DISASTER NURSING Adults and adolescents Ø Adults and adolescents with

witnessed collapse of children likely asphyxia arrest (e.g.

BASIC LIFE SUPPORT and infants drowning)
A.O 168 s,. 2004 – NATIONAL POLICY ON HEALTH Ø Unwitnessed collapse of
EMERGENCIES AND DISASTERS If you are ALONE with no children and infants
● Created Health Emergency Management Staff mobile phone, leave the victim
- Acts as DOH coordinating unit and to activate emergency response 1. Give 2 minutes (5
OPCEN for all health emergencies and system and get cycles) of CPR
coordinates mobilization of resources AED/emergency equipment 2. Leave the victim to
before beginning CPR activate emergency response
RA 10871 also known as “SAMBOY LIM” Law system and get the aed
- Basic life support for basic education Otherwise, send someone and 3. Return to the child or
students. (all public and private basic begin CPR immediately; use infants resume CPR, use the
education schools operating nationwide to the AED as soon as it is AED as soon as it is available
provide their students with basic life support available
training)

A.O 155 s. 2004 – “Basic Life Support Training is

mandatory to all health workers”
2. INFORMATION TO BE REMEMBERED IN
ACTIVATING MEDICAL ASSISTANCE:
HEMB GOAL: “At least one member of each household
● WHAT happened?
shall be trained in BLS”
● LOCATION?
● NUMBER of persons injured?
1. Survey the scene
● EXTENT of injury and first aid given?
2. Activate Medical Assistance (AMA)
● The TELEPHONE no. from where you are
3. Initial Assessment of the victim
calling?
4. Secondary assessment of the victim
● PERSON who activated medical assistance must
5. Referral for further evaluation and management
identify him/herself and drop the phone last…
1. SURVEY THE SCENE
3. DO A PRIMARY SURVEY OF THE VICTIM
Once you recognize that an emergency has occurred and
Check for RESPONSIVENESS
decide to act, you must make sure the scene of the
Check CIRCULATION (carotid pulse)
emergency is safe for you, the victim’s and any
RESPONSIVENESS shall be assessed by calling the victims
bystander/s.
attention by tapping/shaking the shoulder vually checking
a. Is the scene safe?
the victim’s movement.
b. Is the victim a possible COVID-19 case?
c. Are you wearing PPE such as gloves, facemask and
OPEN THE AIRWAY
face shield?
Put the person on his or her back on a firm surface. Kneel
next to the patient’s neck and shoulders. Open the person’s
ELEMENTS OF THE SURVEY THE SCENE
airway using the head tilt-chin lift make sure that the
· Scene safety
patient is cover with mask or cloth in more than 10 seconds
· Mechanism of injury (trauma case)
· Nature of illness (medical case)
If patient is suspected with COVID Direct mouth to mouth
· Determine the number of patients and additional
ventilation is not advised and shall be avoided
resources

PERFORM COMPRESSIONS
In some emergency, you will have enough time to call for
When performing chest compressions, proper hand
specific medical advice before administering first aid. But
placement is very important.
in some situations, you will need to attend to victim first.

Place one hand on top of the other and interface the fingers.
EMS shall be immediately contacted if the person is
Lock your elbows and using your body’s weight, compress
unresponsive
the victim’s chest. The depth of compressions should at
least 2 INCHES. Count aloud as you compress 30 TIMES
Ø During one rescuer resuscitation, if possible, phones
at the rate of about 30 COMPRESSIONS for every 2
with hands-free option shall be used to communicate with
SECONDS or approximately 100-120 compressions per
the EMS dispatch center during the CPR
minute.
Ø Lay rescuers shall strictly follow the instructions given
PERFORM RESCUE BREATHING
by the EMS dispatch center
With the on going pandemic, rescue breathing or the
mouth-to-mouth breathing is not advisable.
CALL FIRST CPR FIRST

4. DO A SECONDARY ASSESSMENT OF THE

VICTIM
· Check vital signs – every 15 minutes if stable condition,
and every 5 minutes if unstable
· Head to toe examination
D- deformity BASIC LIFE SUPPORT
C- contusion Is a series of emergency lifesaving procedures that are
A- Abrasion carried out to prolong the life of a victim with life
P – punctures threatening emergencies
B- Burn
T- tenderness THREE KIDS OF LIFE SUPPORT
L – laceration 1. Basic life support (BLS)
S – swelling 2. Advance Cardiac Life Support (ACLS)
3. Prolonged Life Support (PLS)
5. REFERRAL OF THE VICTIM FOR FURTHER
EVALUATION AND MANAGEMENT ADULT CHAIN OF SURVIVAL (In hospital arrest)
- It refers to the transfer of a victim to a hospital or health Early recognition and prevention – Activation of
care facility if necessary for definitive treatment. Emergency Response – High quality CPR –
Defibrillations – Post cardiac arrest care – Recovery
GOLDEN RULES IN GIVING EMERGENCY CARE
(DO’S) ADULT CHAIN OF SURVIVAL (Outside hospital
1. Do obtain consent when possible Activation of Emergency Response – High quality CPR
2. Do remember to identify yourself – Defibrillations- Advanced Resuscitation - Post
3. Do be as calm and direct as possible cardiac arrest care – Recovery
4. Do provide comfort and emotional support
5. Do respect the victim (modesty and privacy) PEDIATRICS CHAIN OF SURVIVAL (Inside hospital
6. Do care for the most serious injuries first arrest)
7. Do handle the victim to a minimum Early recognition and prevention – Activation of
8. Do assist the victim on medication Emergency Response – High quality CPR – Advanced
9. Do keep on lookers away from the injured person Resuscitation - Post cardiac arrest care – Recovery

