Transcript Incident Management - USF UEMSA

Chapter 21
Incident
Management
National EMS Education
Standard Competencies (1 of 3)
EMS Operations
Knowledge of operational roles and
responsibilities to ensure patient, public,
and personnel safety.
Incident Management
• Establish and work within the incident
management system.
National EMS Education
Standard Competencies (2 of 3)
Multiple-Casualty Incidents
• Triage principles
• Resource management
Hazardous Materials Awareness
• Risks and responsibilities of operating in a
cold zone at a hazardous material or other
special incident.
National EMS Education
Standard Competencies (3 of 3)
Mass-Casualty Incidents due to Terrorism
and Disaster
• Risks and responsibilities of operating on
the scene of a natural or man-made
disaster.
Introduction
• You should be able to identify the signs of a
hazardous materials incident.
• It is important for you to understand:
– The purpose of an incident management
system
– The framework of the National Incident
Management System (NIMS)
– Basic triage
Hazardous Materials Incidents
• HazMat are substances that are toxic,
poisonous, radioactive, flammable, or
explosive and can cause injury or death
with exposure.
• During a HazMat incident, your top priority
is to protect yourself and bystanders from
exposure and contamination.
Response to HazMat Incidents
(1 of 5)
• Identify the substances involved.
– Federal law requires that all vehicles containing
certain quantities of hazardous materials display
a HazMat placard.
– The placard should include a four-digit
identification number.
Response to HazMat Incidents
(2 of 5)
Courtesy of the U.S. Department of Transportation
Response to HazMat Incidents
(3 of 5)
• Emergency Response
Guidebook lists:
Courtesy of the U.S. Department of Transportation
– Most common hazardous
materials
– Their four-digit identification
numbers
– Proper emergency actions
to control the scene
– Emergency care of patients
who become ill or injured
after exposure
Response to HazMat Incidents
(4 of 5)
• Unless you have received training, keep
away from the contaminated area.
• Notify the dispatcher of the suspected
presence of HazMat.
• Identify victims who have sustained an
acute injury as a result of exposure.
– Remove them from the contaminated area and
have them decontaminated.
– Give necessary care and transport.
Response to HazMat Incidents
(5 of 5)
• Very few specific antidotes or treatments
exist for most HazMat injuries.
– Emergency treatment usually consists of
supportive care.
• EMRs should receive specific additional
training in hazardous waste operations and
emergency response (HAZWOPER).
Multiple-Casualty Incidents
(1 of 3)
• Situations with more than one sick or
injured individual
• Require a very different method of operation
from other emergency medical calls
Multiple-Casualty Incidents
(2 of 3)
• Variables in multiple-casualty incidents
– Severity of the crash
– Access routes
– Available resources
– Response times
– Levels of emergency training
– Overall experience of the EMS system
Multiple-Casualty Incidents
(3 of 3)
• Your goal should be to:
– Provide the greatest medical benefit for the
greatest number of people.
– Match patients’ medical needs with appropriate
treatment and transportation.
The Visual Survey (1 of 2)
• As you are on the
way to the scene,
prepare yourself
mentally for what
you may find.
– Where will
additional help
come from?
© David Crigger, Bristol Herald Courier/AP Photos
– How long will it take
for help to arrive?
The Visual Survey (2 of 2)
• When you arrive at the scene, force yourself
to stay calm.
• Make a visual assessment of the scene.
– Number of potential patients
– Severity of their injuries
– How much and what kind of help you will need
Your Initial Radio Report (1 of 3)
• Use clear language, be concise, be calm,
and do not shout into the microphone.
• The key points to communicate are:
– Location of the incident
– Type of incident
– Any hazards
– Approximate number of patients
– Type of assistance required
Your Initial Radio Report (2 of 3)
• Good rule of thumb: Request one
ambulance for every five patients.
• When calling for additional resources:
– Determine the perimeters for emergency
vehicles only.
