pdls © : ems response to disaster prehospital considerations jorge d. yarzebski, nremtp
Post on 21-Dec-2015
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PDLSPDLS©©::EMS Response to DisasterEMS Response to Disaster
Prehospital ConsiderationsPrehospital Considerations
Jorge D. Yarzebski, NREMTP
ObjectivesObjectives
To review EMS considerations in disaster To review EMS considerations in disaster situations and the unique needs of childrensituations and the unique needs of children
What to expect from prehospital providersWhat to expect from prehospital providers
Review the Incident Command System (ICS) Review the Incident Command System (ICS) and Field Triage as it applies to prehospital and Field Triage as it applies to prehospital providersproviders
ObjectivesObjectives
Recognize and formally declare a MCIRecognize and formally declare a MCI
CommunicationCommunication- InteragencyInteragency
- HospitalsHospitals
Emergency Medical ServicesEmergency Medical Services
Network of multiple services and agencies Network of multiple services and agencies ‘coordinated’ to provide aid and medical care ‘coordinated’ to provide aid and medical care from 1º response to definitive care based on from 1º response to definitive care based on trainingtraining- First ResponderFirst Responder
- BasicBasic
- IntermediateIntermediate
- ParamedicParamedic
- RN’s/MD’sRN’s/MD’s
CoordinationCoordination
Incident Command SystemIncident Command System- Management system created to address Management system created to address
concerns of interagency compatibility and concerns of interagency compatibility and interactioninteraction
- Direct Direct
- ControlControl
- CoordinateCoordinate
ICS (Incident Command System)ICS (Incident Command System)
Senior on scene: commandSenior on scene: command- assess need for further resources and direct assess need for further resources and direct
incoming resources to where they are neededincoming resources to where they are needed
- This starts with first to arriveThis starts with first to arrive
- Triage: initial fast assessment of every patient, Triage: initial fast assessment of every patient, sort for evacuation and first in line for care when sort for evacuation and first in line for care when additional resources arriveadditional resources arrive
Responsibilites delegated through ICS Responsibilites delegated through ICS
ICSICS
Scene control Scene control - limit access for civilianslimit access for civilians
- media camerasmedia cameras
- maintain in/out routes for vehicles which do need maintain in/out routes for vehicles which do need entryentry
CommunicationsCommunications- notify hospitals of rough numbers, kinds of notify hospitals of rough numbers, kinds of
injuriesinjuries
When YOU are the first to arrive…When YOU are the first to arrive…
Declaring the Multiple Casualty IncidentDeclaring the Multiple Casualty Incident- Recognize the major incidentRecognize the major incident
- Available resources are insufficient to manage Available resources are insufficient to manage the number and nature of injuries and the number and nature of injuries and environmentenvironment
PossibilitiesPossibilities- More than two ambulances required (dependent More than two ambulances required (dependent
on resources)on resources)
When YOU are the first to arrive…When YOU are the first to arrive…
- HAZMATHAZMAT
- Special resources: Fire, Police, rescue with Special resources: Fire, Police, rescue with specialized extrication equipment, SAR, Medivacspecialized extrication equipment, SAR, Medivac
DispatchDispatch- En route request for assistance, confirm upon En route request for assistance, confirm upon
arriving on scene or cancel request*arriving on scene or cancel request*
*follow SOP for particular department*follow SOP for particular department
EMS ICSEMS ICS
Coordinates EMS activities – Activates MCI Coordinates EMS activities – Activates MCI response planresponse plan
Supervises Supervises - TRIAGE, TAGGING, TREATMENT, TRIAGE, TAGGING, TREATMENT,
TRANSPORTATIONTRANSPORTATION
Assigns personnelAssigns personnel
Guides difficult medical decisions Guides difficult medical decisions
Need Help?Need Help?
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
First to ArriveFirst to Arrive
Initial units assumes commandInitial units assumes command- Senior/most experience takes controlSenior/most experience takes control
- Requests additional supportRequests additional support
- Updates safety/mechanism/conditionsUpdates safety/mechanism/conditions
SupportSupport
TriageTriage
““to sort” or place in orderto sort” or place in order
Guides decisions about allocating scarce Guides decisions about allocating scarce resources and limited timeresources and limited time
““greatest good for greatest number”greatest good for greatest number”
Protocol helps make decisionsProtocol helps make decisions
ICS separates triage from treatment ICS separates triage from treatment immediately: see everybody once briefly for immediately: see everybody once briefly for focusfocus
STARTSTART
Most commonly used triage system across Most commonly used triage system across countrycountry
Initial eval –not finalInitial eval –not final
Time limited (plan 1 min/patient)Time limited (plan 1 min/patient)
Categorize and move onCategorize and move on
STARTSTART
““If you can hear me and are able, walk over here” If you can hear me and are able, walk over here” GREEN triage done – still need individual GREEN triage done – still need individual evaluation, but can await more staff, allows initial evaluation, but can await more staff, allows initial rescuers to focus on more severely injured people.rescuers to focus on more severely injured people.
