Disaster Medical
Operations
“Introduction”
Objectives
1. Identify the 3 Killers.
2. Describe how to and perform:
a. Treatment procedures for the 3 Killers;
b. Splinting procedures;
c. Head-to-Toe Assessment procedures’
d. Triage
In a Disaster there are
3 Phases of Trauma Death:
Phase 1: Death in Minutes
Phase 2: Death in Hours
Phase 3: Death in Days to Weeks
Phases of Trauma Deaths
Peter Safer’s Research:
40 percent of disaster victims in the
second and third phases of death from
trauma could be saved by providing
simple medical care.
Phases of Trauma Deaths
Do the GREATEST GOOD for the GREATEST NUMBER of people!
Medical Operations Philosophy
The 3 “Killers”:
Airway obstruction
Excessive Bleeding
Control Shock
Life-threatening conditions mustreceive immediate treatment!
The 3 Killers
Disaster Medical
Operations
“Opening the Airway”
Respiratory System
Nasopharynx Oropharynx Tongue
Epiglottis
Trachea
Esophagus
Upper Airway
Critical Nature
Airway Obstruction
Head-Tilt / Chin-Lift
Head-Tilt / Chin-Lift
Step Action
1At an arm’s distance, shake the victim by touching the shoulder and shout, “Can you hear me?”
2If the victim does not or cannot respond, place the palm of one hand on the forehead.
3Place two fingers of the other hand under the chin and tilt the jaw upward while tilting the head back slightly.
4Place your ear over the victim’s mouth, looking toward the victim’s feet, and place a hand on the victim’s abdomen.
5 Look for chest rise.
6 Listen for air exchange.
7 Feel for abdominal movement.
Action Steps
1. Check for Responsiveness
Action Steps
2. Head-Tilt / Chin-Lift
Action Steps
3. Look, Listen, Feel
Action Steps
Purpose: This exercise allows you to practice using the Head-Tilt / Chin-Lift method on each other.
Instructions:1. Work in pairs with your buddy – one person will be the
victim and the other person the rescuer.2. Victims should lie on the floor on their backs and close
their eyes.3. The rescuer should use the Head-Tilt / Chin-Lift method
on the victim to open the airway.
After the rescuer has made two or three attempts at using the Head-Tilt / Chin-Lift method, the victim and the rescuer should change roles.
“Opening the Airway” Exercise
“Opening the Airway”
Questions
Disaster Medical
Operations
“Bleeding Control”
The average adult has between 5-6 liters of blood in their body.
Losing one liter can result in death.
Anatomy / Physiology
There are 3 types of blood loss:
Capillary Venous Arterial
Blood Loss
There are 3 methods to control blood loss:
1. Direct Pressure
2. Elevation
3. Pressure Points
Controlling Blood Loss
Direct Pressure
Placing pressure directly over the wound, using a clean dressing.
Followed by a pressure bandage.
Controlling Blood Loss
Elevation
Placing the wound above the level of the heart.
It can take 5-7 minutes to stop the bleeding using Direct Pressure and Elevation.
Controlling Blood Loss
Pressure Points
A pulse point for a major artery.
- Brachial point
- Femoral point
Put pressure with your hand at the proximal pressure point.
Controlling Blood Loss
Tourniquet
A “Last Resort”
Leave in plain sight
Mark the patient’s forehead with “T” and time it was applied
Only a physician should remove
Controlling Blood Loss
Applying a Tourniquet – A “LAST RESORT”
Controlling Blood Loss
Control bleedingTreat for shockSave tissue parts,
wrapped in clean clothKeep tissue coolKeep tissue with the
victim
Treating Amputations
Impaled Objects:
Immobilize.
Don’t move or
remove.
Control bleeding.
Clean and dress
wound.
Wrap.
Treating Impaled Objects
Special Circumstances – Head Wound
Controlling Blood Loss
Special Circumstances – Nose Bleed
Controlling Blood Loss
Special Circumstances – Won’t Stop
Controlling Blood Loss
Purpose: This exercise allows you to practice the techniques for controlling bleeding.
Instructions:1. Work in pairs with your buddy – victims lie on the floor
with their eyes closed.2. The rescuer should use direct pressure to control
bleeding from a simulated wound on the right forearm just below the elbow. The rescuer should:
- apply a pressure bandage- elevate the arm
After the rescuer has made one attempt to control bleeding, the victim and the rescuer should change roles. Complete two attempts each, the second one for speed.
