CERT Unit 3 - Lamorinda CERT
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Transcript CERT Unit 3 - Lamorinda CERT
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
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