation of Evacuation

CP / AMP

Pre-Hospital Organization Hospital Organization

ERor

A&ED


21



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

22



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

23


• Precise location of the event

• Time & type of the event

• Estimated number of casualties

• Added potential risk

• Exposed population

• Resources needed


Initial Assessment

24



• 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)

Pre-Identification of Field Areas

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

27



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 effectivePurpose: 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

29



• 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

Personnel

30



• The communication / coordination hub of the pre- hospital 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 workerso provide info to back-up system, other officials,

and tri-media thru an Information Officero release as soon as situation allows “E” staff

and re- establish normal operationso determine termination of field operations

METHOD

31



• 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.

MANAGEMENT OF VICTIMS

32



Management of Victims

• Field Care

- Pre-established capabilities / inventory: pre-planning

- Integrated community plan: practiced w/ policy support

- The “Golden Hour” Principle

33



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……”

Recent progress in pre-hospital emergency / disaster medicine

34



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

Objectives:Quick identification for immediate

stabilizationfor life-saving (measures) and surgery

Levels:On-site–----- ‘where they lie’Medical ----- at Advance Medical PostEvacuation --- transport

TRIAGE

35


On-site T: AcuteNon-acute

Medical T: RedYellowGreenBlack

Evacuation T - transport:

RedYellowGreenBlack

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

Green: ‘walking wounded’-to AS/OPD

Black: to morgue Forensic Services Public Health & Psycho-Social interventions to relatives/kin


36



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

First Aid

37



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..??

Advance Medical Post (AMP)

38



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

Aiders, etc.

Advance Medical Post (AMP)

39


AMP NON-ACUTE

Black Green

Red Yellow

ACUTE

NON-ACUTE

ACUTE

evacuation

TRIAGE

C

P

C P– Collecting Point


40


COLLECTION AREA

TRIAGE AREA

TREATMENT AREA

PRIORITY II PRIORITY I

(color tagging of victims)

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

PRIORITY III

COMMAND POST


41

(in unstable condition)

(management and stabilization)

1st2nd3rd


Field Management Plan: Diagram

Working Area

Triage

Impact Zone

Evacuation

AMP

Command Post

Strictly Restricted

Restricted

Access Route

Traffic

Traffic

Control


42



• 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

Transfer Organization

43




• Preparation for TransportEvacuation 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: RegulationPrinciples

- not to overwhelm care facility- avoid spontaneous evacuation of unstable patients.

44



• Evacuation Procedures: RegulationRules:

- 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

* conveyor belt’ flow from first aid to the most sophisticated care level..


45


Victim Flow : “Conveyor Belt” Management Diagram

3-T

Tag

Treat

and

Transfer

Triage Treatment

Triage Evacuation

Impact Zone

Collecting Point AMP TRANSFER

HOSPITAL

Victims Flow Transport Resource Flow


46



- 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

Victim Flow

47


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


Victim Flow

48



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

Field Organization Checklist

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

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 55


• Developed in the 1970’s during the California wildfires

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

55


• 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

56



Benefits of Incident Command

• Common terminology

• Position titles and Chain of Command for decision making

• Responder accountability

57


Basic Command Types

• Single Command

• Unified Command

58


Single Command

• Based on first arriving emergency units

• Initial Incident Commander begins assessment of incident

• Rescue, Triage, Treatment, Transport

59


Basic Command StructureSingle Command

R E S C U E /E X TR IC A TIO N

TR IA G E TR E A TM E N T TR A N S P O R T

IN C ID E N TC O M M A N D E R

60


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

61


INCIDENT CO M M AND SYSTEM

SAFETY OFF ICER L IAISON OFF ICER

PUBLIC INFORM ATIONOFF ICER

STAG ING O FF ICER

TREATMENT MEMBERSIMMEDIATE

TREATMENT MEMBERSDELAYED

TREATMENT MEMBERSMINO R

TREATMENT TEAMLEADER

TRIAG E MEMBERS

MO RG UE MANAG ER

TRIAG E TEAMLEADER

MEDICAL G RO UPSUPERVISO R

G RO UND AMBULANCE

AIR AMBULANCE

TRANSPO RT G RO UPSUPERVISO R

OPERAT IONS OFF ICERF IELD M EDICAL COM M ANDER

RESO URCES

SITUATIO N

DO CUMENTATIO N

DEMO BILIZATIO N

PLANNING OFF ICER

CO MMUNICATIO NS

MEDICAL

FO O D

SERVICE

SUPPLY

FACILITIES

G RO UND SUPPO RT

SUPPO RT

LOG IST ICS OFF ICER

TIME

PRO CUREMENT

CO MPENSATIO N

CO ST

ADMINISTRATIVE O FF ICER

INC ID E NTC O M M A ND

62


Overview of Incident Command Process

Process is based on:

