Transcript SECTION 2 - South Dade Senior High School

37: Special Operations
Cognitive Objectives (1 of 4)
7-3.1 Explain the EMT-B’s role during a call
involving hazardous materials.
7-3.2 Describe what the EMT-B should do if there is
reason to believe that there is a hazard at the
scene.
7-3.3 Describe the actions that an EMT-B should
take to ensure bystander safety.
Cognitive Objectives (2 of 4)
7-3.4
State the role the EMT-B should perform until
appropriately trained personnel arrive at the
scene of a hazardous materials situation.
7-3.5
Break down the steps to approaching a
hazardous situation.
7-3.6
Discuss the various environmental hazards
that affect EMS.
Cognitive Objectives (3 of 4)
7-3.7
Describe the criteria for a multiple-casualty
situation.
7-3.8
Evaluate the role of the EMT-B in the multiplecasualty situation.
7-3.9
Summarize the components of basic triage.
7-3.10 Define the role of the EMT-B in a disaster
operation.
Cognitive Objectives (4 of 4)
7-3.11 Describe basic concepts of incident
management.
7-3.12 Explain the methods for preventing
contamination to self, equipment, and
facilities.
7-3.13 Review the local mass-casualty incident plan.
Psychomotor Objectives
7-3.16 Given a scenario of a mass-casualty incident,
perform triage.
Additional Affective Objective*
1. Discuss the psychological impact of wanting to act but
recognizing that a scene is not safe to enter.
*This is a noncurriculum objective.
Incident Command System
• ICS is used to help control, direct, and coordinate
resources.
• It ensures clear lines of responsibility and authority.
• Incident commander has overall responsibility for
the scene.
• Safety officer is designated to circulate among
responders.
Structure of an Incident Command
System
Information Officer
• All information to the public and news media
originates at the command post.
Safety Officer
• Circulates through incident scene to ensure safety
of responders and victims.
• Orders by the safety officer have full authority of
the incident commander.
Sector Commanders
• Coordinate activities of specialty groups
– EMS
– Rescue
– Fire
Sectors of Typical IC Structure
•
•
•
•
Operations
Planning
Logistics
Finance
Incident Command
• Command structure must be established early and
expanded as needed.
• Incident command may vary in different
communities.
• An EMT-B must not deviate from the directions and
orders given by command.
Key Components of the ICS at a
Mass-Casualty Incident (1 of 2)
•
•
•
•
Command center
Staging area
Extrication area
Decontamination area
Key Components of the ICS at a
Mass-Casualty Incident (2 of 2)
•
•
•
•
•
Triage area
Treatment area
Supply area
Transportation area
Rehabilitation area
National Incident
Management System (1 of 2)
• Nationwide template to enable federal, state,
and local governments and private-sector and
non-governmental organizations to work
together in an emergency
National Incident
Management System (2 of 2)
•
•
•
•
Applicable to all jurisdictions
Utilized by a variety of disciplines
Improves coordination and cooperation
Built on existing incident management systems
Mass-Casualty Incidents
• Incidents involving
three or more patients
• Places high demand on
available resources
• May require mutual aid
response
Triage (1 of 2)
• Triage is the sorting of two or more patients based
on the severity of their conditions.
• Patients are ranked in the order of the severity of
their conditions.
• Treatment priority is determined by rank.
Triage (2 of 2)
Triage is an essential component of operations at a
mass-casualty incident.
Triage Categories
Triage Priorities
• Patients should be color coded early.
• Patients tagged red should be assessed in the
treatment area.
• Patients in dangerous areas should be removed to
a non-hazardous environment prior to triage.
Triage Procedures
• Rotate hospital
destinations.
• Trauma center should
receive the most
critical patients.
• Utilize a transport
officer to evenly
distribute patients.
Disaster Management
• The role of the EMT-B is to respond when
requested and report to incident command.
• A casualty collection area may be set up and
staffed by nursing and medical staff with
equipment.