GOLDEN RULES IN GIVING EMERGENCY CARE PEDIATRICS CHAIN OF SURVIVAL (Outside hospital
(DONT’S) arrest)
1. Do NOT let the victim see bis/her injuries Prevention – Activation of Emergency Response – High
2. Do NOT leave the victim alone except to get help quality CPR – Advanced Resuscitation - Post cardiac
3. Do NOT assume that the victim’s obvious injuries are arrest care – Recovery
the only one ________________________________________________
4. Do NOT make unrealistic promises BODY SYSTEMS
5. Do NOT trust the judgment of a confused person
(CIRCULATORY SYSTEM)
BASIC PRECAUTIONS IN DISEASE PREVENTION - Consists of the heart, blood vessels, and blood
HAND WASHING - Delivers oxygen and nutrients to the body’s tissues and
- Hand washing also known as hand hygiene, is the act of removes waste products
cleaning one’s hands with soap and water to remove
viruses/bacterial/microorganisms, dirt, grease or other RESPIRATORY SYSTEM
harmful and unwanted substances stuck to the hands - The network of organs and tissues that help you breathe
- Delivers oxygen to the body
PERSONAL PROTECTIVE EQUIPMENT - Remove carbon dioxide from the body
- Commonly referred to as PPE is equipment worn to - It includes your airways, lungs and blood vessels
minimize exposure to hazards that cause serious workplace
injuries and illnesses FUNCTIONS OF RESPIRATORY SYSTEM
VENTILATION – passage of air into and out of the lungs
INSPIRATION – Inhalation or breathing in
EXPIRATION – exhalation or breathing out
DISINFECTION RESPIRATION – actual exchange of oxygen and carbon
- Is the treatment of surfaces/equipment using physical or dioxide in the alveoli as well as the tissues of the body
chemical means such that the amount of microorganisms
present is reduced to an acceptable level. ● Air that enters the lungs contains:
- 21% oxygen (O2)
TRANSMISSION-BASED PRECAUTIONS - Trace of carbon dioxide (CO2)
CONTACT PRECAUTIONS ● Air inhaled from the lungs contains:
- Use contact precautions for patients with known or - 16% O2
suspected infections that represent an increased risk for - 4% CO2
contact transmission
NERVOUS SYSTEM
DROPLET PRECAUTIONS · Composed of the brain, spinal cord and nerves
- Use droplets precautions for patients known or suspected · Two major functions – communication and control
to be infected with pathogens transmitted by respiratory · Lets a person be aware of and react to the environment
droplets that are generated by a patient who is coughing, · Coordinates the body’s responses to stimuli and keeps
sneezing, or talking. body systems working together
 1. S- SPONTANEOUS signs of circulation are restored
CLINICAL DEATH 2. T- TURED over to medical services or properly
0-1 min – cardiac irritability trained and authorized personnel
1-4 min – brain damaged not likely 3. O – OPERATOR is already exhausted and cannot
4-6 min – brain damage possible continue CPR
BIOLOGICAL DEATH 4. P – PHYSICIAN assumes responsibility (declares
6-10 min – brain damaged very likely deaths, takes over)
Over 10 min – irreversible brain damaged 5. S- SCENE becomes unsafe
__________________________________________ 6. S – SIGNED waver to stop CPR
MODULE 3
CARDIAC ARREST AND AEDs (Automated External Defibrillator)
CARDIOPULMONARY RESUSCITATION - Are sophisticated, computerized devices that can analyze
a heart rhythm and prompt the user to deliver a shock when
EFFECTIVE AND HIGH-QUALITY CPR necessary. These devices only require the user to turn the
· Adequate RATE of chest compression between (100 to AEDon and follow the audio instructions when prompted.
120 min)
· Adequate DEPTH (push hard; push fast) FUNCTIONS OF AED
· Allowing complete recoil after each chest compression · Controlled electrical shock
Minimizing interruptions between compression · May restore an organized rhythm
· Giving ventilation using the C and E or V and E · Enables heart to contract & pump blood
technique)
· Rotating the task of chest compression in multiple TYPES OF AED
rescuers 1. AED Trainer
2. Semi-automated defibrillator
CARDIAC ARREST 3. Fully automated defibrillator
- is the condition in which circulation ceases and vital
organs are deprived of oxygen HOW DOES AED WORKS?
· A brief high voltage electrical shock
3 CONDITIONS OF CARDIAC ARREST · Through the heart between pads on the chest
· Cardio vascular collapse · Shock briefly stops electrical heart activity
· Ventricular fibrillation · May restart beating with a normal rhythm
· Cardiac standstill · But not everyone can be saved, even with defibrillation

3 CLINICAL FINDINGS
● No response
● No breathing
CARDIOPULMONARY RESUSCITATION (CPR) ● No pulse
- This is a combination of chest compressions and rescue
breathing. These must be combined for effective SHOCKED RHYTHMS
resuscitation of the victim of cardiac arrest ● Ventricular fibrillation
● Pulseless ventricular tachycardia
OTHER TECHNIQUES OF CPR
1. Cough CPR NON-SHOCKABLE RHYTHMS
2. Compression only CPR ● Asystole
3. Precordial thump – not used for unwitnessed out-of- ● Pulseless electrical activity (PEA)
the hospital arrest
EARLY DEFIBRILLATION is critical for victims of
CRITERIA FOR NOT STARTING CPR sudden cardiac arrest because;
1. No PPE, No CPR ● The most frequent rhythm in sudden cardiac
2. The patient has valid: “DO NOT RESUSCITATE” arrest is Ventricular fibrillation
order ● The most effective treatment for VF is
3. The patient has signs of irreversible death defibrillation
a. Rigor mortis ● Also indicated for pulseless ventricular
b. Dependent lividity tachycardia
c. Decapitation ● Defibrillation is most likely to be successful if it
d. Decomposition occurs within minutes of collapse (sudden cardiac
arrest)
4. No physiological benefit can be expected ● Defibrillation may be ineffective if it is delayed
5. Withholding attempts to resuscitate in the delivery ● VF deteriorate to asystole if not treated
room is appropriate for newly born infants
a. Confirmed gestation < 23 weeks or SHOCK SUCCESS
birth weight <400gms - Termination of VF for at least 5 seconds following the
b. Anencephaly shock
c. Confirmed trisomy 13 or 18 - VF frequently recurs after successful shocks and these
recurrence should not be equated to shock failure
WHEN TO STOP CPR
VENTRICULAR FIBRILLATION (VF) RESPIRATORY ARREST AND RESCUE
● Common and treatable initial rhythm in adults BREATHING
with witnessed cardiac arrest ● Respiratory Rate
● Survival rates are highest when immediate ● Rhythm/ regular or irregular
bystander CPR is provided and defibrillation ● Quality/ characteristic of breathing
occurs within 3-5 minutes of collapse ● Depth of breathing
● RAPID DEFIBRILLATION is the treatment of
choice RESPIRATORY ARREST - is a condition in which
● Rhythm causing all sudden cardiac arrest breathing stops or is inadequate
● Useless quivering of the heart – no blood flow
● Myocardium is depleted of oxygen and metabolic 1. OBSTRUCTION
substrates ● Anatomical
● Mechanical
PULSELESS VENTRICULAR TACHYCARDIA 2. DISEASES
● RATE – greater than 180 beats per minute ● Bronchitis
● Rhythm – very wide QRS complex in ECG ● Pneumonia
tracings and originates in the ventricles ● COPD
● The patient will be pulseless ● Diphtheria
3. OTHER CAUSES:
● Electrocutio
● Circulatory Collapse
● Stangulation
CRITICAL CONCEPTS: ● Chest Compression by other physical force
The 4 Universal Steps of AED Operation
1. Power on 1. HEAD-TILT-CHIN LIFT
2. Attach Pads 2. JAW THRUST MANEUVER
3. Analyze
4. Shock RESCUE BREATHING- Is a technique of delivering air
into a person’s lungs to supply him/her with the oxygen
● Attach pads needed to survive
● keep following voice prompts ● Given to victims who are not breathing or
(Where to place pads on adults and children over 55 pounds inadequate but still have pulse
or 8 years old ANTERIOR-ANTERIOR) ● Crucial tool to revive the individual or keep him
(Where to place on infants or children under 55 pounds or 8 or her until the help comes
years old ANTERIOR POSTERIOR)
OXYGEN DELIVERY EQUIPMENTS
● Clear the victim and press analyze button (no one NASAL CANNULAS
touches the patient analyzing heart rhythm) ● Use in stable pt.
● Press the shock button if instructed (I am ● Provides 24-44% of inspired oxygen
shocking on three, everybody clear 1,2,3! Clear!) ● Flow rate set at 1-6L/min
● Press the shock button. (shocked delivered)
SIMPLE FACE MASK
SHOCK ENERGY FOR DEFIBRILLATION ● Provides 40-60% of O2
● BIPHASIC: manufacturer recommendation (eg. ● Flow rate set at 8-10L/min
Initial dose of 120-200 J) if unknown, use
maximum available NON-REBREATHER MASK
● Second subsequent doses should be equivalent ● Patient with 8bpm and below or above 25bp
and higher doses may be considered (adult)
● MONOPHASIC: 360 J ● Delivers up to 90% of inspired oxygen
● Flow rate set at 10-15L/min
SPECIAL CONDITIONS THAT AFFECT THE USE ● Should have a good mask to face seal
OF AED ● Use for pt with moderate difficulty of breathing
· Presence of chest hair
· Presence of water (wet or submerged patients) BAG VALVE MASK (BVM) with Reservoir
· Pacemakers (patients with implantable device) ● Delivers nearly 100% of inspired oxygen when
· Transdermal medications patches connected to oxygen
· Pediatric patients ● Flow rate set at 15L/min
● Use in severely dyspneic to apneic patients
DRUG THERAPY
- EPINEPHRINE IV/IO dose: 1mg every 3-5 minutes OXYGEN CYLINDER SIZES
- AMNIODARONE IV/IO: First dose – 300 mg bolus;
SIZE Volume, L Constant
second dose – 150 mg
- LIDOCAINE IV/IO dose: first dose 1-1.5 mg/kg; second D 350 0.16
dose – 0.5-0.75 mg/kg
________________________________________________ Super D 500
MODULE 5
 MODULE 6
E 625 0.28
FOREIGN BODY AIRWAY OBSTRUCTION
M 3,000 1.56 MANAGEMENT