– Establish a one-way route for emergency traffic
to approach the scene and a separate one-way
route for emergency traffic to exit.
Your Initial Radio Report (3 of 3)
• When calling for additional resources:
(cont’d)
– Allow adequate room for emergency vehicles
that need to be close to the scene.
– Keep vehicles and personnel who are not
needed at the scene at a staging area nearby.
Casualty Sorting (1 of 13)
• Triage is the sorting of patients into groups
according to their need for treatment.
– Should be simple and fast
– Do not worry about diagnosing patients.
• START triage system
– Lets EMRs triage each patient in 60 seconds or
less, based on breathing, circulation, and
mental status
Casualty Sorting (2 of 13)
• Triage tagging
– Patients are
tagged so that
other rescuers can
easily recognize
their triage level.
– Tagging uses
colored surveyor’s
tape or colored
paper tags.
Casualty Sorting (3 of 13)
• Triage tagging (cont’d)
– Priority One (red tag): immediate care; injuries
are life threatening.
– Priority Two (yellow tag): urgent care; can
delay up to 1 hour.
– Priority Three (green tag): delayed care; can
delay up to 3 hours.
– Priority Four (gray or black tag): patient is
dead; no care is required.
Casualty Sorting (4 of 13)
• First step in START: get up and walk
– Tell all the people who can get up and walk to
move to a specific area.
– If patients can walk, they rarely have lifethreatening injuries.
– These patients are the “walking wounded,”
designated as Priority Three (green tag).
Casualty Sorting (5 of 13)
• Second step in START: begin where you
stand
– Move through the remaining patients.
– Stop at each patient to provide a quick
assessment and tagging.
– Find and tag the Priority One patients.
– Examine them, correct life-threatening airway
and breathing problems, tag them with a red
tag, and move on.
Casualty Sorting (6 of 13)
• The START triage system is based on three
observations:
– Breathing
– Circulation
– Mental status
Casualty Sorting (7 of 13)
Casualty Sorting (8 of 13)
• Breathing
– Patients with breathing rates of greater than
30 breaths/min: Priority One
– Patients with breathing rate of less than
30 breaths/min: move on to the next step
– Patients who need help maintaining an open
airway: Priority One
– If you are in doubt as to the patient’s ability to
breathe: Priority One
Casualty Sorting (9 of 13)
• Breathing (cont’d)
– Patients who are not breathing and do not start
breathing with airway maneuvers: Priority Four
• Circulation
– Check the patient’s carotid pulse.
– Weak or irregular pulse: Priority One
– Strong pulse: move on to the next step
Casualty Sorting (10 of 13)
• Circulation (cont’d)
– Weak pulse: treat for shock
– Absent pulse: Priority Four
Casualty Sorting (11 of 13)
• Mental status
– Determine whether the patient responds to
verbal stimuli.
– Patients who can follow simple commands and
have adequate breathing and circulation:
Priority Two
– Unresponsive patients: Priority One
Casualty Sorting (12 of 13)
• START is designed to help rescuers find the
most seriously injured patients
• Injured patients do not always remain in the
same condition.
– The process of shock may continue.
– Some conditions become more serious as time
goes by.
– If possible, recheck the condition of Priority Two
and Priority Three patients.
Casualty Sorting (13 of 13)
Working at a Multiple-Casualty
Incident (1 of 2)
• If you are not the first person to arrive,
report to the incident commander.
• If you are the first on the scene:
– Make the initial overview.
– Clearly and accurately report the situation to the
dispatcher.
– Conduct the initial START triage.
Working at a Multiple-Casualty
Incident (2 of 2)
• As more highly trained personnel arrive,
report your findings to the person in charge
by noting:
– Approximate number of patients
– Number of patients whom you have triaged
– Additional assistance required
– Other important information
National Incident Management
System (1 of 3)
• Developed by the US Department of
Homeland Security
• Provides a consistent and unified approach
to handling emergency incidents
• Used to handle the immediate response,
mitigation, and long-term recovery of small
and massive natural and human-made
incidents
National Incident Management
System (2 of 3)
• Six major areas are addressed within the
scope of NIMS.
