September 11, 2001 Lessons Learned

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CERT Program Outline

• Disaster Preparedness
• Preparedness Activities
• CERT disaster and non-disaster roles
• Team concept (buddy system)

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CERT Program Outline

• Fire Suppression/Safety
• PASS
• LIES
• Types of Fire Extinguishers

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CERT Program Outline

• Light Search and Rescue
• Scene Sizeup
• Search Documentation

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CERT Program Outline

• Disaster Medical Operations
• Identify the 3 killers
• START System
• Treatment and transport
• Treatment areas

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CERT Program Outline

• CERT Organization
• Incident Command System
• 4 functions under ICS

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CERT Program Outline

• Disaster Psychology
• Dealing with victims of disaster
• Dealing with other workers (Police, Fire, EMS,
  Volunteers, etc.)

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CERT Program Outline

• Terrorism
• BNICE
• HazMat

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CERT Program Outline

• Final Exercise
• Put it all together and work as a team
• Hands on
• Physical part of all the learning

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Disaster Preparedness

• The President has encouraged Americans to
  volunteer to improve and safeguard the nation.
• Areas of emphasis for volunteer efforts
• Natural Disasters
• Crime
• Terrorism

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Types of Disasters

• Natural
• Man-Made
• Technological

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Disaster Preparedness

• CERTs should prepare by
• Identifying potential hazards in their homes,
  workplaces, schools and community.
• Reduce hazards, where possible.
• Make a plan (evacuation, SIP, fire)
• Developing a disaster supply kit.

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Disaster Roles

• CERTs are responsible for the following
• Themselves
• Family
• Neighborhood
• County

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Disaster Roles

• What will or what can you do?????
• Learn confidence, organization and be an asset to
  the community
• Assist first responders in the previously
  mentioned areas (fire suppression, medical
  triage, search and rescue, psychology)

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Disaster Roles

• CERTs should respond by
• Locating and turning off utilities, if safe.
• Extinguishing small fires.
• Treating injuries.
• Conducting light search and rescue.
• Helping to relieve survivor stress.
• Collecting information and data.

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Non-Disaster Roles

• CERT members can
• Distribute preparedness materials.
• Staff booths at special events such as health and
  safety fairs.
• Assist with functions such as parades,
  graduations, and other public events.

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CERT Team

• Work with a partner (buddy system)
• Accountability
• Responsibility
• Work alongside first responders
• Gain trust and respect from community

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Disaster Preparedness Summary

• Make a kit, make a plan and be prepared
• Disaster and Non-Disaster roles
• Teaches teamwork, confidence and responsibility

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Fire Suppression/Safety

• Objectives
• Learn ways to reduce fire hazards
• L.I.E.S.
• Fire size up
• P.A.S.S.

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Fire Suppression/Safety

• Reduce Fire Hazards
• Avoid the electrical octopus.
• Dont run cords under carpets.
• Replace broken or frayed cords.
• Maintain appliances.
• Install a natural gas detector.
• Locate and label gas shutoffs.

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Fire Suppression/Safety

• L.I.E.S.
• Limit the amounts of chemicals
• Isolate the chemicals
• Eliminate unnecessary chemicals
• Separate from other areas

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Fire Suppression/Safety

• Fire Size Up for CERT Members
• Answer these questions
• Can my buddy and I fight the fire safely?
• Do we have the right equipment?
• Are there other hazards?
• Is the building structurally damaged?
• Can we escape?

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Fire Suppression/Safety

• Types of Fire Extinguishers
• Water
• Dry chemical
• Carbon dioxide
• Specialized fire extinguisher

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Fire Suppression/Safety

• Classes of Fires
• A Ordinary combustibles
• B Flammable and combustible liquids
• C Energized electrical equipment
• D Combustible metals

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Fire Suppression/Safety

• P.A.S.S.
• Pull the pin
• Aim the hose
• Squeeze the handle
• Sweep across the fire

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Fire Suppression/Safety

• Summary
• Reduce Hazards
• L.I.E.S.
• Size Up
• P.A.S.S.

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Disaster Medical Operations - Part 1

• Objectives
• CERT principles
• Identify the 3 Killers
• Treatment of the 3 Killers
• START Triage

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Disaster Medical Operations - Part 1

• The 6 hour session, which is part of the full
  24-hour course, is taught by a licensed and
  certified Paramedic. This short course is only
  designed to introduce you to some of the
  objectives of the full course.
• This course is not meant to provide you with any
  life saving skills nor is it meant to encourage
  you to perform any of the duties until the
  complete and proper training is achieved.