G 5,300 2.41 FOREIGN BODY AIRWAY OBSTRUCTION - is a

condition when solid material like chunked foods, coins,
H, A, K 6,900 3.14 vomitus, small toys, etc., are blocking the airway

(Gauge pressure in psi-safe residual pressure) x constant / CAUSES OF AIRWAY OBSTRUCTION:

flow rate in L/min = duration of flow in minute 1. Improper chewing of large pieces of food
2. Excessive alcoholic intake:
AIRWAY ADJUNCTS a. Relaxation of tongue back into the throat
- Prevent obstruction of the upper airway by the b. Aspirated vomitus (stomach content)
tongue 3. Presence of loose upper and lower dentures
- Allow the passage of air and oxygen to the lungs 4. For children who are running while eating
5. For smaller children of hand-to-mouth stage left
OROPHARYNGEAL AIRWAY unattended
● Indicated in unconscious patient (no gag reflex)
● Keep the tongue from blocking the upper airway TYPES OF AIRWAY OBSTRUCTION
● Use with bag valve mask ventilation 1. ANATOMICAL OBSTRUCTION- It happens when
● Facilitates easy suctioning the tongue drops back and obstructs the throat. Other
causes are acute asthma, croup, diphtheria, swelling and
NASOPHARYNGEAL AIRWAY cough (WHO)
● Used on conscious patients who can’t maintain
an airway 2. MECHANICAL OBSTRUCTION - when foreign
● Can be used on patients with a gag reflex objects lodge in the pharynx or airways; fluid accumulate
● Should not be used on patients with possible skull in the back of the throat
fractures
CLASSIFICATION OF AIRWAY OBSTRUCTION
WAY TO VENTILATE LUNGS 1. MILD OBSTRUCTION
- BAG VALVE MASK DEVICE ● Good air exchange
ONE PERSON BAG VALVE MASK ● Responsive and can cough forcefully
● Insert on oral airway ● May wheeze between coughs
● Place mask on patient’s face ● Has increased respiratory difficulty and possibly
● Maintains seal using the C and E technique cyanosis
● Squeeze bag to deliver ventilation
TWO-PERSON BAG VALVE MASK 2. SEVERE OBSTRUCTION
● Insert on oral airway ● Poor or no air exchange
● Place mask on patient’s face ● Weak or ineffective cough or no cough at all
● One caregiver maintains seal using the double ● High-pitched noise while inhaling or no noise at
C and E technique all
● Squeeze bag to deliver ventilation ● Increased respiratory difficulty
● Cyanotic (turning blue), unable to speak
- On Rescue breathing for children with a pulse but absent ● Presence of universal sign of choking
or inadequate respiratory effort, it is reasonable to give 1 ● Movement of air is absent
breath every 3 seconds (40 breaths/min)
- On Rescue breathing for infants with a pulse but absent or UNIVERSAL SIGNS OF CHOKING- a sign wherein the
inadequate respiratory effort, it is reasonable to give 1 victim is clutching his/her neck with one or both hands and
breath every 2 seconds (60 breaths/min) grasping for breath.
- Conduct ventilation via bag-tube connected to a HEPA
filter at a rate of 1 breath every 6 seconds (10 breaths/min) ABDOMINAL THRUST- an emergency procedure for
removing a foreign object lodged in the airway that is
SPECIAL CONSIDERATION preventing a person from breathing
● Avoid pressing soft tissue under the chin - use for conscious patients
● Don’t use the thumb to lift the chin REMEMBER!
● Don’t close the victim’s mouth (unless mouth to A.T should not be used in infants under 1 year of
nose is the technique) age due to risk of causing injury
● Each rescue breath should give enough air to
make the chest rise and be given at 1 second COMPLICATIONS OF ABDOMINAL THRUST
● Avoid delivering more breaths (more than the ● Incorrect application can damage the chest, ribs,
number recommended) or breaths that are too and internal organs
large or too forceful ● May also vomit after being treated with the
● Rescuers should take a normal breath (not a deep abdominal thrust
breath) mouth to mouth or mouth-to-barrier ● They should be examined by a physician to rule
device rescue breaths. out any life-threatening complications
________________________________________________
 FBAO MANAGEMENT UNDER SPECIAL position
CIRCUMSTANCES
● Obviously pregnant If foreign object is not visible, NO BLIND FINGER
● Very obese patient SWEEP, NO DIRECT MOUTH TO MOUTH RESCUE
- instead of using abdominal thrusts, chest thrusts are used BREATH
for this group of people
● The fists are placed against the middle of the ADMINISTRATION OF CHEST THRUST
breastbone and pressing the patient’s chest with With pulse and breathing:
backward thrust ● Place in recovery position
● If the victim is unconscious (adult, child or ● Monitor / observe and advise the victim to seek
infant) the chest thrust are similar to those used in through medical consultation
CPR

