Contra Costa County CERT

Released: 18 August 2011

Program Unit 4 – Emergency Medical Operations Part 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 4.1

     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)

Visual 4.2

Unit Objectives

Public Health Considerations

 Maintain proper hygiene  Maintain proper sanitation  Purify water (if necessary)  Prevent spread of disease Visual 4.3

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 4.4

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 4.5

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 4.6

Functions:

 Triage  Transport  Treatment  Morgue  Supply Visual 4.7

Disaster Medical Operations

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 4.8

Establishing Treatment Areas

Site selected should be:

 In a safe area  Close to but upwind, upstream and uphill from the hazard zones  Accessible by transportation vehicles  Expandable

Wind TREATMENT SITE

Visual 4.9

Hazard

Establishing Treatment Areas

Assign treatment leader to each treatment area

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

Visual 4.10

medical care if possible

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 Visual 4.11

Head-to-Toe Assessment

Look for “The Killers”



R

espirations – Airway obstruction 

P

erfusion – Circulation, excessive bleeding 

M

ental Status – Signs of shock Visual 4.12

Indicators of Injury

 Bruising  Swelling  Severe pain  Disfigurement

Provide

immediate

treatment for life-threatening injuries!

Visual 4.13

 Deformities  Contusions  Abrasions  Punctures  Burns  Tenderness  Lacerations  Swelling Visual 4.14

Types of Injury

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 4.15

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 4.16

Head to Toe Assessment

Let them know what you are doing. Communicate!

1.

2.

3.

4.

5.

6.

7.

8.

9.

Head Neck Shoulders Chest Arms Abdomen Pelvis Legs Back

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

Visual 4.17

Symptoms

Signs of a closed-head, neck or spinal injury       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

Minimize movement of head, neck and spine

Visual 4.18

Layers of Skin



Epidermis - First Degree



Dermis - Second Degree



Subcutaneous layer - Third Degree

Visual 4.19

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 4.20

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 4.21

 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 Visual 4.22

Inhalation Burns

Objective of wound care:

  Control bleeding Prevent secondary infection

Treatment of wounds :

 Clean wounds – don’t scrub  Apply dressing to wound  Apply bandage to hold dressing in place No tourniquets No Hydrogen Peroxide Visual 4.23

Wound Care

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 Visual 4.24

    Swelling around wound site Discoloration Discharge from wound Red striations from wound site

Signs of Infection

Visual 4.25

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 4.26

Treating Impaled Objects

 Immobilize  Don’t move or remove  Control bleeding  Clean and dress wound  Wrap Visual 4.27

     

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 4.28

Guidelines for Splinting

All fracture & suspected fractures require 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 Visual 4.29

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 Visual 4.30

  Tenderness at site Swelling and bruising  Restricted use or loss of use

Signs of Sprain

Visual 4.31

Types of Fractures

Open

Visual 4.32

Closed Nondisplaced Closed Displaced

Treating an Open Fracture

DO:

 Cover wound  Splint fracture without disturbing wound  Place a moist 4" x 4" dressing over bone end to prevent drying

DO NOT:

 Draw exposed bones back into tissue  Irrigate wound Visual 4.33

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 4.34

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 4.35

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 Visual 4.36

Symptoms of Hyp

O

thermia

Primary signs and symptoms:

 A body temperature of 95 o Fahrenheit (35 o 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 4.37

Treating Hyp

O

thermia

 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 4.38

Symptoms of Frostbite

 Skin discoloration  Burning or tingling sensation  Partial or complete numbness Visual 4.39

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 Visual 4.40

Symptoms of Hyp

ER

thermia

Heat Exhaustion

Heavy sweating Paleness Muscle cramps

Heat Stroke

Body Temperature over 103 ˚F Red, hot, dry skin (no sweating) Rapid, strong pulse Weakness Tiredness Dizziness or headache Nausea Nausea or vomiting Confusion Fainting Throbbing headache Dizziness Unconsciousness

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

Visual 4.41

Treating Hyp

ER

thermia

 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 4.42

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 4.43

Exercise

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

Visual 4.44