Avg 80% of victims will be green, self extricate Avg 80% of victims will be green, self extricate (may self transport – eases burden on field but hard (may self transport – eases burden on field but hard on hospitals)on hospitals)
*Not applicable for under 8 years old**Not applicable for under 8 years old*
Kids in triageKids in triage
Don’t follow commandsDon’t follow commands
May actually hide from rescuers in full gear May actually hide from rescuers in full gear (spaceman look)(spaceman look)
May be extricated by GREEN parents/ adults May be extricated by GREEN parents/ adults with delay in triage and treatmentwith delay in triage and treatment
Need distraction and dedicated supervisor Need distraction and dedicated supervisor able to run after wandering toddlersable to run after wandering toddlers
JumpSTART (under 8)JumpSTART (under 8)
Kids more airway dependent – rescue Kids more airway dependent – rescue breaths attempted if pulse present (unlike breaths attempted if pulse present (unlike adults) Resp 15-40 instead of <30adults) Resp 15-40 instead of <30
Vascular system clamps down sooner, so Vascular system clamps down sooner, so cap refill less reliablecap refill less reliable- Use peripheral pulse insteadUse peripheral pulse instead
Mental status AV/PU instead of follow/notMental status AV/PU instead of follow/not
JumpSTARTJumpSTART
““If you can hear me and you are able, walk If you can hear me and you are able, walk over here for help.” over here for help.”
GREENs are done. Screen GREEN adults GREENs are done. Screen GREEN adults for RED/YELLOW kids carried out.for RED/YELLOW kids carried out.
Assess non-ambulatory patients as you find Assess non-ambulatory patients as you find them using RPM.them using RPM.
ICSICS
Treatment: patients may outnumber Treatment: patients may outnumber transport, leading to time in field where transport, leading to time in field where treatment can be started. treatment can be started.
Sort patients by category (greens, yellow, Sort patients by category (greens, yellow, red, black) and treat within areas. If greens red, black) and treat within areas. If greens self triaged, they need evaluation.self triaged, they need evaluation.
TreatmentTreatment
Limited initial treatment – don’t delay Limited initial treatment – don’t delay evacuation if vehicle availableevacuation if vehicle available
Oxygen, dressings, splintsOxygen, dressings, splints
Airway management? Remember, no Airway management? Remember, no intubations during triage, and no codes intubations during triage, and no codes during mass casualty event, unless sufficient during mass casualty event, unless sufficient personnel and equipment that no other care personnel and equipment that no other care is delayedis delayed
TreatmentTreatment
Kids will be mixed in – do you have enough Kids will be mixed in – do you have enough supplies in kid size (oxygen, IVs, splints)?supplies in kid size (oxygen, IVs, splints)?
Does your locality stock a “disaster truck”?Does your locality stock a “disaster truck”?
Does it have kid size equipment and kid Does it have kid size equipment and kid sized doses of Hazmat antidotes?sized doses of Hazmat antidotes?
Do you have Broselow tapes to guide Do you have Broselow tapes to guide dosing?dosing?
Treatment - airwayTreatment - airway
Non breathing child (with pulse): rescue Non breathing child (with pulse): rescue breaths, then if no response, BLACKbreaths, then if no response, BLACK
Non breathing child without pulse: BLACKNon breathing child without pulse: BLACK
Oxygen: how administered? Do you have Oxygen: how administered? Do you have octopus adaptors to set more than one octopus adaptors to set more than one NRBM off each nozzle? REDs first.NRBM off each nozzle? REDs first.
TreatmentTreatment
IV fluids? Depends on numbers: does IV fluids? Depends on numbers: does everyone need an IV? Are there enough IV everyone need an IV? Are there enough IV kits to give everyone an IV? Use triage to kits to give everyone an IV? Use triage to guide => treat REDs first, then YELLOWs. guide => treat REDs first, then YELLOWs. Do GREENs need IV?Do GREENs need IV?
BLACK/expectant: pain control (if drugs BLACK/expectant: pain control (if drugs available) NO IV fluids, NO oxygenavailable) NO IV fluids, NO oxygen
Treatment:Treatment:
Dressings – rinse gross dirt with sterile fluids or tap Dressings – rinse gross dirt with sterile fluids or tap water if available, sterile cover to prevent further water if available, sterile cover to prevent further contaminationcontamination
Pressure dressing for active bleedingPressure dressing for active bleeding- Recruit neighbor to help hold pressure during triage while Recruit neighbor to help hold pressure during triage while
awaiting transport/evacuationawaiting transport/evacuation
- ARE KIDS CAPABLE OF THIS?ARE KIDS CAPABLE OF THIS?