FBAO MANAGEMENT (UNCONSIOUS ADULT)

If victim becomes unconscious:
● Carefully lay the victim down while
simultaneously checking the victim's oral cavity
● Activate emergency medical services
● Perform 30 chest compression
● Check oral cavity for presence of obstruction
● If foreign object is visible, perform a finger
sweep, then carefully remove the gloves inside
out with the foreign object in it and immediately
change the pair of gloves. Check pulse and
breathing and place the victim in a recovery
position
● If foreign object is not visible, NO BLIND
FINGER SWEEP, NO DIRECT MOUTH TO
MOUTH RESCUE BREATH

If foreign object is still not visible:

● Repeat chest compression
● Assess pulse and breathing after 2 mins
approximately 5 cycles of chest compression

If still unresponsive, no pulse, no breathing:

● GO TO ADULT CARDIAC ARREST
ALGORITHM

With pulse and breathing:

● Place in recovery position
● monitor/observe and advise the victim to seek
thorough medical consultation

ADMINISTRATION OF BACK SLAP & CHEST

THRUST (CONSCIOUS PATIENT)
● Using the heel of your dominant hand, deliver 5
back slaps in the middle of the infant’s shoulder
blades
● Locate the compression site used in conventional
infant CPR
● Deliver 5 chest thrust

FBAO MANAGEMENT FOR

INFANT( UNCONSIOUS)
If victim becomes unconscious:
● Carefully lay the victim down while
simultaneously checking the victims oral cavity
● Activate emergency medical services
● Perform 30 chest compression
● Check oral cavity for presence of obstruction

If foreign object is visible, perform finger sweep then

carefully remove the gloves inside out with the foreign
object in it and immediately change pair of gloves. Check
pulse and breathing and place the victim in a recovery
 HEART ATTACK

SIGNS AND SYMPTOMS

● Chest pressure, squeezing or pain that lasts longer
than a few minutes or goes away and come back
● Pain radiating to shoulders, neck jaw and arms
● dizziness sweating, nausea
● Shortness of breath

INTERVENTIONS
1. Call for help
2. Help victim into a comfortable position
3. Assist him or her in taking any maintenance
medications
4. Monitor breathing

STROKE (BRAIN ATTACK)

F-ace
A-rm
S-peech
T-ime

SIGNS AND SYMPTOMS

● Weakness, numbness or paralysis of face or one
side of the body
● Blurred or decreased vision
● Problem speaking,
● Dizziness or loss of balance
● Sudden, severe headache

INTERVENTIONS
1. Seek medical care
2. If responsive, lay patient on back with head and
shoulders slightly elevated
3. If unresponsive, open airway, check breathing
and provide care
4. If unresponsive patient is breathing, place in a
recovery position

BREATHING DIFFICULTY
MEDICAL EMERGENCIES SIGNS AND SYMPTOMS
(PRE-HOSPITAL) ● Abnormally fast or slow
● Abnormally deep or shallow
SHOCK ● Noisy breathing: wheezing, gurgling, crowing,
snoring
TYPES OF SHOCK ● Pause when speaking to catch breath
1. CARDIOGENIC SHOCK - due to heart CAUSES:
problem ● Asthma
2. HYPOVOLEMIC SHOCK - caused by blood ● Hyperventilation
volume loss
3. ANAPHYLACTIC SHOCK - caused by INTERVENTIONS
allergic reaction 1. Position of comfort
4. SEPTIC SHOCK - due to infection 2. Seek medical care
5. NEUROGENIC SHOCK - caused by damage to 3. Assist with any medications
the nervous system 4. May provide O2 therapy if available
5. If hyperventilating, have victim inhale, hold
SIGNS AND SYMPTOMS breathe then exhale slowly
Recognizing shock:
- Altered mental status SEIZURE
- pale , cold and clammy skin SIGNS AND SYMPTOMS
- Nausea and vomiting ● Sudden falling
- Rapid breathing and pulse ● Unresponsiveness
- Unresponsive in later stage ● Rigid body and arching
● Jerky muscle movement
INTERVENTIONS CAUSES:
1. Treat severe and life threatening injuries - Heatstroke, epilepsy, hypoglycemia, high fever
2. Position victim on his or her back
3. Raise victim’s legs 6 to 12 inches high INTERVENTIONS
4. Prevent heat loss by putting a blanket over the 1. Protection from injury
body 2. Loosen clothing
3. Place in a recovery position after seizure
● Place the victim in shock position 4. Seek medical care if:
● Keep the person warm and comfortable - Unknown reason or longer than 5
● Turn the victims head to one side if neck injury is minutes
not suspected - Slow to recover, second seizure or
difficulty of breathing
 - Pregnant or with medical condition ● Nausea and vomiting
● Flushed face
HYPOGLYCEMIA INTERVENTIONS
SIGNS AND SYMPTOMS 1. Monitor breathing
Low - blood sugar (hypoglycemia) 2. Look for any injuries
● Poor coordination 3. Recovery position
● Anger 4. If victim becomes violent seek medical care
● Pale colour 5. If victim becomes unresponsive, open the airway,
● Confusion check breathing and provide care
● Sudden hunger
● Excessive sweating ANIMAL AND HUMAN BITE
● Trembling, seizure, unresponsiveness SIGNS AND SYMPTOMS
● Determine if victim was exposed to rabies
INTERVENTIONS ● Spread through saliva by bite or lick
1. Give sugar ● Consider rabies if
2. If condition does not improve in 15 minutes, - Animal attacked without provocation
repeat giving sugar - Animal behaving strangely
3. Seek medical care - High-risk species
● Animal should be captured or confined for
HYPERGLYCEMIA observation
SIGNS AND SYMPTOMS INTERVENTIONS
High blood sugar (hyperglycemia) 1. Clean wound with soap and water
● Drowsiness 2. Control bleeding and cover wound with sterile
● Extreme thirst, frequent urination dressing
● Warm and dry skin 3. Seek medical care for cleaning, tetanus shot or
● Vomiting rabies vaccine
● Fruity, sweet breath odor
● Rapid breathing SNAKE BITE
● responsiveness SIGNS AND SYMPTOMS
INTERVENTIONS ● dizziness/fainting
1. Check blood sugar ● Increase thirst
2. Increase fluid intake ● Headache
3. Seek medical care if symptoms does not improve ● Difficulty of breathing
in 15 minutes ● Burning sensation and swelling on wound site
● Rapid pulse/low blood pressure
HEAT STROKE ● Sweating
SIGNS AND SYMPTOMS ● Convulsion
● Extremely hot, dry skin ● Muscle weakness
● Severe thirst INTERVENTIONS
● Confusion 1. Remain calm, remove jewelry and tight clothing
● Seizure 2. Clean the wound but don't flush it with water,
● Unresponsiveness cover it with clean dry dressing
INTERVENTIONS 3. Position yourself so that the bite is at or below
1. Stop activity and rest in cool place the level of your heart
2. Seek medical care 4. Don’t use tourniquet or apply ice
3. If unresponsive, open airway, check breathing, 5. Don’t cut the wound or attempt to remove the
and provide care venom
4. Rapidly cool patient with cool patient with cool 6. Don’t drink caffeine or alcohol which could
wet towels, fanning and cold packs speed the rate at which your body absorbs venom
7. Try to remember the color and shape of the snake
HEAT EXHAUSTION
SIGNS AND SYMPTOMS FOOD POISONING
● Heavy sweating SIGNS AND SYMPTOMS
● Severe thirst ● Nausea
● Headache ● Vomiting
● Nausea and vomiting ● Watery diarrhea
INTERVENTIONS ● Abdominal pain and cramps
1. Stop activity and rest in cool place ● Fever
2. Remove excess clothing INTERVENTIONS
3. Provide hydration 1. Replacement of lost fluids
4. Have victim lie down, raise legs 6 to 12 inches 2. Antibiotics
5. Apply cool, wet towels to victim
6. Seek medical care if condition persists CHEMICAL POISONING
a. Inhalation
● Use a fan to lower temperature b. Ingestio
● Elevate feet c. Exposure
● Give fluids d. contact
● Apply cold compresses
● Have the person lie down SIGNS AND SYMPTOMS
● Difficulty breathing
ALCOHOL INTOXICATION ● Changes in skin color
SIGNS AND SYMPTOMS ● Headaches or blurred vision
● Odor of breath ● Irritated eyes, skin or throat
● Unsteadiness ● Sweating
● Confusion ● Dizziness
● Slurred speech ● Breath odor: bitter almond (cyanide poisoning)
 garlic odor (arsenic poisoning) - Swelling
● Nausea, vomiting, diarrhea - Reddening
- Warmth
- Throbbing pain
- Pus discharge