“Bleeding Control” Exercise I
Purpose: This exercise allows you to practice the techniques for controlling bleeding.
Instructions:1. Work in pairs with your buddy – victims lie on the floor
with their eyes closed.2. Complete different bleeding control exercises to stop
head wounds, lower extremity wounds, etc…
After the rescuer has made one attempt to control bleeding, the victim and the rescuer should change roles. Complete two attempts each, the second one for speed.
“Bleeding Control” Exercise II
“Bleeding Control”
Questions
Disaster Medical
Operations
“Recognizing & Treating for Shock”
• Shock is a disorder from ineffective circulation of blood.
• In a disaster situation, this ineffective circulation of blood usually results from uncontrolled bleeding.
Definition of Shock
• The loss of blood volume will ultimately lead to the death of cells, tissue, & entire
organs.
Definition of Shock
• Rapid, shallow breathing
• Capillary refill >2 sec.
• Unable to follow simple commands
• Skin color & temperature
Signs of Shock
Capillary Refill
• Lay victim on his back
• Elevate feet 6 – 10”
• Control obvious bleeding
• Maintain body temperature
• Avoid rough handling
Action Steps for Treating Shock
Purpose: This exercise allows you to practice the steps for treating shock.
Instructions:1. Work in pairs with your buddy – victims lie on the floor
with their eyes closed.2. The rescuer should treat the victim based on the
scenario given by the instructor.
The rescuer and the victim should switch roles.
“Treating for Shock” Exercise
“Recognizing & Treating Shock”
Questions
Disaster Medical
Operations
“Triage”
French Term meaning – “to sort”
Victims are sorted by
the urgency of their
need for treatment.
Definition of Triage
Effective Strategy used when:
Mass Casualty IncidentLimited ResourcesTime is Critical
Military Tested
V
TRIAGE EXERCISE
Triage
Functions of Disaster Med. Ops.
Incident Location Triage Medical Treatment
Delayed Care Area
ImmediateCare Area
Morgue
Search & Rescue
Medical Treatment Site
Hazard
Treatment Site
WIND
SELECTION PROCESS:
1. Safe Area free of debris & hazards2. Close to the hazard but upwind & uphill3. Accessible4. Expandable
Categorization
Triage is done as quickly as possible!
Victims are sorted
into 1 of 4 colored
categories.IMMEDIATEDELAYEDWALKING WOUNDED
DEAD
Triage Procedures
1. Stop, Look, Listen, Think!
2. Conduct voice Triage
3. Start where you stand
4. Evaluate each victim
5. Treat “IMMEDIATE” victims pronto!
Triage System
S.T.A.R.T.
1. Airway
2. Respirations
3. Pulse
4. Level of Consciousness
POST - TRIAGE EXERCISE
Triage
MALE – 2 YEARS OLD
Whimpering: “I want my mommy.”Cries vigorously and draws back when you touch his
left arm.
Radial Pulse: PresentRespirations: 44
1
1
MALE – APPROX30 YEARS OLD
Conscious but disorientedHolding left arm; grimaces when you touch it.Laceration to forehead
Radial Pulse: PresentRespirations: 32
2
2
FEMALE – APPROX60 YEARS OLD
Disoriented / ConfusedCuts and abrasions to face and arms.Rigid, swollen abdomen
Radial Pulse: PresentRespirations: 34
3
3
FEMALE – APPROX20 YEARS OLD
Conscious / Alert to person, place, & time.Complains of pain to left leg.Compound fracture to upper left leg.Cuts to face and arms.
Radial Pulse: PresentRespirations: 20
4
4
MALE – APPROX55 YEARS OLD
Disoriented, wants to wander away.Open head wound.Pain to right arm, swollen right elbow.
Radial Pulse: PresentRespirations: 28
5
5
FEMALE – APPROX30 YEARS OLD
Unconscious / UnresponsiveOpen wound to abdomen, penetrating trauma.Laceration to forehead.
Radial Pulse: AbsentRespirations: 0
6
6
FEMALE – APPROX45 YEARS OLD
Unconscious / UnresponsiveOpen wound to abdomen, penetrating trauma.Laceration to forehead.