National Incident Management
System (3 of 3)
• EMRs fall within the first category.
• Three major components of Command and
Management:
– The Incident Command System (ICS)
– Multiagency Coordination Systems
– Public Information Systems
Terrorism Awareness (1 of 2)
• Terrorism is the systematic use of violence
by a group to intimidate a population or
government to achieve a goal.
• Terrorist acts may be instigated by a
country’s citizens or by people from other
countries.
Terrorism Awareness (2 of 2)
• Methods used to incite terror
– Explosives
– Fire
– Chemicals
– Viruses
– Bacteria
– Radiation
Weapons of Mass Destruction
• Any agent designed to bring about mass
death, casualties, and/or massive damage
to property and infrastructure
• Include explosive, chemical, biologic, and
nuclear weapons
• The preferred WMD to date has been
explosive devices.
Potential Targets and Risks
(1 of 3)
• Potential terrorist targets
– Bridges, tunnels, pipelines, and harbors
– National monuments
– Housing developments and automobile
dealerships
– Computer networks and data systems
– Farms and agricultural installations
– Schools, government buildings, churches, and
shopping centers
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© Steve Allen/Brand X Pictures/Alamy Images
© phdpsx/ShutterStock, Inc.
Potential Targets and Risks
(2 of 3)
Potential Targets and Risks
(3 of 3)
• EMRs should
always be alert for
hazards.
• Although you
should be prepared
for terrorist events,
most of your
emergency medical
calls will not be for
these events.
Agents and Devices (1 of 11)
• Explosives and
incendiary devices
– Explosives produce a
concussion that destroys
property and inflicts
injury and death.
Courtesy of Captain David Jackson,
Saginaw Township Fire Department
– Incendiary devices are
designed to start fires.
– The first indication that
such a device is present
is the explosion or fire
from its deployment.
Agents and Devices (2 of 11)
• WMD safety considerations
– Be alert for safety hazards.
– Do not enter an area that may be unsafe until
properly trained personnel assess the risks.
– Be alert for the possibility of a second explosive
device.
– Use the same safety skills you developed for
other types of emergency situations.
– Staging should occur upwind and uphill.
Agents and Devices (3 of 11)
• Chemical agents
– Pulmonary agents
• Gases that cause immediate distress and
injury
• Cause intense coughing, gasping, shortness
of breath, and difficulty breathing
– Metabolic agents
• Affect the body’s ability to use oxygen at the
cellular level
• Most common metabolic agents: cyanides
Agents and Devices (4 of 11)
• Chemical agents
(cont’d)
– Insecticides
• Class of poisonous
chemicals that are
inhaled or absorbed
through the skin
• Absorption
produces SLUDGElike symptoms.
Agents and Devices (5 of 11)
• Chemical agents (cont’d)
– Nerve agents
• Among the most deadly chemicals developed
• Cause SLUDGE-like symptoms
• Sarin, soman, tabun, and V agent (VX)
– Blister agents
• Produce burn-like blisters, pain, skin irritation,
severe shortness of breath, and severe
coughing
• Include sulfur mustard and Lewisite
Agents and Devices (6 of 11)
• Safety considerations when dealing with
chemical agents
– Anytime multiple people experience
unexplained symptoms, suspect a common
agent as the cause.
– Your primary role is to recognize that a problem
exists and to avoid contaminating yourself,
other rescuers, and bystanders.
– Stay upwind and call for assistance.
Agents and Devices (7 of 11)
Agents and Devices (8 of 11)
• Biologic agents
– Naturally occurring substances that produce
diseases
– Incubation period: the time from exposure to the
time the person shows symptoms of the disease
– The first awareness of a biologic incident would
likely come from hospital emergency
departments.
