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Reference Handout for Disaster Medicine— Triage

Reference Handout for Disaster Medicine— Triage. RESCUER PPE : Exam Gloves New Each Victim OR Sterilize (10% bleach) Helmet Goggles N95 Face Mask TRIAGE PROCESS : Can Victim Walk? Victim Breathing? Respiration Rate? Blanch Test Responsive?. - twice. Respiration < 30/min

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Reference Handout for Disaster Medicine— Triage

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  1. Reference Handout for Disaster Medicine— Triage • RESCUER PPE: • Exam Gloves • New Each Victim • OR Sterilize (10% bleach) • Helmet • Goggles • N95 Face Mask • TRIAGE PROCESS: • Can Victim Walk? • Victim Breathing? • Respiration Rate? • Blanch Test • Responsive? - twice Respiration < 30/min Blanch Test < 2 sec Mental Status: Responsive SAVING LIVES: Airway (Head-Tile/Chin-Lift) Bleeding (Pressure/Elevation) Shock (Keep Warm/Lie Down) TRIAGE STEPS: Stop, Observe, Think Voice Triage First Be Systematic Evaluate/Tag All Victims Treat “I” On The Spot Document Findings TRIAGE CATEGORIES: (I) Immediate (D) Delayed (M) Minor (DEAD) Dead (= Deceased) CERT Supplemental Module #1 – Disaster Triage

  2. Disaster Medical Operations — Triage CERT Supplemental Training Module 1

  3. Module Objectives • Specify “killers” requiring immediate treatment • Review how to open airway, control bleeding, and treat for shock • Conduct triage under simulated disaster conditions CERT Supplemental Module #1 – Disaster Triage

  4. Importance of Quick Action • Immediate: Death within minutes; result of severe trauma, not breathing, shock • Immediate: Death within several hours; result of excessive bleeding • Delayed: Death in several days or weeks; result of infection Provide greatest good for greatest number by conducting START (Simple Triage And Rapid Treatment) CERT Supplemental Module #1 – Disaster Triage

  5. Importance of Quick Action • Emergency medicine “killers” • Airway obstruction • Bleeding • Shock • First priority of medical operations: • Open airway • Control excessive bleeding • Treat for shock CERT Supplemental Module #1 – Disaster Triage

  6. How to Approach a Victim • Be sure victim can see you • Identify yourself • Your name and CERT Volunteer • Request permission to treat, if possible (unconscious = permission) • Respect cultural differences CERT Supplemental Module #1 – Disaster Triage

  7. What Do You Think? • What is the most common airway obstruction? Student Manual pg 3-5 & 3-6 • What is the most obvious sign of arterial bleeding? Student Manual pg 3-9 • What does it mean if a victim cannot follow simple commands, such as “Squeeze my hand”? Student Manual pg 3-15 CERT Supplemental Module #1 – Disaster Triage

  8. Head-Tilt/Chin-Lift Review • Only the head is manipulated to avoid spine injury • Listen and feel for breathing • If none, try second time before giving up CERT Supplemental Module #1 – Disaster Triage

  9. Types of Bleeding • Arterial bleeding • Bleeding from artery spurts • Venous bleeding • Bleeding from vein flows • Capillary bleeding • Bleeding from capillaries oozes • Bleeding from head abundant “flow” • Direct pressure & elevation will stop most bleeding of any type CERT Supplemental Module #1 – Disaster Triage

  10. Ineffective circulation of blood in body Shock can lead to unconsciousness and death Maintain body temp with blanket under victim plus covering Shock CERT Supplemental Module #1 – Disaster Triage

  11. Triage • Immediate (I):Victim has life-threatening injuries (airway, bleeding, or shock) • Delayed (D): Injuries do not jeopardize victim’s life; treatment can be delayed • Minor (M): Walking wounded and generally ambulatory (use as assistants?) • Dead (DEAD): No respiration after two attempts to open airway CERT Supplemental Module #1 – Disaster Triage

  12. Triage Concept Process for helping many victims • Victims are evaluated quickly • Victims are sorted by urgency of treatment they need • Victims are set up for immediate or delayed treatment • Minor injured may be used to help move or assist CERT Supplemental Module #1 – Disaster Triage

  13. Triage Steps • Step 1: Stop, Look, Listen, and Think • Step 2: Conduct voice triage • Step 3: Follow systematic path around • Step 4: Evaluate each victim and tag • Check airway and breathing • Check circulation and bleeding • Check mental status (shock) • Step 5: Treat “I” victims immediately • Step 6: Document triage results CERT Supplemental Module #1 – Disaster Triage

  14. Poor team sizeup, organization, or goal Indecisive leadership Too much focus on one injury Treatment (rather than triage) performed Triage Pitfalls CERT Supplemental Module #1 – Disaster Triage