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Disaster Medical Operations - Part 1

• CERT Principles
• CERTS are trained and taught to triage and to
  treat life-threatening conditions and other less
  urgent conditions
• CERTs do the greatest amount of good for the
  greatest number of victims in the shortest amount
  of time

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Disaster Medical Operations - Part 1

• The 3 Killers
• Airway Obstruction
• Excessive Bleeding
• Shock

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Disaster Medical Operations - Part 1

• Airway Obstruction
• 1 obstruction is the tongue
• Perform Head-Tilt/Chin-Lift Method

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Disaster Medical Operations - Part 1

• 7 Steps
• At an arms distance, shake the victim by
  touching the shoulder and shout, Can you hear
  me?
• If the victim does not or cannot respond, place
  the palm of one hand on the forehead.
• Place two fingers of the other hand under the
  chin and tilt the jaw upward while tilting the
  head back slightly.

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Disaster Medical Operations - Part 1

• 4) Place your ear over the victims mouth,
  looking toward the victims feet, and place a
  hand on the victims abdomen.
• 5) Look for the chest rise.
• 6) Listen for air exchange.
• 7) Feel for abdominal movement.

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Disaster Medical Operations - Part 1

• Excessive Bleeding
• ?Arterial arteries transport blood under high
  pressure spurting bleeding.
• ?Venous veins transport blood under low
  pressure flowing bleeding.
• ?Capillary also carry blood under low pressure
  oozing bleeding.

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Disaster Medical Operations - Part 1

• Methods to control bleeding
• ?Direct Pressure place pressure on the wound
  with a clean dressing. Maintain pressure by
  wrapping with a clean bandage.
• ?Elevation above the level of the heart.
• ?Pressure Points put pressure on the nearest
  pressure point to slow the flow of blood to the
  wound.

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Disaster Medical Operations - Part 1

• Recognizing Shock
• ?Rapid and shallow breathing (30 times per
  minute)
• ?Capillary refill blanch test (2 seconds)
• ?Failure to follow simple commands such as
  Squeeze my hand.

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Disaster Medical Operations - Part 1

• Controlling Shock
• ?Place victim on back and protect from ground
  temperature (hot or cold). Elevate feet 6-10 and
  maintain open airway.
• ?Control obvious bleeding
• ?Maintain body temperature
• ?Avoid rough or excessive handling.
• ?Do not give victim anything to eat or drink as
  they may be nauseated.

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Disaster Medical Operations - Part 1

• START
• Simple
• Triage
• And
• Rapid
• Treatment

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Disaster Medical Operations - Part 1

• Triage
• French term meaning to sort.
• Initiated by the military and it has proven to be
  effective when
• There are more victims than rescuers
• There are limited resources
• Time is critical

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Disaster Medical Operations - Part 1

• Triage Codes
• (same as local EMS and FDs use)
• Green minor injuries that may or may not
  require professional care
• Yellow injuries not likely life-threatening,
  but will require professional care
• Red life threatening injuries (airway, bleeding
  or shock) that require immediate attention and
  life-saving treatment is urgent.
• Black victim is dead

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Disaster Medical Operations - Part 1

• Summary
• CERT principles
• Identify the 3 Killers
• Treatment of the 3 Killers
• START

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Disaster Medical Operations - Part 2

• Objectives
• Hygiene and Sanitation
• Location of Treatment Areas
• Head to Toe Assessment
• Wound Care
• Other Injuries

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Disaster Medical Operations - Part 2

• Hygiene
• Wash hands frequently using soap and water.
• Wear latex gloves change or disinfect after each
  patient.
• Wear a mask and goggles.
• Keep dressings sterile.
• Avoid contact with body fluids.

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Disaster Medical Operations - Part 2

• Sanitation
• Control disposal of bacterial sources.
• Put waste products in plastic bags, tie off, and
  mark as medical waste.
• Bury human waste.

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Disaster Medical Operations - Part 2

• Location of Treatment Areas
• In a safe area.
• Close to (but upwind and uphill from) the hazard.
• Accessible by transportation vehicles.
• Expandable.