• Size up

• Setting Incident Priorities

• Predicting incident course and harm

• Strategic goals and tactical objectives

63


Size Up

• Rapid mental evaluation of factors influencing an incident

• Must continue throughout incident with ongoing evaluation

• Incident situation, incident cause and incident status

64


Incident Situation

May be one or combination of:

• Biological• Nuclear• Fire • Chemical• Explosion or natural event• Natural disaster with MCI

65


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

66


Incident Status

Is the incident:

• In a somewhat controlled state or

• Does it remain uncontrolled

67


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

68


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

69


Strategic Goals

• Broad general statements of desired outcome of the incident

• Example: mass casualty overturned school bus

- extrication, triage, treatment, transport

70



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

- Command Staff- General Staff

71

Organization


Command Staff

Consists of the :

• Incident Commander• Safety Officer• Liaison Officer • Public Information Officer

72



73

Incident Commander


Incident Commander

• First person on the scene with communications capability

• Remains in command until transferred or incident is terminated

• Complete authority and responsibility

74


Incident Commander

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

75

• Fill command staff and functional areas

• Must approve all information releases to the media

75


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

76


General Staff

Consists of:

• Operations (includes staging)• Planning• Logistics• Administrative/Finance

77


Operations Section

O P E R A TIO N S



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

79


Planning Section

O P E R A TIO N S P L A N N IN G


80


• 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

81

Planning Section


O P E R A TIO N S P L A N N IN G L O G IS TIC S

IN C ID E N TC O M M A N D

82

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

83

Logistics Section


Administrative / Finance Section

O P E R A TIO N S P L A N N IN G L O G IS TIC S A D M IN IS TR A TIV EF IN A N C E


84


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

85


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

86


Thank you 87


CRITICAL INCIDENT MANAGEMENT

88



• Discuss critical incident stages

• Discuss decision making in a critical incident

89


• 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

90

Critical Incident Management Characteristics


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

91


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

92


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

93


Critical Incident Stages

They consist of:

• Initial Response• Incident Control using the Six Step Response• Recovery Stage

94


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

95


Initial Response Objectives

As soon as possible:

• Gain control of the scene

• Restore order

• Prevent target opportunities

96


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

97


# 1 – Assume Command

• Must advise incoming responders of incident location

• Secure tactical frequency

• Request supervisory support

98


# 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.

99


# 2 – Situation Assessment

In simple terms the assessment describes:

• What do you have

• What are you doing

• What do you need

100


# 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

101


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

102


Inner Perimeter• Protects responders in hot zone• Uniformed personnel only• Used as decontamination area, treatment area

and evacuation area for walking wounded

103

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

104


# 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

105


# 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

106

# 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

107

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

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

109


Post Incident Analysis

Critical for operational review. Benefits include:• Operational performance• Organizational needs• Procedure modification• Additional training

110


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

111


9-11-01

112

9-11-01


TRIAGE

113


• 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.

2

Description


QUESTION 1

What is the meaning of Triage ? What is the basis of triage ?


QUESTION 2

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


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

• Demonstrate the decision-making process in determining priority of care

3

Objectives

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

• Demonstrate the decision-making process in determining priority of care

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

118


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

119

Intermediate Priority

• Patient treatment and transport can be delayed


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

120


Initial Triage Officer

• Must size up situation

• Ensure safe approach and scene survey

• Activate additional resourceso Number of victimso Size of the incidento Better off requesting more equipment

and personnel than not enough

121


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

122



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

123



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

124



• 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

125



• 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

126



• 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

127


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

128

Patient Assessment


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

129

Patient Assessment


Patient Assessment

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

130


Patient Assessment

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

131


START TRIAGE

MINOR

all walking wounded

RESPIRATION

IMMEDIATE

YES NO

Position Airway

YES NO

IMMEDIATE DECEASED

over under30/min 30/min

PERFUSION

Radial Pulse Present

Radial Pulse Absent

Capillary Refill

Over Under

2 2

ControlBleeding

IMMEDIATE

Secs Secs

Respirations 30/min

Perfusion 2 secs

Mental Status can do

MENTAL STATUS

Can’t Follow Can Follow

Simple Commands Simple Commands

IMMEDIATE DELAYED



Thank You

Date post:	16-Dec-2015
Category:	Documents
Upload:	jasper-merritt
View:	248 times
Download:	0 times

Mass Casualty Management First National Course on Public Health Emergency Management 12 – 23 March...

Documents