FIRECRACKER POISONING INTERVENTIONS

1. Wash with soap and water
2. Flush with water
3. Remove small objects
4. Apply direct pressure to control bleeding
5. Apply antibiotic ointment
6. Cover wound
7. Seek medical care

BURN
3 TYPES
1. Thermal (heat) Burns
2. Chemical Burns
3. Electrical Burns

THERMAL BURNS (Considerations)

- Depth (degree )
● First degree (superficial)
● Second degree (partial thickness)
● Third degree (full thickness)
IMMEDIATE TREATMENT - Extent (rule of palm)
● If ingested, DO NOT induce vomiting - Parts of body injured
● Children may be given 6-8 raw egg whites and - Other injuries or medical conditions
adults 8-12 raw eggs whites - Whether patient is elderly or young
● Bring the child immediately to the nearest
hospital NEED TO KNOW. . . . .
● If there is dermal exposure, bathe the patient THE RULE OF NINES
using alkaline soap like perla Head and neck - 9%
________________________________________________ Upper back - 9%
____ Anterior chest - 9%
Each upper extremity - 9%
TRAUMA EMERGENCIES
Anterior abdomen - 9%
BLEEDING
Lower back - 9%
EXTERNAL BLEEDING
External genitalia - 1%
Signs and Symptoms
Each anterior lower extremity - 9%
Three types:
Each posterior lower extremity - 9%
1. Capillary (oozing)
Posterior trunk - 9%
2. Venous (flowing)
3. Arterial (spurting)
Parkland Formula
Open Wounds
In a burn pt, the Parkland formula gives you the calculation
● Abrasions
you need to know how much fluids to give to him/her. Here
● Lacerations
is the formula:
● Incisions
● Puncture
V ( fluids volume )= total body surface area of burn (%)
● Avulsion
x weight (kg) x 4
● Amputation
INTERVENTIONS
THERMAL BURN
1. Wear gloves
2. Expose wound
First degree burns
3. Cover with clean cloth or gauze
Signs and Symptoms
4. Apply direct pressure
- Redness
5. Elevate the area
- Mild swelling
6. DO NOT remove blood-soaked dressings
- Tenderness
7. Apply pressure bandage
- Pain
8. Apply pressure at a pressure point if needed
INTERVENTIONS
1. Stop the burning process
INTERNAL BLEEDING
2. Cool burns
Signs and Symptoms
3. Apply moisturizer such as aloe vera gel
- Skin is not broken and blood is not seen
4. Administer ibuprofen to relieve pain
- Recognizing internal bleeding by
5. Seek medical attention if:
● Bruising
● There are other injuries
● Painful, tender, rigid, bruised abdomen
● Victim is <5 y/o or >55 y/o
● Vomiting or coughing up blood
● Face, feet, hands or genitals are burned
● Black or red stool
● Child abuse is suspected
INTERVENTIONS
1. Call for medical help
Second degree burns
2. Care for shock
Signs and Symptoms
3. If vomiting occurs, roll victim on his or her side
- Blisters
- Swelling
WOUND INFECTION
- Weeping fluids
Signs and Symptoms
 - Intense pain 1. Open airway and check breathing
2. Apply sterile dressing
INTERVENTIONS 3. Apply pressure around edges of the wound
1. Stop the burning process 4. Stabilize the head and neck
2. Cool burns 5. Seek medical care
3. Apply antibiotic
4. Cover burn with dry, non-stick, sterile dressing Brain Injury
5. Administer ibuprofen to relieve pain Signs and Symptoms
6. Seek medical attention if: - Vacant stare
● There are other injuries - Slow to answer
● Victim is <5 y/o or >55 y/o - Unaware at time and place
● Face, feet, hands or genitals are burned - Slurred speech
● Child abuse is suspected - Stumbling
- Unresponsiveness
Third degree burns - Headache, dizziness and nausea
Signs and Symptoms
- Dead nerve-endings INTERVENTIONS
- Leathery, waxy skin 1. Open airway and check breathing
- Pearly gray or charred skin 2. Control any external bleeding carefully
3. Keep head slightly elevated if no spinal injury suspected
INTERVENTIONS 4. Seek medical care
1. Stop the burning process
2. Cool burns BRAIN FUNCTIONS
3. Apply antibiotic RIGHT LEFT
4. Monitor airway and breathing - Colour - Words
5. Cover burn with dry, non-stick, sterile dressing - Rhythm - Numbers
6. Care for shock - Daydreaming - Analysis
7. Seek medical care - Imagination - Logic
- Movement - Order
CHEMICAL BURNS - Dimension - Order
Signs and Symptoms - Music - Language
- Results from corrosive or caustic substance e.g.,
acids, alkalis, and organic compounds WARNING SIGNS after a head injury (the first 24
- Continue to burn as long as they are in contact hours)
with the skin ● Change in LOC
INTERVENTIONS - ↑Drowsiness
1. Flush the skin to remove quickly the substance - Confusion
2. Removed contaminated clothing - Difficult to arouse
3. Cover burn ● Seizure
4. Seek medical care ● Bleeding or watery drainage from nose or ears
● Pupils slow to react or unequal
ELECTRICAL BURNS ● Blurred vision
Signs and Symptoms ● Loss of sensation to any extremity
- Thermal burns (flames) ● Slurred speech
- Arc burn (flash) ● Vomiting
- True electrical injury (contact)
INTERVENTIONS EYE INJURY
1. Make the scene safe Signs and Symptoms
2. Open airway and check breathing - Foreign objects in the eye
3. Check for spinal injuries INTERVENTIONS
4. Cover burns 1. Lift upper lid over lower lid to brush object off
5. Care for shock 2. Gently rinse with warm water
6. Seek medical care 3. Examine lower lid by lifting lid down
* If contact with electric current please turn off power 4. Remove object with moistened, sterile gauze
before approaching patient and must have training and 5. Examine upper lid by rolling lid upward over stick or
appropriate tools swab
6. Remove object with moistened, sterile gauze
HEAD INJURIES
Signs and Symptoms Signs and Symptoms
- Scalp wounds - Penetrating eye injuries
INTERVENTIONS INTERVENTIONS
1. Control bleeding by direct pressure over wound 1. DO NOT remove the object
2. Keep head and shoulders slightly elevated (if spinal 2. Stabilize the object
injury is not suspected) 3. Cover the undamaged eye
3. Seek medical care 4. Seek medical care