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Disaster Medical Operations - Part 2
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Disaster Medical Operations - Part 2

• Head to Toe Assessments
• Determines the extent of injuries and
• treatment.
• Determines the type of treatment needed.
• Documents injuries.

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Disaster Medical Operations - Part 2

• Head 6. Abdomen
• Neck 7. Pelvis
• Shoulders 8. Legs
• Chest 9. Back
• Arms

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Disaster Medical Operations - Part 2

• Other Wounds
• ?Burns cool the burned area and cover to reduce
  infection.
• ?Amputations - Control bleeding, treat for shock,
  save tissue parts-wrapped in clean cloth-keep
  tissue cool and keep tissue with the victim

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Disaster Medical Operations - Part 2

• Other Wounds cont.
• ?Impaled Objects Immobilize the object, dont
  move or remove control bleeding clean and dress
  wound wrap.
• ?Open Fracture - Do not draw exposed bones back
  into tissue do not irrigate wound immobilize
  cover wound splint fracture without disturbing
  wound place a moist 4" x 4" dressing over bone
  end to prevent drying.

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Disaster Medical Operations - Part 2

• Other Wounds cont.
• ?Sprains, strains and closed fractures -
  Immobilize the injury and joints above and below
  the injury.
• If questionable, treat as a fracture and
  splint.
• Splinting - Support the injured area.
• Splint injury in the position that you find it.
• Dont try to realign bones.
• Check for color, warmth, and sensation.
• Immobilize above and below the injury.

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Disaster Medical Operations - Part 2

• Other Wounds Cont.
• Nasal Bleeding pinch bridge of nose and lean
  forward.
• Hypothermia remove wet clothing wrap victim in
  warm blanket covering head and neck protect from
  weather provide warm, sweet drinks and food to
  conscious victims, place unconscious victims in
  recovery position place victim in warm back if
  conscious and possible.

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Disaster Medical Operations - Part 2

• Summary
• ?Hygiene
• ?Sanitation
• ?Treatment Areas
• ?Head to Toe Assessments
• ?Other Injuries and Care

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Light Search and Rescue Operations

• Objectives
• ?Search and Rescue Goals
• ?Scene size-up
• ?Search and Rescue Techniques
• ?Extrication Concepts

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Light Search and Rescue Operations

• Goals
• ?Rescuer safety is 1 priority
• ?Greatest good for the greatest amount of people
  in shortest amount of time
• ?Rescue lightly trapped victims first
• ?Effective size-up
• ?Victim safety

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Light Search and Rescue Operations

• Size-Up
• Gather Facts 7. Develop Plans of
• Assess Damage Action
• Consider Probabilities 8. Take Action
• Assess Your Situation 9. Evaluate Progress
• Establish Priorities
• 6. Make Decisions

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Light Search and Rescue Operations

• Safety Considerations
• Personnel
• Tools
• Equipment
• Make rescuer safety your primary concern.
• Use a buddy system.
• Be alert for hazards.
• Use safety equipment.
• Rotate teams.

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Light Search and Rescue Operations

• Gather Facts
• Time of event and day of week.
• Type of structure.
• Construction type.
• Weather.
• Hazards.
• Gather facts accurately.

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Light Search and Rescue Operations

• Assess Damage
• CERT mission changes if
• Damage is light.
• Damage is moderate.
• Damage is heavy.
• Consider structure type and age.
• Never enter a structure with heavy damage!

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Light Search and Rescue Operations

• Light

• Moderate

• Heavy

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Light Search and Rescue Operations

• Search Methodology
• Indicates rescuer location
• Prevents duplication of effort

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Light Search and Rescue Operations

• Search Methods
• Call out to victims.
• Use systematic search pattern.
• Stop frequently to listen.
• Triangulate.
• Mark searched areas to document results.
• Report results.