• You may have to bring patients to this area.
Introduction to
Hazardous Materials
• Any substance that is toxic, poisonous, radioactive,
flammable, or explosive and can cause injury or
death with exposure
• Responders must have special training before
becoming involved with hazardous materials.
Hazardous Materials Situations
• A train or truck with a leaking substance
• A leak, fire, or other emergency at an industrial
plant, refinery, or other storage facility
• A gas pipe leak or rupture
• Deterioration of underground fuel tanks
• Buildup of methane in sewers
• Car crash involving a ruptured gas tank
Recognition of Hazardous Materials (1 of 2)
• Warning signs
• Placards
• Labels
Recognition of Hazardous Materials (2 of 2)
• Visible cloud or odd-looking smoke coming
from an escaping substance
• A leak or spill from a tank, container, truck,
or railroad car
• An unusually strong, noxious, acrid odor
HazMat Placards
The four-digit number that appears on the warning
placard identifies the specific hazardous material.
First Arrival
•
•
•
•
•
•
Stop at safe distance.
Call for a HazMat team.
Stay out of danger zone.
Gather information.
Do not reenter the scene.
Do not leave until cleared by HazMat.
Identifying Hazardous Materials
• Safety perimeters
• Uphill and upwind
• Efforts to ensure safety and survival of the masses.
HazMat Scene Safety
Approach a hazardous incident cautiously from
upwind.
HazMat Scene Operations
• HazMat will determine the specific hazardous
material involved.
• Only those trained in HazMat and wearing
protective gear should enter the zone.
• As an EMT-B, your job is to remain in the
designated treatment area.
• HazMat will bring patients to you.
Decontamination Area
• Designated area where contaminates are
removed
• Anyone who leaves the hazard zone must
pass through this area.
• Wait for the patients to be brought to you.
Classification of Hazardous
Materials—Toxicity Levels
Level
Health Hazard
Protection Needed
0
Little or no hazard
None
1
Slightly hazardous
SCBA (level C suit) only
2
Slightly hazardous
SCBA (level C suit) only
3
Extremely hazardous
Full protection; with no exposed
skin (level A or B suit)
4
Minimal exposure
causes death
Special HazMat gear (level A suit)
Caring for Patients at a HazMat
Incident
• Only essential treatment will take place in the
hazard zone and decontamination area.
• Injuries should be treated as any other patient.
• Treatment for exposure will be mainly supportive.
• Initiate transport.
Special Care
• Some patients may need to be treated
without full decontamination.
• Protect yourself with proper gear.
• Ensure the receiving hospital is aware
patient has not been fully decontaminated.
• Ambulance will need to be decontaminated
after transport.
Resources
• Emergency Response
Guidebook
• Chemical Transportation
Emergency Center
(CHEMTREC)
– 1-800-424-9300
Personal Protective Equipment
Levels
• Level A—Fully encapsulated, chemical-resistant
protective clothing
• Level B—Nonencapsulated protective clothing with
respiratory protection
• Level C —Nonpermeable clothing, eye protection,
filtering face mask
• Level D —Work uniform; minimal protection
Four Levels of Protection
Level A
Level B
Level C
Level D
Review
1. Which of the following statements BEST describes
a mass-casualty incident?
A. At least half of the patients are dead
B. Either a bus or an airplane has crashed
C. You have more than two critical patients
D. The patient count exhausts your resources
Review
Answer: D
Rationale: A mass-casualty situation is one that
places such a great demand on available
equipment or personnel that the system is
stretched to its limits or beyond. While bus
accidents and plane crashes are classic examples
of mass-casualty incidents, they are not the only
situations that can exhaust your resources.
Review
1. Which of the following statements BEST describes a mass-casualty
incident?
A. At least half of the patients are dead
Rationale: Mass-casualty incidents are not based upon the number of
fatalities.