Skull Fracture Signs and Symptoms

Signs and Symptoms - Blows to the eye
- Pain at point of injury INTERVENTIONS
- Deformity 1. Apply ice for about 15 minutes
- Bleeding from ears and nose 2. Seek medical care
- Bruising under eyes or behind ears
- Changes in pupils Signs and Symptoms
- Heavy scalp bleeding - Eye burns from light
- Penetrating wound INTERVENTIONS
INTERVENTIONS 1. Cover eyes with wet dressing and cold packs
2. Seek medical care weakness or loss of function, stiffness and pain
with movement
Signs and Symptoms MUSCLE CONTUSION
- Eye avulsion (eyes knocked-out) ● Pain and tenderness, swelling, bruise
INTERVENTIONS MUSCLE CRAMP
1. Cover the eye loosely ● Uncontrolled spasm, pain
2. Protect the injured eye with paper cup or doughnut INTERVENTIONS
shaped pad 1. For strain and contusion:
3. Cover the undamaged eye with a patch - Rest
4. Seek immediate medical care - Apply ice
2. For cramps:
Signs and Symptoms - Stretch muscle
- Cuts of the eye or lid - Apply gentle pressure
INTERVENTIONS RICE
1. If eyeball is cut, do not apply pressure Rest Ice Compression Elevation
2. If eyelid is cut, apply gentle pressure
3. Bandage both eyes lightly SPINAL INJURY
4. Seek medical care Signs and Symptoms
- Painful movement or paralysis of arms and legs
NOSE INJURY - Numbness, tingling, weakness, burning sensation in arms
Signs and Symptoms and legs
- EPISTAXIS (nosebleed) - Loss of bowel and bladder control
● Anterior nosebleed - Deformity of neck
- From front of nose INTERVENTIONS
- Most common, easier to treat 1. Stabilize head and neck
● Posterior nosebleed 2. If unresponsive, open airway, check breathing and
- From back of nose provide care
- More serious, require medical care 3. Seek medical care
INTERVENTIONS
1. Sit and lean slightly forward CHEST INJURY
2. Pinch the soft parts of the nose together Signs and Symptoms
3. Apply ice over nose - RIB FRACTURE
4. Seek medical care if needed ● Flail chest
● Sharp pain especially when victim breaths,
Signs and Symptoms coughs or move
- BROKEN NOSE ● Shallow breathing
● Pain, swelling and crooked ● Victim holds injured area
● Bleeding and difficulty breathing through nostrils INTERVENTIONS
● Black eyes 1. Help victim find a comfortable position for breathing
INTERVENTIONS 2. Support the injured area
1. If bleeding persists, give care as for a nosebleed 3. Seek medical care
2. Apply ice pack to nose for 15 minutes
3. DO NOT try to straighten a crooked nose Signs and Symptoms
4. Seek medical care - IMPALED OBJECT
● Object stuck on the chest
BONE INJURY INTERVENTIONS
Signs and Symptoms 1. DO NOT remove the object
A. Closed (simple) fracture 2. Stabilize the object
B. Open (compound) fracture 3. Control bleeding
Recognized by DOTS: 4. Seek medical care
Deformity
Open wound Signs and Symptoms
Tenderness - SUCKING CHEST WOUND
Swelling ● Blood bubbling out of the wound
INTERVENTIONS ● Sound of air being sucked in and out of the
1. Examine area using DOTS wound
2. Stabilized injured part to prevent movement INTERVENTIONS
3. Cover wound and exposed bones without applying 1. Seal open wound with plastic wrap
pressure 2. Tape on three sides
4. Apply ice pack to prevent swelling 3. If victim with difficulty of breathing, remove cover to let
5. Seek medical care air escape and reapply
4. Lay victim on the injured side
MUSCLE INJURY 5. Seek medical care
A sprain is an injury to ligaments, the tough, fibrous tissue
that connects bones to other bones. Ligament injuries ABDOMINAL INJURY
involve a stretching or a tearing of this tissue Signs and Symptoms
- CLOSED ABDOMINAL INJURY (from direct blow)
A strain is an injury to either a muscle or a tendon, the ● Bruises or other marks
tissue that connects muscles to bones. Depending on the ● Pain, tenderness, muscle tightness or rigidity
severity of the injury, a strain may be a simple overstretch INTERVENTIONS
of the muscle or tendon, or it can result in a partial or 1. Place the victim in a comfortable position
complete tear. 2. Care for shock
3. Seek medical care
Signs and Symptoms
MUSCLE STRAIN (pull) Signs and Symptoms
● Sharp pain, tenderness, indentation or bump, - OPEN ABDOMINAL INJURY
 ● Protruding organs ● Fires - wildfires
- Internal organs escape from wound ● Floods - flash floods
INTERVENTIONS ● Earthquakes
1. Position of comfort ● Tropical storms and hurricanes
2. Cover the organs with sterile, moist dressing ● Tornadoes
3. Care for shock ● Epidemics
4. Seek medical care
________________________________________________ TECHNICAL HAZARDS
____ ● Building collapse
THE 90/10 PRINCIPLE ● High rise incidents
● Hazardous materials incidents
What is this Principle? ● Transportation accidents
- 10% of life is made up of what happens to you. - aircraft
…90% of life is decided by how you react… - marine
- railroad
What does this mean? - highway
- We really have NO control over 10% of what - pipeline
happens to us. ● Major industrial accidents

