Health Science Core Chapter 8 Disaster: Preparedness, Hazards, and Prevention Broward County Triage Broward County Incident Command

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Health Science Core Chapter 8 Disaster
Preparedness, Hazards, and PreventionBroward
County TriageBroward County Incident Command
McFatter Technical Center Emergency Medical
Technician - Basic
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Chapter 18 Disasters Preparedness
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Disaster

• An unexpected event that causes great damage and
  depletes or exhausts currently available
  resources
• Earthquakes
• Hurricanes
• Floods
• Tornadoes
• Airplane accident
• Hazardous waste
• accident

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Triaging Terms

• Triage - To sort or prioritize care for a group
  of patients
• Assessment evaluation of the patient
• Objective Information obtained from observing
  the patient
• Subjective Information obtained from the
  patient
• The goal of triage Prompt and efficient patient
  care

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Disaster Preparedness

• 1. Disaster preparedness has become a recognized
  specialty which requires cooperation of many
  agencies.
• 2. Proper preparation takes
• Foresight
• Thought
• Planning
• Experience is the best teacher

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Disaster Basic Guidelines

• Remain calm
• Know who the designated person in charge of you
• Keep agency telephone lines clear for official
  business
• Communicate and cooperate with other workers
• Always speak in a firm voice but a caring tone

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Occupational Safety

• OSHA Occupational Safety and Health
  Administration agency that develops safety
  standards and establishes maximum levels of
  exposure to many hazardous material.
• NIOSH National Institute for Occupational
  Safety and Health Investigates requests of
  unsafe working conditions and how they relate to
  employee illnesses.

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Hospital Hazards

• Anesthesia gases used to cause loss of
  sensation and/or consciousness caused by the
  administration of drugs
• Radiation and chemotherapy toxic substances
  that can have a high risk of developing tissue
  damage
• Asbestos fireproofing material in old
  construction
• Always read the label and mixing instructions
  before using any chemicals

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Hazard Communication / HazCom

• Program that protects employees from the dangers
  of chemicals and medical gases.
• Employee training
• Written program
• Material Safety Data Sheets
• Warning Labels

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Mass Casualty Incidents Uniform Pre-hospital MCI
Procedure
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• What is an MCI ?
• Any Incident Which Overwhelms the Capabilities of
  the First Arriving Unit (s).

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Predetermined Response

• Amount of resources that will automatically be
  issued based on the number of patients
• First responding unit will notify dispatch center
  the MCI Level
• There are 5 Levels of response

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MCI Level 1 Response (5-10 Victims)

• 4 ALS Transport Units
• 2 Suppression units
• 1 Shift Supervisor
• 1 EMS Supervisor

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MCI Level 2 Response (11-20 Victims)

• 6 ALS Rescue Units
• 3 Suppression Units
• 2 Shift Supervisors
• 2 EMS Supervisors

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MCI Level 3 Responses(21-100 Victims)

• 8 ALS Transport Units
• 4 Suppression Units
• 3 Shift Supervisors
• 3 EMS Supervisors
• 1 Operations Chief
• 1 Command Vehicle
• 1 Supply Trailer

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• MCI LEVEL 4 Response
• (101-1000 Victims)
• 5 MCI Task Forces (25 units)
• 2 ALS Transport Unit Strike Teams (10 units)
• 1 Suppression Unit Strike Team (5 units)
• 2 BLS Transport Unit Strike Teams (10 units)
• 2 Mass Transit Buses
• 5 Shift Supervisors
• 3 EMS Supervisors
• 1 EMS Chief
• 1 Operations Chief
• 1 Command Vehicle
• 2 Supply Trailers
• 1 Communications Trailer

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• MCI LEVEL 5 Response
• (Over 1000 victims)
• 10 MCI Task Forces (50 units)
• 4 ALS Transport Unit Strike Teams (20 units)
• 2 Suppression Unit Strike Teams (10units)
• 4 BLS Transport Unit Strike Teams (20 units)
• 4 Mass Transit Buses
• 10 Shift Supervisors
• 6 EMS Supervisors
• 2 EMS Chiefs
• 2 Operations Chief
• 2 Command Vehicles
• 4 Supply Trailers
• 1 Communication Trailers

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First Arriving Unit Procedure
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• First Arriving
• A. Unit Officer will establish COMMAND
• 1. Size-up and estimate number of victims
• 2. Request MCI level response
• 3. Identify a Staging Area