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Light Search and Rescue Operations

• Extrication Concepts
• ?Creating safe rescue environment
• Lift objects out of the way.
• Use tools to move objects.
• Remove debris.
• ?Triaging or stabilizing victims
• ?Removing victims

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Light Search and Rescue Operations

• Extrication Concepts
• ?Assist in self-removal if possible
• ?Use lift or drag techniques
• ?Strength and ability of rescuer is key
• ?Number of victims/rescuers
• ?Condition of victim
• ?Stability of environment

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Light Search and Rescue Operations

• Summary
• ?Search and Rescue Goals
• ?Scene size-up
• ?Search and Rescue Techniques
• ?Extrication Concepts

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CERT Organization

• Objectives
• CERT Organization
• Incident Command System
• Documentation

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CERT Organization

• ?Maintain safety of disaster workers
• ?Provide clear leadership and organizational
  structure
• ?Improve effectiveness of rescue efforts
• ?Provides common terminology
• ?Effective communication among team members
• ?A well-defined management structure
• ?Accountability

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CERT Organization

• CERT Organization Objectives
• ?Identifies the scope of the incident (What is
  the problem?)
• ?Determines an overall strategy (What can we do
  and how will we do it?)
• ?Deploys teams and resources (Who is going to do
  what?)
• ?Documents actions and results

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CERT Organization

• Basic ICS Structure

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CERT Organization
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CERT Organization

• Responsibilities for Documentation
• ?Provide command post with ongoing information
• ?Document incident status
• ?Incident locations
• ?Access routes
• ?Identified hazards
• ?Support locations

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CERT Organization

• Documentation Forms
• ?Damage Assessment Survey
• ?Personnel Resources
• ?Equipment Resources
• ?Incident Briefing
• ?Message Form
• ?Incident Status Record
• ?Site Map and Building Plans
• ?Victim Treatment Area Record

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CERT Organization

• Summary
• CERT Organization
• Incident Command System
• Documentation

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Disaster Psychology

• A key to being truly prepared
• CERT members prepare themselves for their roles
  before, during and following a disaster by
  learning about the possible impacts of a disaster
  on themselves and others, emotionally and
  physically.

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Disaster Psychology

• Objectives
• Describe disaster and post-disaster emotional
  environments
• How to deal with their own stress and the stress
  of disaster survivors

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Disaster Psychology

• Psychological Symptoms
• Irritability, anger
• Self-blame, blaming others
• Isolation, withdrawal
• Fear of recurrence
• Feeling stunned, numb, or overwhelmed
• Feeling helpless
• Mood swings
• Sadness, depression, grief
• Denial
• Concentration, memory problems
• Relationship conflicts/marital discord

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Disaster Psychology

• Physiological Symptoms
• Loss of appetite
• Headaches, chest pain
• Diarrhea, stomach pain, nausea
• Hyperactivity
• Increase in alcohol or drug consumption
• Nightmares
• Inability to sleep
• Fatigue, low energy

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Disaster Psychology

• Team Well-Being
• Provide pre-disaster stress management training.
• Brief personnel before response.
• Emphasize teamwork.
• Encourage breaks.
• Provide for proper nutrition.
• Rotate.
• Phase out workers gradually.
• Conduct a brief discussion.
• Arrange for a post-event debriefing.

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Disaster Psychology

• Reducing Stress
• Get enough sleep.
• Exercise.
• Eat a balanced diet.
• Balance work, play, and rest.
• Allow yourself to receive as well as give.
  Remember that your identify is broader than that
  of a helper.
• Connect with others.
• Use spiritual resources.

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Disaster Psychology

• Critical Incident Stress Debriefing
• Introduction and a description
• Review of the factual material
• Sharing of initial thoughts/feelings
• Sharing of emotional reactions to the incident
• Instruction about normal stress reactions
• Review of the symptoms
• Closing and further needs assessment

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Disaster Psychology

• Traumatic Crisis
• An event in which people experience or witness
• Actual or potential death or injury to self or
  others.
• Serous injury.
• Destruction of homes, neighborhood, or valued
  possessions.
• Loss of contact with family/close relationships.

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Disaster Psychology

• Stabilizing Individuals
• Assess the survivors for injury and shock.
• Get uninjured people involved in helping.
• Provide support by
• Listening.
• Empathizing.
• Help survivors connect with natural support
  systems.

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Disaster Psychology

• Avoid Saying.
• I understand.
• Dont feel bad.
• Youre strong/Youll get through this.
• Dont cry.
• Its Gods will.
• It could be worse or At least you still have .
  . .