- IS IT APPROPRIATE PSYCHOLOGICALLY?IS IT APPROPRIATE PSYCHOLOGICALLY?
Splint – extremity injuriesSplint – extremity injuries
TreatmentTreatment
Medications: pain control, specific antidotes Medications: pain control, specific antidotes with Hazmat event/teamwith Hazmat event/team
Monitoring: repeat assessment after triage, Monitoring: repeat assessment after triage, re-categorize if necessary (to worse, never re-categorize if necessary (to worse, never better – even if they respond to treatment, better – even if they respond to treatment, they have the same underlying injury)they have the same underlying injury)
ICSICS
Transport: decides which patients leave Transport: decides which patients leave scene first and where they’re goingscene first and where they’re going- Remember that helpful bystanders and self Remember that helpful bystanders and self
transporters will fill nearest hospital firsttransporters will fill nearest hospital first
- Includes decisions about longer transport times Includes decisions about longer transport times for specialty care ( e.g. out of town for burn unit for specialty care ( e.g. out of town for burn unit straight from scene rather than to hospital for straight from scene rather than to hospital for transfer)transfer)
- PEDIATRIC SPECIALTY CENTERSPEDIATRIC SPECIALTY CENTERS
CommunicationCommunication
TelephonesTelephones
Cellular PhonesCellular Phones
Pager SystemPager System
Radios Radios
WhistlesWhistles
Loudspeakers/MegaphonesLoudspeakers/Megaphones
Your Pedi First in BagYour Pedi First in Bag
Is your ambulance equipped to handle a Is your ambulance equipped to handle a Pediatric MCI?Pediatric MCI?
What is essential to your first in bag?What is essential to your first in bag?- Airway suppliesAirway supplies
- DressingsDressings
- TagsTags
Do we include Broselow tapes to guide Do we include Broselow tapes to guide dosing?dosing?
Ambulance / Disaster PreparednessAmbulance / Disaster Preparedness
Top to bottomTop to bottom
BLS / ALS specificBLS / ALS specific
Pre-determined scope of practice rulesPre-determined scope of practice rules
Policy formulationPolicy formulation
Incident specific arrangementsIncident specific arrangements
Sectioning shell - age specificSectioning shell - age specific
Supplies:Supplies:
Oral pharyngeal Oral pharyngeal airwaysairways
Bag Valve Mask’sBag Valve Mask’s
O2 / delivery devicesO2 / delivery devices
Pulse oximeter Pulse oximeter
P.O. ear probesP.O. ear probes
CO2 monitorsCO2 monitors
Trauma scissorsTrauma scissors
StethoscopesStethoscopes
Blood pressure cuffsBlood pressure cuffs
Cervical collarsCervical collars
Portable suctionPortable suction
Padded board splintsPadded board splints
Obstetrics kitObstetrics kit
BlanketsBlankets
SheetsSheets
SuppliesSupplies
Car seats Car seats
ToysToys
Airway rollsAirway rolls
O2 multiplexerO2 multiplexer
Naso-gastric tubesNaso-gastric tubes
Chest tubesChest tubes
NebulizersNebulizers
I.V. solutionsI.V. solutions
NeedlesNeedles
Sharps containersSharps containers
GlucometerGlucometer
I.O. needlesI.O. needles
Broselow TapeBroselow Tape
Adhesive tapeAdhesive tape
MedicationsMedications
Clean water / cupsClean water / cups
SuppliesSupplies
FormulaFormula
Purifier / preservativePurifier / preservative
hand lights with hand lights with batteriesbatteries
Light sticksLight sticks
Candles / waterproof Candles / waterproof matchesmatches
Rain tarps/ polesRain tarps/ poles
Ground clothesGround clothes
Paper / waterproof Paper / waterproof penspens
Disaster TagsDisaster Tags
Disposable bagsDisposable bags
Chlorine bleachChlorine bleach
Soap / towelsSoap / towels
Hand toolsHand tools
SuppliesSupplies
Radio CB/am/fmRadio CB/am/fm
WhistleWhistle
Meals Ready to EatMeals Ready to Eat
BandageBandage
Triangular bandageTriangular bandage
KlingKling
Aluminum foilAluminum foil
Vaseline gauzeVaseline gauze
Trauma dressingsTrauma dressings
GauzeGauze
Hydrogen peroxideHydrogen peroxide
AlcoholAlcohol
Cold / hot packsCold / hot packs
GlovesGloves
InstaglucoseInstaglucose
Sterile water / salineSterile water / saline
SuppliesSupplies
Backboards/ strapsBackboards/ straps
Optional / Monitors defibrillatorsOptional / Monitors defibrillators
AED / SAEDAED / SAED
Other regional specific adjunctsOther regional specific adjuncts