  15. Rescuer Safety During Triage • If hazmat or terrorist event is suspected, CERT members DO NOT respond • Evacuate as safely as possible • ALWAYS wear PPE: • Helmet & Goggles • N95 face mask • Work gloves • Sturdy shoes or boots • Non-latex exam gloves CERT Supplemental Module #1 – Disaster Triage

  16. What Do You Think? Triage Evaluation • Victims will be shown and symptoms listed • You determine which category they are in • Press Enter to show “book” solution Like this CERT Supplemental Module #1 – Disaster Triage

  17. Triage Evaluation Victim #1: • Bleeding from legs • Unresponsive • After two attempts to open airway, still not breathing Dead CERT Supplemental Module #1 – Disaster Triage

  18. Triage Evaluation Victim #2: • Can walk and talk • Bleeding from left arm • Blanch test < 2 sec • Respiration 25/min Minor CERT Supplemental Module #1 – Disaster Triage

  19. Triage Evaluation Victim #3: • Bleeding from left arm • Conscious but won’t follow commands • Respiration 38/min Immediate CERT Supplemental Module #1 – Disaster Triage

  20. Triage Evaluation Victim #4: • Responds to voice triage • Bleeding from right arm and left leg • Respiration 26/min • Blanch test < 2 sec Minor CERT Supplemental Module #1 – Disaster Triage

  21. Triage Evaluation Victim #5: • Bleeding from head and left shoulder • Follows commands • Respiration 30/min • Complains of chest pain • Blanch test > 2 sec Immediate CERT Supplemental Module #1 – Disaster Triage

  22. Triage Evaluation Victim #6: • No bleeding • Leg pain and unable to walk • Breathing 20/min • Pulse 108 bpm Delayed CERT Supplemental Module #1 – Disaster Triage

  23. Triage Evaluation Victim #7: • Bleeding from head • Responds to voice triage • Breathing 30/min • Blanch test < 2 sec Delayed CERT Supplemental Module #1 – Disaster Triage

  24. Triage Evaluation Victim #8: • No bleeding • Deformity to left wrist • Respiration 23/min • Blanch test < 2 sec Delayed CERT Supplemental Module #1 – Disaster Triage

  25. Triage Evaluation Victim #9: • Bleeding from leg with bone visible • Follows all commands • Respiration 29/min • Blanch test 2 sec Immediate CERT Supplemental Module #1 – Disaster Triage

  26. Triage Evaluation Victim #10: • No bleeding • Complains of back pain • Follows all commands • Respiration 20/min • Blanch test 2 sec Minor CERT Supplemental Module #1 – Disaster Triage

  27. Triage Evaluation Victim #11: • Abrasions on torso • Airway is clear • Does not follow commands • Respiration 17/min • Blanch test > 5 sec Immediate CERT Supplemental Module #1 – Disaster Triage

  28. Triage Evaluation Victim #12: • Can move all limbs • No bleeding found • Does not follow commands • Respiration 22/min • Blanch test 3 sec Immediate CERT Supplemental Module #1 – Disaster Triage

  29. Triage Evaluation Victim #13: • Minor head bleeding • Airway seems clear • Does not follow commands • Respiration 30/min • Blanch test < 2 sec Immediate CERT Supplemental Module #1 – Disaster Triage

  30. Triage Evaluation Victim #14: • Minor bleeding from arm & obviously pregnant • Complains of back pain • Follows all commands • Respiration 26/min • Blanch test < 2 sec Delayed CERT Supplemental Module #1 – Disaster Triage

  31. Triage Evaluation Victim #15: • Right leg bleeding • Complains of severe pain in leg • Follows all commands • Respiration 20/min • Blanch test 3 sec Delayed CERT Supplemental Module #1 – Disaster Triage

  32. Triage Evaluation Victim #16: • No bleeding • Deformity in left leg • Crying; does not follow commands • Respiration 26/min • Blanch test 2 sec Immediate CERT Supplemental Module #1 – Disaster Triage

  33. Triage Evaluation Victim #17: • No bleeding visible • Unresponsive child • No respiration after head tilt and retry • Blanch test > 5 sec Dead CERT Supplemental Module #1 – Disaster Triage

  34. Triage Evaluation Victim #18: • Minor bleeding • Deformed right wrist • Follows all commands • Respiration 28/min • Blanch test 2 sec Delayed CERT Supplemental Module #1 – Disaster Triage

  35. You should now be able to: Identify primary 3 “killers” Apply techniques to open the airway, control bleeding, and treat for shock Safely conduct triage in a disaster Immediate Delayed Minor Module Summary CERT Basic Training Unit 3: Disaster Medical Operations — Part 1

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