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Disaster Psychology

• Summary
• Describe disaster and post-disaster emotional
  environments
• How to deal with their own stress and the stress
  of disaster survivors

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Terrorism

• Objectives
• Define Terrorism
• Terrorist Weapons
• Preparing for Terrorism
• Procedures

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Terrorism

• What is Terrorism?
• The unlawful use of force or violence committed
  by a group or individual against persons or
  property to intimidate or coerce a government,
  the civilian population, or any segment thereof,
  in furtherance of political or social objectives.
• --U.S. Department of Justice

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Terrorism

• Examples of Terrorism
• ?New York City and The Pentagon (2001)
• ?Anthrax in the U.S. Mail (2001)
• ?Atlanta Olympic Games (1996)
• ?Bombing of the Murrah Federal Building on OKC
  (1995)
• ?Bombing of World Trade Center (1993)

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Terrorism

• Terrorist Goals
• Mass casualties
• Loss of critical resources
• Disruption of vital services
• Disruption of the economy
• Individual and mass panic

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Terrorism

• Terrorist Weapons
• Biological
• Nuclear
• Incendiary
• Chemical
• Explosive

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Terrorism

• Biological Weapons
• ?Found in nature, but weaponized to be
  disseminated
• ?Targets People, animals, crops
• ?Routes of exposure Inhalation, ingestion,
  absorption
• ?Agents
• May take days or weeks to be confirmed.
• May spread far beyond initial contamination
  point.
• Considered high risk.

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Terrorism

• Nuclear Weapons
• Much different than conventional weapons
• Many casualties
• Very large area affected
• Long-term health effects
• Considered relatively low risk
• RDDs (Radiation Dispersal Devices)
• Conventional explosive with radioactive element
• Radiological materials readily available
• Considered moderate to high risk

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Terrorism

• Incendiary Devices
• Used to initiate combustion
• Easy to make
• Easy to use
• Considered high risk/low impact
• Three basic components
• An igniter or fuse
• A container or body
• An incendiary material or filler

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Terrorism

• Chemical Agents
• Five types
• Blister Agents (Mustard Gas)
• Blood Agents (Hydrogen Cyanide)
• Choking Agents (Chlorine)
• Nerve Agents (VX, GB, Sarin)
• Riot-Control Agents (CS-tear gas, capsicum-pepper
  spray)
• Components readily available
• Onset of symptoms from immediate to 18 hours
• Considered moderate risk

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Terrorism

• Explosives
• Terrorists weapons of choice
• Can be
• Military munitions
• Improvised explosive devices
• Considered high risk

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Terrorism

• B-NICE Environmental Indicators
• Sick or dead animals, fish, or birds
• Unscheduled spraying
• Vapor clouds or mists
• Absence of crops, wildlife, or insects
• Out of place and unattended packages, boxes, or
  vehicles
• Packages that are leaking
• Unusual materials or equipment
• Small explosions that disperse liquids, mists, or
  gases
• Unusual odors or tastes

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Terrorism

• Physical Indicators
• Many casualties without signs of obvious trauma
• Victims who are exhibiting similar symptoms
• Large numbers seeking medical attention

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Terrorism

• Preparing for Terrorism
• ?Assembling a disaster supply kit.
• ?Identify a safe room and meeting place outside
  of the home or workplace
• ?Develop a family communication plan
• ?Learn shelter-in-place procedures

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Terrorism

• Shelter In Place Procedures
• ?Shut off ventilation system.
• ?Go to safe room with disaster supply kit.
• Duct tape plastic sheeting over openings where
  outside air can come in.
• Seal with duct tape other areas where air can
  come in.
• Wet towels at bottom of doorways.
• Listen to battery-powered radio for all clear.

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Terrorism

• CERT Guiding Principles
• ?Team safety is the number one priority.
• ?Always do a thorough size up.
• What are the dangers?
• What are team capabilities?
• What are team limitations?
• ?Do not touch it!
• ?Move away from the object or area.
• ?Report it to authorities.

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Terrorism

• Self-Care
• At the incident
• TIME DISTANCE SHIELDING
• Limit exposure time.
• Increase the distance from the hazard.
• Add shielding.

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Terrorism

• Basic Decontamination Procedures
• Leave the contaminated area.
• Take decontamination action.
• Remove everything (all clothes, jewelry, etc.)
  place in a bag and mark it (name, location)
  removes approximately 60 of contaminant.
• Wash hands before using them to shower (always
  use soap) removes another 15 of contaminate.
• Shower or flush with cool water.
• Blot dry.
• Report for decontamination.

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Terrorism

• Summary
• Objectives
• Define Terrorism
• Terrorist Weapons
• Preparing for Terrorism
• Procedures