Radial Pulse: PresentRespirations: 24
7
7
MALE – APPROX20 YEARS OLD
Unconscious / Responsive to painLeft knee & ankle dislocated.Abrasions & bruising to left side of face .Fractured ribs, left side of chest.
Radial Pulse: PresentRespirations: 22
8
8
MALE – APPROX30 YEARS OLD
Unconscious / unresponsive Left knee & ankle dislocated.Abrasions & bruising to left side of face .Fractured ribs, left side of chest.
Radial Pulse: AbsentRespirations: 4
9
99
FEMALE – APPROX5 YEARS OLD
Conscious, Alert & Oriented Laceration to left arm and face.Complains of pain to abdomen & left arm.
Radial Pulse: PresentRespirations: 40
10
10
“Triage”
Questions
Disaster Medical
Operations
“Patient Assessment”
Should follow the completion of Triage and Treatment.
Looking for:
Bruising, Swelling, Pain, Disfigurement
Patient Assessment Objectives
Three Objectives of Patient Assessment:
1. Determine the extent of the injuries.
2. Determine what additional treatment is needed.
3. Document injuries.
Patient Assessment Objectives
1. A Head-to-Toe Assessment is to be completed on all victims.
2. Talk to your patients.a. Ask for permission
b. Ask questions
3. Hands-on approach.
4. Step by Step process.
Procedure
Orderly procedure – Starting with:
Head→Neck→Shoulders→Chest→Arms→
Abdomen→Pelvis→Legs→Back
Step by Step Procedure
Orderly procedure – Starting with:
Step by Step Procedure
HEAD
Step by Step Procedure
HEAD
Step by Step Procedure
Neck
Step by Step Procedure
Shoulders
Step by Step Procedure
Chest
Step by Step Procedure
Arms
Step by Step Procedure
Abdomen
Step by Step Procedure
Pelvis
Step by Step Procedure
Legs
Step by Step Procedure
Back
Step by Step Procedure
Purpose: This exercise allows you to practice conducting head-to-toe assessments.
Instructions:1. Work in pairs with your buddy – one person will be the
victim and the other person the rescuer.2. Victims should lie on the floor on their backs and close
their eyes.3. The rescuer should conduct a head-to-toe assessment
on the victim following the procedure demonstrated earlier.
After the rescuer has made one assessment, the victim and the rescuer should change roles. Compete two assessments each.
“Head-to-Toe Assessment” Exercise
“Patient Assessment”
Questions
Disaster Medical
Operations
“Splinting”
Treating Fractures, Dislocations, Sprains, and Strains
Immobilize the injury and joints above and below the injury site.
If questionable, treat as a fracture.
ObjectivesObjectives
Treating Fractures, Dislocations, Sprains, and Strains
A CLOSED FRACTURE is a broken bone with no associated wound.
First aid treatment for closed fractures may require only splinting.
Fractures
An OPEN FRACTURE is a broken bone with some kind of wound that allows contaminants to enter into or around the fracture site.
Fractures
Open fractures are more dangerous because of the risk
of severe bleeding and infection. Therefore, they are a higher priority and need to be checked more frequently.
Treating an Open Fractures
DO:
Cover wound.
Splint fracture
without disturbing wound.
Place a moist 4" x 4" dressing over bone end to prevent drying.
DO NOT:
Do not draw
exposed bones back into tissue.
Do not irrigate wound
Displaced Fractures
DISPLACED
fractures in which the fractured bones are no
longer aligned.
Non-Displaced Fractures
NON-DISPLACED
fractures in which the fractured bone remains aligned.
Dislocations
DISLOCATION:
an injury to the ligaments around a joint that permits a separation of the bone from its normal position in a joint.
Dislocations
Signs of a dislocation are similar to those of a fracture….
A suspected dislocation should be treated like a fracture.
Dislocations
Never try to relocate a suspected dislocation.
Immobilize the joint until professional medical help is available.
Sprains
A sprain involves a stretching or tearing of ligaments at a joint
Is usually caused by stretching or extending the joint beyond its normal limits.
Signs of Sprain
Tenderness at injury site
Swelling and/or bruising
Restricted use or loss of use
Immobilize and elevate.
Strains
Stretching and/or tearing of muscles or tendons.
Most often involves the muscles in the neck, back, thigh, or calf.
