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

Health Science Core Chapter 8 Disaster: Preparedness, Hazards, and Prevention Broward County Triage Broward County Incident Command. Chapter 18: Disasters: Preparedness. Disaster. An unexpected event that causes great damage and depletes or exhausts currently available resources

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

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  1. Health Science CoreChapter 8 Disaster: Preparedness, Hazards, and PreventionBroward County TriageBroward County Incident Command Revised: August 2007

  2. Chapter 18: Disasters: Preparedness Revised: August 2007

  3. Disaster An unexpected event that causes great damage and depletes or exhausts currently available resources • Earthquakes • Hurricanes • Floods • Tornadoes • Airplane accident • Hazardous waste accident Revised: August 2007

  4. 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 Revised: August 2007

  5. 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 Revised: August 2007

  6. 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 Revised: August 2007

  7. 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. Revised: August 2007

  8. 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 Revised: August 2007

  9. 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 Revised: August 2007

  10. Mass Casualty Incidents Uniform Pre-hospital MCI Procedure Revised: August 2007

  11. What is an MCI ? Any Incident Which Overwhelms the Capabilities of the First Arriving Unit (s). Revised: August 2007

  12. 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 Revised: August 2007

  13. 4 ALS Transport Units 2 Suppression units 1 Shift Supervisor 1 EMS Supervisor MCI Level 1 Response (5-10 Victims) Revised: August 2007

  14. 6 ALS Rescue Units 3 Suppression Units 2 Shift Supervisors 2 EMS Supervisors MCI Level 2 Response(11-20 Victims) Revised: August 2007

  15. 8 ALS Transport Units 4 Suppression Units 3 Shift Supervisors 3 EMS Supervisors 1 Operations Chief 1 Command Vehicle 1 Supply Trailer MCI Level 3 Responses(21-100 Victims) Revised: August 2007

  16. 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 Revised: August 2007

  17. 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 Revised: August 2007

  18. First Arriving Unit Procedure Revised: August 2007

  19. 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 Revised: August 2007

  20. 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 Revised: August 2007

  21. Mass Casualty Operational Structure Revised: August 2007

  22. 1. Triage 2. Treatment 3. Transport 4. Staging Operational Groups Revised: August 2007

  23. Basic Command Structure for Mass Casualty Incidents Revised: August 2007

  24. Other Possible Operational Groups 1. Medical Branch 2. Landing Zone 3. Extrication 4. Hazmat 5. Rehabilitation 6. Safety 7. PIO 8. Medical Intelligence Revised: August 2007

  25. Complex Command Structure for Mass Casualty Incidents Revised: August 2007

  26. START Triage Revised: August 2007

  27. 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 Initial Triage Revised: August 2007

  28. Secondary Triage Procedure • Perform during Treatment phase • Use DMS All Risk Triage Tag • Trauma criteria will apply Revised: August 2007

  29. Adult START Triage RPM Respirations Perfusion Mental Revised: August 2007

  30. Respirations • Less Than 30/minute – Go To Perfusion • Over 30/Minutes – RED Tag • No Respirations – Open Airway: • Breathing – RED Tag • Not Breathing – BLACK Tag Revised: August 2007

  31. Perfusion • Radial Pulse present or Capillary Refill is < 2 seconds - Go To Mental Status • No Radial Pulse or Capillary Refill > 2 Seconds – RED Tag Revised: August 2007

  32. Mental Status • Follows Simple Commands & AAOX3 – GREEN • Does not follow commands, not AAOX3 or is Unconscious – RED Tag • Depending on Injuries – YELLOW Tag Revised: August 2007

  33. START Flow Chart Revised: August 2007

  34. Pediatrics Jump START Triage Revised: August 2007

  35. Triage system adapted for pediatrics < 8 years old, which use a modify version of evaluating: Respiration Perfusion Mental Status JumpSTART Triage Revised: August 2007

  36. Rate between 15 and 45 BPM – Go to Perfusion Rate over 45 BPM or under 15 BPM – REDTag 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 Respiration Revised: August 2007

  37. Peripheral pulse present – Go to Mental Status Peripheral pulse absent – RED Tag Perfusion Revised: August 2007

  38. 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 Mental Status Revised: August 2007

  39. JumpSTART Flow Chart Revised: August 2007

  40. Secondary Triage with All Risk Triage Tag Revised: August 2007

  41. All Risk Triage Tags Revised: August 2007

  42. Contaminated Section • Must remove if patient is not contaminated • If strip is not remove patient is considered contaminated. Revised: August 2007

  43. Contaminated Section • When the patient’s cloths are removed, the strip should be placed in the bag for evidence Revised: August 2007

  44. Front Back 1 watch, 2 rings, and 1 wallet • Personal Property Receipt • Patient valuables in plastic bag Revised: August 2007

  45. Personal Property Receipt Revised: August 2007

  46. Front HMW R19 Back John Smith • Patient Ground Transport Tracking Tag • Removed by Transport Officer for patient tracking Revised: August 2007

  47. X X X Mark 1 • Chemical Exposure Symptoms and Treatment • Salivation • Lacrimation • Urination • Defecation • G.I. Distress • Emesis • Miosis Revised: August 2007

  48. X X X 28 X • Patient Assessment • Decontamination • Area of injury • WMD type Revised: August 2007

  49. 11:30 180/78 120 14 11:30 Normal Saline KVO • Vital Signs • Documenting B/P, Pulse, Respiration, and IV solution Revised: August 2007

  50. Triage Category • Remove all of the tags distal to desires color and half of the color. • Above is Yellow Tag Revised: August 2007

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