B. Either a bus or an airplane has crashed
Rationale: This is a good example of a potential mass-casualty
incident; however, there may be very few patients.
C. You have more than two critical patients
Rationale: This situation places a burden upon the first EMS providers,
but it may not stress available resources.
D. The patient count exhausts your resources
Rationale: Correct answer
Review
2. Which of the following patients would have the
HIGHEST treatment priority at the scene of a
mass-casualty incident?
A. 24-year-old man, who is unconscious, has snoring
respirations, and severe burns.
B. 32-year-old woman, who is pulseless and apneic
with an abdominal evisceration.
C. 29-year-old woman, who is in full cardiac arrest
with massive open chest trauma.
D. 32-year-old man with an open head injury,
exposed brain mater, and no carotid pulse.
Review
Answer: A
Rationale: Three of the four patients (B, C, and D) are
dead. Triage efforts are aimed at providing the
greatest amount of good for the greatest number of
people. Attempting to resuscitate a patient in
traumatic cardiac arrest is futile in almost all cases.
Review (1 of 2)
2. Which of the following patients would have the HIGHEST
treatment priority at the scene of a mass-casualty incident?
A. 24-year-old man, who is unconscious, has snoring
respirations, and severe burns.
Rationale: Correct answer
B. 32-year-old woman, who is pulseless and apneic with an
abdominal evisceration.
Rationale: In a mass-casualty situation, this is a traumatic
arrest. The woman has minimal possibilities of survival with
no vital signs upon arrival.
Review (2 of 2)
2. Which of the following patients would have the HIGHEST
treatment priority at the scene of a mass-casualty incident?
C. 29-year-old woman, who is in full cardiac arrest with massive
open chest trauma.
Rationale: Efforts must be directed toward the patients with the
greatest possibility of survival.
D. 32-year-old man with an open head injury, exposed brain
mater, and no carotid pulse.
Rationale: This patient presents with the lowest possibility of
surviving.
Review
3. Patient #1 is a conscious male with a large scalp
laceration and moderate venous bleeding. Patient #2
is a semiconscious infant with shallow breathing and
bradycardia. Patient #3 is an unconscious older man
with open head trauma, exposed brain matter and
agonal breathing. Patient #4 is a middle-aged woman
with bilateral open femur fractures and cool, clammy
skin. Which patient should you treat FIRST?
A. Patient #1
B. Patient #2
C. Patient #3
D. Patient #4
Review
Answer: B
Rationale: Patients #2 and #4 are both critical
patients; however, patients with airway and/or
breathing problems have the highest priority. The
infant in this scenario has an altered level of
consciousness, shallow breathing, and
bradycardia—ominous signs that indicate
impending cardiac arrest. Patient #1 should be
tagged as delayed; his injury is not life-threatening.
Patient #3 has the lowest priority; his injury is fatal.
Review (1 of 2)
3. Patient #1 is a conscious male with a large scalp laceration and
moderate venous bleeding. Patient #2 is a semiconscious infant
with shallow breathing and bradycardia. Patient #3 is an
unconscious older man with open head trauma, exposed brain
matter and agonal breathing. Patient #4 is a middle-aged
woman with bilateral open femur fractures and cool, clammy
skin. Which patient should you treat FIRST?
A. Patient #1
Rationale: Patient #1 will be the third patient treated in this scenario.
B. Patient #2
Rationale: Correct answer
Review (2 of 2)
3. Patient #1 is a conscious male with a large scalp laceration and
moderate venous bleeding. Patient #2 is a semiconscious infant
with shallow breathing and bradycardia. Patient #3 is an
unconscious older man with open head trauma, exposed brain
matter and agonal breathing. Patient #4 is a middle-aged
woman with bilateral open femur fractures and cool, clammy
skin. Which patient should you treat FIRST?
C. Patient #3
Rationale: Patient #3 is the lowest priority since his injuries are
considered fatal.