Agents and Devices (9 of 11)
• Safety considerations when dealing with
biologic agents
– Be alert for unusual patterns of diseases with
flulike symptoms.
– Practice appropriate standard precautions.
– Call for specially trained assistance and wait in
a safe location.
– Patients need to be decontaminated.
Agents and Devices (10 of 11)
• Radiologic agents
– Ionizing radiation is a kind of energy that is
formed by the decay of a naturally occurring or
human-made radioactive source.
Agents and Devices (11 of 11)
• Radiologic agents (cont’d)
– Radiation cannot be seen,
felt, or detected without
special instruments.
– A dirty bomb is an
explosive device containing
a small amount of
radioactive material.
– Stay away from the blast
site until specially trained
teams check for radiation.
Courtesy of Atomex Scientific and Production
Enterprise (www.atomex.com).
Your Response to Terrorist
Events (1 of 3)
• In all emergencies,
the same safety
rules apply:
– Good scene safety
– Vigilant standard
precautions
Courtesy of FEMA
Your Response to Terrorist
Events (2 of 3)
• Be prepared and know the limits of your
training.
• Many types of terrorist events require you to
stay a certain distance away to avoid
contaminating additional people.
• Be alert for secondary devices.
Your Response to Terrorist
Events (3 of 3)
• Establish an ICS as soon as possible.
– Know your role in working within the ICS.
– Treat these incidents as mass-casualty
situations.
– Establish good working relationships with
appropriate local, state, and federal agencies.
Summary (1 of 5)
• During a HazMat incident, your top priority
is to recognize that a hazard is present and
to protect yourself and bystanders from
exposure and contamination from the
hazardous material.
Summary (2 of 5)
• The START system is a simple triage
system that you can use at multiplecasualty incidents. It sorts patients in
groups so that the most serious patients are
treated and transported first.
• NIMS is designed to provide a unified
approach to emergency incidents of any
size.
Summary (3 of 5)
• The goal of terrorists is to intimidate a
population or government so as to achieve
a goal. Terrorists may use many
approaches to incite terror, including the
use of explosives, fire, chemicals, viruses,
bacteria, and radiation.
Summary (4 of 5)
• Chemical agents are human-made
substances that can have devastating
effects on living organisms. They include
pulmonary, metabolic, insecticides, nerve,
and blister agents.
• Biologic agents are organisms that cause
disease.
Summary (5 of 5)
• Radiologic weapons can create a massive
amount of destruction. They include
radiologic dispersal devices, also known as
dirty bombs.
• EMRs need to consider their safety, the
safety of other rescuers, and the safety of
bystanders whenever dealing with a
terrorist-related event.
Review
1. The first step in the START triage process
involves:
A. quickly determining who is most injured.
B. asking all the people who can get up and walk
to move to a specific area.
C. opening the airway of unconscious victims.
D. calling dispatch.
Review
Answer:
B. asking all the people who can get up
and walk to move to a specific area.
Review
2. Which of the following patients would be
tagged as a Priority One (red tag)?
A. the patient who cannot maintain an open
airway
B. the patient with a strong carotid pulse
C. the patient who does not start breathing with
airway maneuvers and does not have a pulse
D. the patient with a broken femur
Review
Answer:
A. the patient who cannot maintain an
open airway
Review
3. The function of the National Incident
Management System (NIMS) is to:
A. assist EMS providers in managing natural
disasters.
B. oversee the operations of all EMS and fire
agencies in the United States.
C. provide a consistent and unified approach to
handling emergency incidents.
D. educate city governments regarding foreign
terrorist attacks.
Review
Answer:
C. provide a consistent and unified
approach to handling emergency
incidents.
Credits
• Opener: Courtesy of Captain David Jackson,
Saginaw Township Fire Department
• Background slide image (ambulance): ©
Comstock Images/Alamy Images
• Background slide images (non-ambulance):
© Jones & Bartlett Learning. Courtesy of
MIEMSS.