EMR ch27

Emergency Medical ResponderEmergency Medical ResponderFirst on SceneFirst on Scene

CHAPTER

TENTH EDITION

Copyright © 2016, 2011, 2009by Pearson Education, Inc.

All Rights ReservedEmergency Medical Responder: First on Scene, 10/eChristopher J. Le Baudour | J. David Bergeron

Introduction to Multiple-Casualty Incidents, the Incident Command System, and Triage

26&27



Operations



The Call

• Six Phases of Emergency Call Preparation Dispatch En route to scene Arrival at scene Transferring patients After emergency



Figure 26.3 You must check all of your equipment at the start of each shift.



Figure 26.1 Ensure the safety of you and your crew before entering the scene.(© Edward T. Dickinson, MD)



Extrication



Figure 26.2 There are many ways you can make the scene safer once you arrive.



26.1.1 Various tools can be used to help unlock vehicle doors in older vehicles (check model years):• Wire hook • Straight wire • Slim Jim (or similar device) • Screwdriver • Flat pry bar An oil dipstick or a keyhole saw may be used to help force up a locking button.

continued on next slide



26.2.1 To break a window, first place duct tape across the window to help keep the glass intact after breaking.




Figure 26.4 If you can, cover the patient with a blanket prior to breaking any glass. This will prevent the patient from being hit with broken glass.



Figure 26.5 Stabilize the vehicle before attempting to gain access to the patients. This may require specialized training. Do only what you have been trained to do.



Figure 26.6 When arriving on scene, position your vehicle at least one utility pole away from the damaged pole.



Hazardous Materials



Figure 26.7 A typical DOT hazardous materials placard.



Figure 26.8 Examples of the safety zones at a hazardous materials incident.



Figure 27.1 Multiple-casualty incidents require the resources of many agencies.(© Edward T. Dickinson, MD)



Figure 26.9 The decontamination of a fellow rescuer.



MULTIPLE-CASUALITY INCIDENTS



Multiple-Casualty Incidents

• Multiple-Casualty Incident (MCI) Any emergency that involves multiple

victims and overwhelms first responding units

Multiple vehicles Earthquakes Floods Large explosions Building collapses



Multiple-Casualty Incidents

• Low-Impact Incidents Manageable by local emergency

personnel• High-Impact Incidents

Stresses local EMS, fire, and police resources

• Disaster, Terrorism Incidents Overwhelms regional emergency

response resources



INCIDENT COMMAND SYSTEM



Incident Command System

• Model tool for command, control, coordination of resources at scene of large-scale emergency involving multiple agencies

• Procedures for organizing personnel, facilities, equipment, and communications




• Incident Commander Responsible for all aspects of an

emergency response• Modules in Incident Command System

Command Operations Planning Logistics Finance



Figure 27.2 The EMS Branch of a typical ICS organizational plan.(From Pre-Hospital Emergency Care, 10th Edition by Joseph J. Mistovich, Keith J. Karren, and Brent Hafen. Published by Pearson Education, © 2013.)




• National Incident Management System Developed so that federal, state, local,

and tribal resources can respond more efficiently to natural disasters and emergencies





• National Incident Management System Teaches unified approach to incident

management, standard command and management structures

Emphasizes preparedness, mutual aid, resource management, common terminology among agencies




• The Medical Branch Branch of ICS Designates and coordinates three

functional areas or groups• Triage• Treatment• Transport




• Triage Group Determines location of triage areas Conducts primary triage and ensures all

patients are assessed and sorted using local triage protocol

The triage group leader communicates resource requirements to the medical group supervisor.





• Triage Group Communicates with treatment group

leader to allow for movement of patients into treatment area for prehospital care




• Treatment Group Determines treatment group location Coordinates with triage group to move

patients from triage to treatment areas Maintains communications with medical

group supervisor





• Treatment Group Reassesses patients• Conducting secondary triage to match

patients with resources Directs movement to transport group




• Transport Group Coordinates transportation of victims to

appropriate facilities for treatment Manages patient movement and

accountability from scene to hospitals Works with treatment group to establish

adequately sized, easily identifiable patient loading area





• Transport Group Designates ambulance staging division Maintains communication with medical

group supervisor




• Medical Staging Designates easily located site for

resources to stage near incident area Determines whether several staging

divisions required Determines whether staging will need to

be relocated as situation evolves



TRIAGE



Triage

• Method of sorting patients for care and transport based on severity of injuries or illnesses

• Used in hospital emergency departments, battlefields, emergencies when there are multiple victims and limited medical resources



Figure 27.3 At the scene of a multiple-casualty incident, triage is the system used to identify victims who are most in need of immediate medical care.



Triage

• EMRs First on scene Must be able to triage patients and

initiate care rapidly



Triage

• Serious medical or trauma related problems should be transported quickly. Heart attack Shock Major injuries Heat stroke



Triage

• START Triage System Simple Triage And Rapid Treatment Based on rapid assessment of patients

using three criteria• Respirations • Perfusion• Mental status

60 seconds or less per patient Do not begin treatment during triage.




Triage

• START Triage System Patients classified into one of four

categories and tagged with denoted color-coded tag indicator• Immediate (red)• Delayed (yellow)• Minor (green)• Deceased (black)



Figure 27.4 An example of a standard triage tag, front and back.



Figure 27.5 The START triage algorithm.



Triage

• Primary triage When patient is first identified and

triaged• Secondary triage

When patient is relocated to treatment area, they will immediately be re-triaged by treatment team.



Table 27.1 Multiple-Casualty Incidents



Triage

• JumpSTART Pediatric Triage System Specialized pediatric triage system

designed for patients from one to eight years of age




Triage

• JumpSTART Pediatric Triage System Assessment categories for JumpSTART

system are the same as for START system.• Respirations • Perfusion (peripheral pulses) • Mental status (AVPU)



Figure 27.6 The JumpSTART pediatric triage algorithm.



Triage

• Be aware of your mental and physical stress levels. Critical Incident Stress Debriefing (CISD)



SUMMARY



Summary

• While rare, Multiple-Casualty Incidents (MCIs) can easily overwhelm first responding units at scene.

• First units quickly request additional resources and begin to establish command over incident.




Summary

• Incident Command System (Incident Management System) Tool used to manage overall control of

large scenes involving many resources and multiple agencies




Summary

• Triage Sorting of patients based on severity of

injuries or illnesses Goal is to save as many patients as

possible using available resources.




Summary

• Triage Categories Immediate• Most critical but salvageable patients

Delayed• Less critical but still in need of care

Minor• Ambulatory at scene

Deceased• No signs of life




Summary

• START System Simple Triage And Rapid Treatment Uses respirations, perfusion, and mental

status assessments to categorize patients into one of four treatment categories




Summary

• JumpSTART Variation of START Triage System

designed specifically for pediatric patients

Takes into account unique needs and presentation of pediatric patients



REVIEW QUESTIONS



Review Questions

1. What are the criteria that define a Multiple-Casualty Incident?

2. What are common causes of Multiple-Casualty Incidents?

3. What is the role of the Emergency Medical Responder in the multiple-casualty situation?




Review Questions

4. What are the key principles and structure of an Incident Command System?

5. What are the key principles of triage at a Multiple-Casualty Incident?

6. What are the assessment criteria of the START triage system?

7. What is the difference between primary and secondary triage?



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EMR ch27

Healthcare

Transcript of EMR ch27