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• First Arriving
• 4. Initiate triage with crew members and initial
  crews
• a. Perform START or JumpSTART Triage
• b. Prioritize victims
• RED (Immediate)
• YELLOW (Delayed)
• GREEN (Minor)
• BLACK (Non-salvageable)
• 5. Direct walking wounded to one location

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Mass Casualty Operational Structure
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Operational Groups

• 1. Triage
• 2. Treatment
• 3. Transport
• 4. Staging

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Basic Command Structure for Mass Casualty
Incidents
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Other Possible Operational Groups

• 1. Medical Branch
• 2. Landing Zone
• 3. Extrication
• 4. Hazmat
• 5. Rehabilitation
• 6. Safety
• 7. PIO
• 8. Medical Intelligence

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Complex Command Structure for Mass Casualty
Incidents
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START Triage
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Initial Triage

• Locate and direct all walking wounded
• Assign someone to keep green group together
• Assess non-ambulatory
• Use colored ribbons tied to upper extremity
• Borderline use higher priority tag

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Secondary Triage Procedure

• Perform during Treatment phase
• Use DMS All Risk Triage Tag
• Trauma criteria will apply

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Adult START Triage RPM

• Respirations
• Perfusion
• Mental

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Respirations

• Less Than 30/minute Go To Perfusion
• Over 30/Minutes RED Tag
• No Respirations Open Airway
• Breathing RED Tag
• Not Breathing BLACK Tag

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Perfusion

• Radial Pulse present or Capillary Refill is lt 2
  seconds -
• Go To Mental Status
• No Radial Pulse or Capillary Refill gt 2 Seconds
  RED Tag

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Mental Status

• Follows Simple Commands AAOX3
• GREEN
• Does not follow commands, not AAOX3 or is
  Unconscious RED Tag
• Depending on Injuries YELLOW Tag

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START Flow Chart
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Pediatrics Jump START Triage
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JumpSTART Triage

• Triage system adapted for pediatrics lt 8 years
  old, which use a modify version of evaluating
• Respiration
• Perfusion
• Mental Status

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Respiration

• Rate between 15 and 45 BPM
• Go to Perfusion
• Rate over 45 BPM or under 15 BPM RED Tag
• No Respiration
• Open Airway and remove any obstruction
• Still no breathing, than check radial or pedal
  pulse
• No pulse - BLACK Tag
• Pulse present Give 5 respirations
• Breathing begins RED Tag
• No breathing BLACK Tag

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Perfusion

• Peripheral pulse present
• Go to Mental Status
• Peripheral pulse absent
• RED Tag

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Mental Status

• Assess child with AVPU Scale
• (Alert, Verbal, Painful, or Unconscious)
• If unconscious or only responds to painful
  stimuli
• RED Tag
• If child is alert or responds to verbal stimuli
  assess for further injuries -
• YELLOW Tag or GREEN Tag

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JumpSTART Flow Chart
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Secondary Triage with All Risk Triage Tag
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All Risk Triage Tags
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• Contaminated Section
• Must remove if patient is not contaminated
• If strip is not remove patient is considered
  contaminated.

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• Contaminated Section
• When the patients cloths are removed, the strip
  should be placed in the bag for evidence

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Front
Back
1 watch, 2 rings, and 1 wallet

• Personal Property Receipt
• Patient valuables in plastic bag

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Personal Property Receipt
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Front
HMW
R19
Back
John Smith

• Patient Ground Transport Tracking Tag
• Removed by Transport Officer for patient
  tracking

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X
X
X
Mark 1

• Chemical Exposure Symptoms and Treatment
• Salivation
• Lacrimation
• Urination
• Defecation
• G.I. Distress
• Emesis
• Miosis

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X
X
X
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X

• Patient Assessment
• Decontamination
• Area of injury
• WMD type

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1130 180/78 120 14
1130 Normal Saline KVO

• Vital Signs
• Documenting B/P, Pulse, Respiration, and IV
  solution

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• Triage Category
• Remove all of the tags distal to desires color
  and half of the color.
• Above is Yellow Tag

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X
X
X
X
START Triage Method
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John Smith 14801 SW 27 Street Miramar
FL 33027
Personal Information
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References

• Stevens, Kay, and Garber, Debra. Introduction to
  Clinical Allied Healthcare. 2nd ed. Clifton
  Park, New York Thomson Delmar Learning, 1996.
• Jones and Bartlett Publishers. (2004). Florida
  Regional Common EMS Protocols, Sudbury, MA
  Jones and Bartlett.