emr ch27
TRANSCRIPT
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
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Operations
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Copyright © 2016, 2011, 2009by Pearson Education, Inc.
All Rights ReservedEmergency Medical Responder: First on Scene, 10/eChristopher J. Le Baudour | J. David Bergeron
Copyright © 2016, 2011, 2009by Pearson Education, Inc.
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Copyright © 2016, 2011, 2009by Pearson Education, Inc.
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The Call
• Six Phases of Emergency Call Preparation Dispatch En route to scene Arrival at scene Transferring patients After emergency
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Figure 26.3 You must check all of your equipment at the start of each shift.
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Copyright © 2016, 2011, 2009by Pearson Education, Inc.
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Copyright © 2016, 2011, 2009by Pearson Education, Inc.
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Figure 26.1 Ensure the safety of you and your crew before entering the scene.(© Edward T. Dickinson, MD)
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Extrication
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Figure 26.2 There are many ways you can make the scene safer once you arrive.
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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
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26.2.1 To break a window, first place duct tape across the window to help keep the glass intact after breaking.
continued on next slide
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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.
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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.
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Figure 26.6 When arriving on scene, position your vehicle at least one utility pole away from the damaged pole.
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Hazardous Materials
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Figure 26.7 A typical DOT hazardous materials placard.
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Figure 26.8 Examples of the safety zones at a hazardous materials incident.
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Figure 27.1 Multiple-casualty incidents require the resources of many agencies.(© Edward T. Dickinson, MD)
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Figure 26.9 The decontamination of a fellow rescuer.
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MULTIPLE-CASUALITY INCIDENTS
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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
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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
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INCIDENT COMMAND SYSTEM
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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
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Incident Command System
• Incident Commander Responsible for all aspects of an
emergency response• Modules in Incident Command System
Command Operations Planning Logistics Finance
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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.)
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Incident Command System
• National Incident Management System Developed so that federal, state, local,
and tribal resources can respond more efficiently to natural disasters and emergencies
continued on next slide
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Incident Command System
• 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
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Incident Command System
• The Medical Branch Branch of ICS Designates and coordinates three
functional areas or groups• Triage• Treatment• Transport
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Incident Command System
• 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.
continued on next slide
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Incident Command System
• Triage Group Communicates with treatment group
leader to allow for movement of patients into treatment area for prehospital care
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Incident Command System
• Treatment Group Determines treatment group location Coordinates with triage group to move
patients from triage to treatment areas Maintains communications with medical
group supervisor
continued on next slide
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Incident Command System
• Treatment Group Reassesses patients• Conducting secondary triage to match
patients with resources Directs movement to transport group
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Incident Command System
• 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
continued on next slide
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Incident Command System
• Transport Group Designates ambulance staging division Maintains communication with medical
group supervisor
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Incident Command System
• 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
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TRIAGE
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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
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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.
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Triage
• EMRs First on scene Must be able to triage patients and
initiate care rapidly
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Triage
• Serious medical or trauma related problems should be transported quickly. Heart attack Shock Major injuries Heat stroke
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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.
continued on next slide
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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)
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Figure 27.4 An example of a standard triage tag, front and back.
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Figure 27.5 The START triage algorithm.
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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.
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Table 27.1 Multiple-Casualty Incidents
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Triage
• JumpSTART Pediatric Triage System Specialized pediatric triage system
designed for patients from one to eight years of age
continued on next slide
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Triage
• JumpSTART Pediatric Triage System Assessment categories for JumpSTART
system are the same as for START system.• Respirations • Perfusion (peripheral pulses) • Mental status (AVPU)
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Figure 27.6 The JumpSTART pediatric triage algorithm.
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Triage
• Be aware of your mental and physical stress levels. Critical Incident Stress Debriefing (CISD)
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SUMMARY
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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.
continued on next slide
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Summary
• Incident Command System (Incident Management System) Tool used to manage overall control of
large scenes involving many resources and multiple agencies
continued on next slide
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Summary
• Triage Sorting of patients based on severity of
injuries or illnesses Goal is to save as many patients as
possible using available resources.
continued on next slide
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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
continued on next slide
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Summary
• START System Simple Triage And Rapid Treatment Uses respirations, perfusion, and mental
status assessments to categorize patients into one of four treatment categories
continued on next slide
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Summary
• JumpSTART Variation of START Triage System
designed specifically for pediatric patients
Takes into account unique needs and presentation of pediatric patients
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REVIEW QUESTIONS
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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?
continued on next slide
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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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