MASS CASUALTY INCIDENT CIVIL - POLITICAL

Beyond Red, Yellow, Green and Black ● Civil disobedience
- demonstrations
MASS CASUALTY INCIDENT - Any event resulting in - strikes
a number of victims large enough to disrupt the normal - riots
course of emergency and health care services. ● Criminal or terrorist incidents
- mass shootings
● Overwhelms resources available in a system or - hostage taking
area - explosive, chemical, biological, or
● Places great demand on resources: nuclear
- equipment ● Military attack on the vital government
- rescuers installations
- facilities
Incident Command System
MASS CASUALTY MANAGEMENT- Management of - A system for command, control , coordination
victims of a mass casualty event, aimed at minimizing loss and communication of multisectoral agencies as
of life and disabilities they work towards common goal of stabilizing an
emergency
MASS CASUALTY INCIDENT MANAGEMENT - to protect life, property & environment
SYSTEM- The group of units, organizations and sectors - triage, treat & transport
which work jointly, through institutionalized procedures, to
minimize disabilities and loss of life in a mass casualty INFLUENCING FACTORS
event through the efficient use of all existing resources ● Magnitude of the event
● Available resources
Mass Casualty Incident Management
● A multisectoral coordination system MAGNITUDE
● Based on daily utilized procedures ● How big is the incident?
● Managed by skilled personnel - Number of patients
● Maximize use of resources - Area
● Provide prompt care to victims - boundaries: open or closed
RESOURCES
Aims of MCM in Disaster Management ● Response and support personnel
- Reduce (avoid, if possible) the potential losses of ● Vehicles and equipment
lives/limbs from hazards ● Facilities
- Assure prompt and appropriate assistance to
victims when necessary GOAL #2
- Achieve rapid and durable recovery ● Determine needs

GOAL #1 Preparation for Mass Casualty

Evaluate risk potential ● Pre-planning and training are critical
- Identify potential resources ● Establish guidelines and procedures
- Identify target hazards ● Early implementation of Incident Command
…….To predict possible MCI events ● First five minutes will determine next five hours

THE PROBLEM GOAL #3

● Given: Geographic location ● Develop appropriate resources
Population centers - Inventory existing resources
Transportation routes - Evaluate manual aid resources
Unique hazards - Acquire needed resources
There is potential for an incident: - Alternate resource sources
● With large numbers of patients
● Overwhelm local, multi-jurisdiction and regional Develop Appropriate Resources
mutual aid resources ● INTERNAL
- Within the Facility
MCI TYPES ● EXTERNAL
NATURAL DISASTERS - From other agencies
● Extreme heat or cold weather
GOAL #4 ● Don’t move the incident to the hospital
● Develop a response plan
- Generic
- Who, what, where, when, why, how Problems in Mass Casualty Incidents
- EMS, police, fire, hospitals, others.. Most common:
- Include mutual aid companies ● Who is in Command of the incident???
● Location of the Incident Command Post ( ICP )
Points to Ponder ● Lack of Communication between agencies
● What are the capabilities of the Emergency leading to conflicting priorities and orders
Medical Service System? ● Perimeter establishment delayed or not done at
all
● What is the Role of the following in a MCI? ● Large crowds of people
● Media and Political involvement
Police - Armed Forces ● Inadequate resources
Fire - Hospital
EMS - Volunteers Importance of MCI Training
NGO’s 4C
Command
CATEGORIES OF MCI’S Controlled
● Expanded medical incident Communicated
● Major medical incident Coordinated way that all orders/tasks are carried in an
● Disaster orderly manner.
● Catastrophe
Management Approach . . .
EXPANDED MEDICAL INCIDENT ● Triage
- Produces multiple casualties - a multiple vehicle accident ● Assessment and Stabilization
- Prehospital resources adequate ● Evacuation and Transport
- Hospital capacity adequate ● Hospital Treatment

MAJOR MEDICAL INCIDENT MCI APPROACHES

- Produces a large number casualties - the Wowowee 1. SCOOP & RUN
stampede 2. A Classical Approach
- Multi-jurisdictional and regional EMS response 3. Sophisticated Multisectoral
- Regional allocation of patients to hospitals Approach

DISASTER THE FIVE S’s

- Mass casualties - a major earthquake Safety Assessment
- Overwhelms local, provincial and regional mutual aid, Scene Safety
such as typhoon REMING Send
- Assistance from local, provincial or national resources Information
- Exist when government makes a declaration of disaster Setup
- Legal step that suspends the normal budget, personnel, & START
purchasing rules and focuses attention of all departments on
resolving the emergency 5 S’s - SAFETY ASSESSMENT
- Most MCIs are not declared disasters ● Fire
- Relatively few disasters involve MCIs ● Electrical hazard
● Flammable liquids
CATASTROPHE ● Hazardous materials
- Overwhelms local, regional, national resources ● Other life threats and
- National and international resources needed - as in hazards to rescuers
typhoon ONDOY
- Local resources are concentrating on their own survival 5 S’s - SCENE SAFETY
● Type of incident
GOALS OF MCI MANAGEMENT ● Approximate number of patients
● Greatest good for greatest number ● Severity of injuries
● Scarce resource management ● Area involved and access
● DON’T RELOCATE THE DISASTER!
5 S’s - SEND INFORMATION
DO THE GREATEST GOOD ● Contact dispatch with survey information
● Make the best possible use of available resources ● Request resources and mutual aid
● Salvage the most patients possible ● Notify command hospital
● Heroic resuscitation not appropriate
● Concentrate on those we can save FIRST EMS PROVIDER
● Establishes Medical Group
RESOURCE MANAGEMENT ● Directs triage of all patients
● Call for needed resources early ● Assigns resources as available to get key
● Be prepared for delays functions running
● Use command hospitals
- to coordinate with other hospitals 5 S’s - SETUP
- to coordinate transportation decisions ● Medical Group supervision
● Triage
DON’T RELOCATE THE DISASTER ● Treatment
● Transport patients to facilities based on: ● Transportation
- predetermined plan ● Extrication
- ability of facility to receive types and ● Staging
numbers of patients ● Medical Supply
 ● Medical Communications ➔ Selection of strategies
➔ Control of joint operations
5 S’s - START ➔ Maximum use of resources
Simple
Triage DELEGATION OF DUTIES
And
Rapid
Treatment