D. Patient #4
Rationale: Patient #4 is a high priority, but patients with breathing or
airway complications are a higher concern.
Review
4. A large tanker truck has overturned on a highway.
When you arrive, you see a clear liquid leaking from
the rear of the tanker. The driver, who appears to be
unconscious, is still in the vehicle and is bleeding
heavily from the face. You should:
A. immediately notify law enforcement for traffic control.
B. fully assess the situation and request the appropriate
assistance.
C. put on gloves, a gown, and a mask and quickly
remove the driver.
D. go to the rear of the tanker and determine what type
of fluid is leaking.
Review
Answer: B
Rationale: Upon arriving at the scene of a possible
hazardous materials incident, you must first step
back and assess the situation. This can be very
stressful—especially if you see a patient. However,
rushing into such a situation puts your own life in
jeopardy. Once you have properly assessed the
scene, you should request the appropriate
assistance, such as the fire department or
hazardous materials team.
Review (1 of 2)
4. A large tanker truck has overturned on a highway. When you
arrive, you see a clear liquid leaking from the rear of the tanker.
The driver, who appears to be unconscious, is still in the
vehicle and is bleeding heavily from the face. You should:
A. immediately notify law enforcement for traffic control.
Rationale: Law enforcement is part of the assistance needed at the
scene; however, rescue, fire, and hazmat providers must also
be notified.
B. fully assess the situation and request the appropriate assistance.
Rationale: Correct answer
Review (2 of 2)
4. A large tanker truck has overturned on a highway. When you
arrive, you see a clear liquid leaking from the rear of the tanker.
The driver, who appears to be unconscious, is still in the
vehicle and is bleeding heavily from the face. You should:
C. put on gloves, a gown, and a mask and quickly remove the
driver.
Rationale: This is a potentially hazardous environment. Access
should not be attempted until the scene has been deemed
safe.
D. go to the rear of the tanker and determine what type of fluid is
leaking.
Rationale: Unless you are trained as a hazardous materials
technician and part of the entry team, do not enter the hazard
zone.
Review
5. During a natural disaster, a command post is set
up and an incident commander is in charge.
He/she is also joined in a unified command with
three other commanders. Which of the following is
NOT a commander in a unified command
structure?
A. Fire operations
B. EMS operations
C. Law enforcement
D. Red Cross disaster chief
Review
Answer: D
Rationale: In a large-scale MCI, in which a unified
command structure has been established, the
incident commander will also be joined in
command with a fire commander, EMS commander
and a law enforcement commander.
Review
5. During a natural disaster, a command post is set up and an
incident commander is in charge. He/she is also joined in a
unified command with three other commanders. Which of the
following is NOT a commander in a unified command structure?
A. Fire operations
Rationale: This is part of the unified command structure.
B. EMS operations
Rationale: This is part of the unified command structure.
C. Law enforcement
Rationale: This is part of the unified command structure.
D. Red Cross disaster chief
Rationale: Correct answer
Review
6. What type of hazardous materials are transported
with white warning placards?
A. Corrosive
B. Explosive
C. Poisonous
D. Flammable
Review
Answer: C
Rationale: Placards that are predominantly white in
color signify the presence of poisons. Black
placards indicate a corrosive chemical, orange
placards indicate an explosive chemical, and red
placards indicate a flammable or combustible
chemical.
Review
6. What type of hazardous materials are transported with white
warning placards?
A. Corrosive
Rationale: The corrosives placard is black.
B. Explosive
Rationale: The explosives placard is orange.
C. Poisonous
Rationale: Correct answer
D. Flammable
Rationale: The flammable materials placard is red.
Review
7. Which toxicity level would you assign a hazardous
material spill that could cause a person temporary
damage or residual injury unless prompt medical
treatment is given?