May be difficult to distinguish from sprains or fractures.
Strains
When uncertain whether an injury is a strain, sprain, or fracture, treat the injury as if it is a fracture.
Splinting
Splinting is the most
common procedure
for immobilizing an
injury.
Cardboard is the material typically used for “makeshift” splints but a variety of
materials can be used, including:
Splinting
Splinting using a towel, in which the towel is rolled up and wrapped around the limb, then tied in place.
SOFT MATERIALS: Towels or blankets tied with
bandaging materials or soft cloths.
Splinting
Pillow splint, in which the pillow is
wrapped around the limb and tied.
SOFT MATERIALS: Pillows tied with bandaging
materials or soft cloths.
RIGID MATERIALS:
Using a board, metal strip, folded magazine or newspaper, or other rigid item.
Splinting
ANATOMICAL SPLINTS:
Created by securing a fractured bone to an adjacent un-fractured bone.
Splinting using a blanket in which the victim’s legs are
immobilized by tying blankets at intervals from
mid-thigh to feet.
Splinting
Guidelines for Splinting
Support the injured area above and below the site of the injury,including the joints.
If possible, splint the injury in the position that you find it.
Don’t try to realign bones or joints.
Guidelines for Splinting
After splinting, check for proper circulation (warmth, feeling, and color).
Immobilize above and below the injury.
“Splinting”
Questions
Disaster Medical
Operations
“Burns & Hypothermia”
4 Major Sub-functions
TRIAGE: The initial assessment and sorting of victims for treatment based on the
severity of their injuries.
TREATMENT: The area in which disaster medical services are provided to victims.
TRANSPORT: The movement of victims from the Triage area to the Treatment area.
MORGUE: The temporary holding area for victims who have died as a result of their injuries.
Treating Burns
Two Objectives:
1. Cool the burned area
2. Cover with sterile cloth to reduce the risk of infection
Treating Burns
Severity of a Burn depends on:
1. Temperature of the Burning agent
2. Length of exposure
3. Area of body affected
4. Size of the area Burned
5. Depth of the Burn
Classification of Burns
Epidermis
Dermis
Subcutaneous
Layers of Skin
Classification of Burns
11stst Degree 2 Degree 2ndnd Degree 3 Degree 3rdrd Degree Degree
Classification of Burns
11stst Degree Degree
Classification of Burns
22ndnd Degree Degree
33rdrd Degree Degree
Classification of Burns
Electrical Burns
Electrical Burns
Entrance Wound Exit Eound
Treatment of Burns
Remove the victim from the hazard.Remove the victim from the hazard. Cool with water for no more than Cool with water for no more than
1 minute. 1 minute. Cover with loosely dry, sterile dressings.Cover with loosely dry, sterile dressings. Elevate the wound site.Elevate the wound site. Do not use ice.Do not use ice. Do not apply antiseptics or ointments.Do not apply antiseptics or ointments. Do not remove items from the wound Do not remove items from the wound
site. site.
Hypothermia – Definition
HHYPOTHERMIAYPOTHERMIA is a condition that occurs is a condition that occurs when the body’s temperature drops when the body’s temperature drops below normal.below normal.
HHYPOTHERMIAYPOTHERMIA may be caused by exposure may be caused by exposure to cold air or water or by inadequate to cold air or water or by inadequate food combined with inadequate clothing food combined with inadequate clothing and/or heat, especially in older people.and/or heat, especially in older people.
Hypothermia – Signs & Symptoms
A body temperature of 95° Fahrenheit or less.A body temperature of 95° Fahrenheit or less. Redness or blueness of the skin.Redness or blueness of the skin. Numbness accompanied by shivering.Numbness accompanied by shivering.
IINN L LATERATER S STAGESTAGES::
Slurred speech.Slurred speech. Unpredictable behavior.Unpredictable behavior. Listlessness.Listlessness.
Hypothermia – Treatment Remove wet clothingRemove wet clothing
Wrap the victim in Wrap the victim in warm blanketswarm blankets
Remove from the Remove from the ElementsElements
Do not give alcoholDo not give alcohol
Do not massage cold extremitiesDo not massage cold extremities
Place unconscious victims in recovery Place unconscious victims in recovery positionposition
Disaster Medical
Operations
Questions / Comments