INCIDENT MANAGEMENT SYSTEM

● Allows effective control, direction, and
coordination of response resources
● Communications and information gathering
● Improved interaction with fire, police, and other
agencies

MANAGEMENT APPROACH TO MCI

● Scene Assessment
● Alerting Process
● Field Organization
● Rescuec

TYPES OF COMMAND SYSTEM

● SINGLE COMMAND
➔ Based on 1st arriving emergency unit
➔ Initial Incident Commander begins
assessment of incident
➔ Rescue, Triage, Treatment, Transport

● UNIFIED COMMAND
➔ Incidents that involve multiple
jurisdictions or agencies in the
decision making & planning
process
➔ Ensures plan is communicated &
supported by all resources
assembled
➔ Includes determination of objectives
 TRIAGE
● From French word “to sort”
● Separates patients needing rapid care
● Reduces urgent burden on capabilities
● Provides rational casualty distribution
TRIAGE PROBLEMS
● Reliance on specific diagnosis to put patients in
categories
● Too slow a process
IDEAL TRIAGE SYSTEM
● Simple
● No advanced skills
● No specific diagnosis
● Easy to do
● Rapid and simple life-saving intervention
● Easy to teach and learn
START does these things!

TRIAGE RIBBON CONCEPT

ESTABLISHING A MASS CASUALTY
MANAGEMENT SYSTEM RED
➔ IMMEDIATE (highest priority)
➔ poor respiration, perfusion, mental status, and
severe burns
YELLOW
➔ DELAYED (second priority)
➔ burns, major or multiple bone or back injuries
GREEN
➔ MINOR (third priority)
➔ Minor painful, swollen deformities, minor soft
tissue injuries
➔ “The walking wounded”
BLACK
➔ DEAD (lowest priority)
➔ deceased or non-salvageable

FIRST TRIAGE CRITERIA

MANAGEMENT OF A MASS CASUALTY INCIDENT START Triage System
(Simple Triage And Rapid Treatment/Transport)
A - ABILITY TO WALK (Ambulatory)
R - RESPIRATION
P - PERFUSION
M - MENTAL STATUS

STARTS FIRST STEPS

● Begin where you stand
● Move all who can walk
- away from the site
- use GREEN ribbons
● Move in orderly pattern through patients
● Assess using START and put ribbons on
● Keep a count of casualties
- mark on thigh
● Give only minimal treatment
- open the airway
- stop gross bleeding
● Keep moving!

RESPIRATION ASSESSMENT
● Not breathing? Open airway!
- Still not breathing - BLACK (Dead)
- starts to breathe - RED (Immediate)
● Breathing:
- >30 breaths per min - RED
- <30 breaths per min - NEXT STEP
● Maintain airway any way you can

PERFUSION ASSESSMENT
4T ● Radial pulse absent? RED (Immediate)
● Triage ● Radial pulse present - NEXT STEP
● Treatment ● Stop any gross hemorrhage
● Transport
● Transfer MENTAL STATUS ASSESSMENT
S.T.A.R.T ● Ask patient to do something simple
Simple Triage And Rapid Treatment - squeeze fingers
- blink eye
● Does not follow command - RED (Immediate) ➔ can be stabilized
● Able to follow command - YELLOW (Delayed ~Airway and breathing difficulties
~Uncontrolled or severe bleeding
~Decreased mental status ~Severe medical problems:
poisoning, diabetic and cardiac emergencies, etc.
~Severe burns
~Shock (hypotension)

● YELLOW (Delayed) (Stable)

➔ Potentially life threatening injury
➔ Severely debilitating injury
➔ Can stand a delay in treatment and
transport
(Burns without airway problems , Major or multiple bone
or joint injuries , Back injuries with or without spinal cord
damage)

● GREEN (Minor)
➔ Non life threatening injuries
➔ Minimal care with minimal risk
~Minor burns
~Minor bone or joint injuries
Minor soft tissue injuries

● BLACK (Deceased or non-salvageable)

➔ Deceased
- at the site
- en route to treatment area
- in treatment area
➔ Unresponsive with no circulation

TRANSPORT DECISIONS
● Patient prioritization
● Destination facilities
● Transportation resources

3rd TRIAGE
EVACUATION OR TRANSPORTATION

PRINCIPLES OF EVACUATION OR TRANSPORT

● Strict control of the evacuation rate
● Victim must be in the most stable condition
before transporting
● Victims must be adequately equipped before
transfer.
● Receiving facility must be informed and
prepared for transfer the best possible vehicle
must be used
TREATMENT FUNCTIONS
● Purpose HOSPITAL ORGANIZATION
- identify specific injury
- categorize patients and give care Hospital Disaster Plan
- prioritize for transport - Hospital Mass Casualty Management (MCM)
● START depends on three simple observations Plan
- respiration, perfusion, mental status - Dissemination and Regular Drills amongst the
- secondary triage is more in depth Hospital Staff & Multi-Sectoral Groups
● Reassessment and tagging
- on the way to treatment, or (in small incidents) at Activation of Hospital MCM Plan
the site - Alerting Process CodeWhite 5-20pts.
- in treatment area Code Blue 21-50
- in ambulance Code Red > 50
- At the receiving medical facility Dispatch / Opcen /Unqualified Observer
● MCIs will require four triage stages * ER / A&ED
● Reassessment in treatment is secondary triage * Operator to Activate System Recall
- more subjective - Mobilization
- based on specific condition and experience - Hospital Scene Response Team
● Some patient distinctions may become blurred -
guidelines best match patient with resources

SECONDARY TRIAGE

● RED (Immediate) (Unstable)

➔ life threatening injury
➔ risk of asphyxiation or shock is present
or imminent
➔ high probability of survival
 SUMMARY - TOP TEN
1. First On Scene Report
2. Escalated Response
3. Think Incident Command
4. Triage
5. Treat by Priority
6. Separate victims by priority
7. Transport by priority
8. Re-Triage Constantly
9. Only move the dead when it is effecting
patient care
10. Train, Train, Train and Practice

SUMMARY
● MCIs can overwhelm you - go for the goals:
- greatest good for greatest number
- scarce resource management
- don’t relocate the problem
● First responders take first steps - the 5 S’s
- Safety, Survey, Send, Set-up, START
● START sorts large numbers of patients
● Treatment phase requires secondary triage as in-
depth assessment
● Triage Tag
- Supports secondary assessment
- provides continuous documentation
● Incident Management System expands to meet
the needs of response

MCI Drill : Application of the

4C
● Command
● Controlled
● Communicated
● Coordinated way that all orders/tasks are carried
in an orderly manner.