A. Level 1
B. Level 2
C. Level 3
D. Level 4
Review
Answer: B
Rationale: Level 2 toxicity includes materials that
could cause temporary damage or residual injury
unless prompt medical treatment is provided. Level
1 toxicity includes materials that would cause little,
if any, health hazard. Level 3 toxicity includes
materials that are extremely hazardous to health
and requires full protective gear. Level 4 toxicity
includes materials that are so hazardous that even
minimal contact will cause death.
Review
7. Which toxicity level would you assign a hazardous material
spill that could cause a person temporary damage or
residual injury unless prompt medical treatment is given?
A. Level 1
Rationale: Level 1 materials cause little health hazards.
B. Level 2
Rationale: Correct answer
C. Level 3
Rationale: Level 3 materials are extremely hazardous.
D. Level 4
Rationale: Level 4 materials cause death, even with minimal
contact.
Review
8. When dealing with a hazardous materials incident,
where should you set up your decontamination
area?
A. Inside the hazard zone
B. Inside the treatment area
C. Between the hazard zone and treatment area
D. Between the treatment and transportation zone
Review
Answer: C
Rationale: The decontamination area should be set
up between the hazard zone and the treatment
area. This way, patients cannot bring any
hazardous materials into the treatment area and
contaminate any one else.
Review
8. When dealing with a hazardous materials incident, where
should you set up your decontamination area?
A. Inside the hazard zone
Rationale: It needs to be on the edge of the hazard zone — not
inside it.
B. Inside the treatment area
Rationale: You do not want contaminated patients in the
treatment area.
C. Between the hazard zone and treatment area
Rationale: Correct answer
D. Between the treatment and transportation zone
Rationale: Patients need to be decontaminated prior to entering
the treatment and transport area.
Review
9. Upon arriving at a scene in which the incident
command system has been activated, you should
expect to:
A. be passed from sector to sector, as needed, in
between assignments.
B. report directly to the incident commander in
between assignments.
C. be assigned a specific responsibility for the
duration of the incident.
D. be given general directions and allowed to function
independently.
Review
Answer: A
Rationale: The incident commander establishes
sectors of responsibility and sector officers. When
functioning at an incident in which the incident
command system has been activated, you should
report to the appropriate sector officer, carry out
your assignment, and report back to the sector
officer. In many cases, you will be asked to report
to a different sector.
Review (1 of 2)
9. Upon arriving at a scene in which the incident command system
has been activated, you should expect to:
A. be passed from sector to sector, as needed, in between
assignments.
Rationale: Correct answer
B. report directly to the incident commander in between
assignments.
Rationale: Only sector or unit officers report to the incident
commander.
Review (2 of 2)
9. Upon arriving at a scene in which the incident command system
has been activated, you should expect to:
C. be assigned a specific responsibility for the duration of the
incident.
Rationale: Responsibilities may change as sector officers see the
need for change.
D. be given general directions and allowed to function
independently.
Rationale: The purpose behind the incident command system is to
prevent personnel from functioning independently.
Review
10. Which of the following situations MOST likely
involves a hazardous material?
A. Milk truck that overturned and is leaking fluid
B. Tractor trailer rig that is emitting a visible cloud
C. Moving van that collided head-on with a small car
D. Pickup truck from the gas company that struck a
tree
Review
Answer: B
Rationale: A crash does not need to occur for a spill
or leak to happen. A vehicle that is emitting a
visible cloud should make you suspicious that a
hazardous material is involved—especially if the
vehicle is a tractor trailer rig. In such cases, you
should stay uphill and upwind and notify the fire
department or hazardous materials team.
Review
10. Which of the following situations MOST likely involves a
hazardous material?
A. Milk truck that overturned and is leaking fluid
Rationale: This is a possibility, but not the most likely possibility.
B. Tractor trailer rig that is emitting a visible cloud
Rationale: Correct answer
C. Moving van that collided head-on with a small car
Rationale: This is a possibility, but not the most likely possibility.
D. Pickup truck from the gas company that struck a tree
Rationale: This is a possibility, but not the most likely possibility.