Chap3.doc

              Chapter III

              Disaster Medical OperationsCPart 1

In this chapter you will learn aboutC

C              Life-threatening conditions:  How to recognize and treat airway obstruction, bleeding, and shock.

C              Triage:  Principles of triage and how to conduct triage evaluations.

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III.  Disaster Medical Operations - Part 1

              Introduction

Most disasters are relatively unexpected, endanger lives and health, and overwhelm existing emergency resources.  These elements lead to some basic assumptions about disaster medical operations:

$              The number of victims will exceed local capacity for treatment.

$              Survivors will assist others.  They will do whatever they know how to do, although it cannot be assumed that most people know lifesaving first aid or post-disaster survival techniques.

The American College of Surgeons has described three phases of death due to trauma:

$              Phase 1.  Death within minutes due to overwhelming and irreversible damage to vital organs.

$              Phase 2.  Death within several hours due to excessive bleeding.

$              Phase 3.  Death in several days or weeks due to infection or multiple-system failure (i.e., not from the injury per se).

Experts agree that over 40 percent of disaster victims in the second and third phases of death could be saved by providing simple medical care.  CERT disaster medical operations personnel are trained to provide treatment for life-threatening conditionsCairway obstruction, bleeding, and shockCand treatment for other less urgent conditions.  They are also trained to provide the greatest good for the greatest number of victims through principles of triage.  Given the overwhelming nature of disasters, the CERT members’ training in medical operations can play a critical role in disaster response.

              Introduction

              (Continued)

This chapter will introduce disaster medical operations and train you to:

$              Recognize and treat life-threatening conditions (i.e., open the airway, control bleeding, treat for shock).

$              Conduct triage evaluations.

Remember that the goal of disaster medical operations is to do the greatest good for the greatest number.

Your instructor may present additional information not covered in this Participant Handbook.  Be sure to take notes during the classroom presentation of this material.

RESCUER SAFETY:  Be sure to wear a helmet, goggles, mask, gloves, and boots for all medical operations.

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              Recognizing And Treating Life-Threatening Conditions

Introduction

In emergency medicine, airway obstruction, bleeding, and shock are “killers”Clife-threatening conditions that can kill a patient if not treated immediately.  The first priority of medical operations workers is to attend to these potential killers by:

$              Restoring breathing.

$              Controlling severe bleeding.

$              Ensuring adequate circulation (treating for shock).

When working in a disaster with multiple casualties, the first goal is Simple Triage And Rapid Treatment (START).

This section will train you how to recognize the “killers” by recognizing their symptoms and their effects on body systems.  It will also provide you with practice in providing immediate treatment to minimize disaster casualties.

Opening The Airway

An airway obstruction is anything that hinders or prevents the exchange of oxygen and carbon dioxide through the body’s respiratory system.  Through the respiratory system, we obtain oxygen by inhaling and rid ourselves of carbon dioxide by exhaling.  Once in the lungs, oxygen is transferred to red blood cells and transported through the bloodstream to nourish our cells.  The major components of the respiratory system are shown in Figure III-1.

Opening The Airway (Continued)

              Figure III-1.  Components Of The Respiratory System

An unconscious or semiconscious victim may have an obstructed airway.  If the airway is obstructed, the victim cannot get oxygen, and the impact is felt very quickly in the heart and brain.  A victim with suspected airway obstruction must be checked immediately for breathing, and if necessary, the airway must be opened. 

Time is critical when dealing with airway obstructions.  Heart function may be affected within the first few minutesCand brain damage is possible after 4 minutes without oxygen.

Opening The Airway (Continued)

The most common airway obstruction is the tongue.  In an unconscious victim, especially one positioned on his or her back, the tongue relaxes and may block the airway.  This condition is shown in the figure below.

              Figure III-2.  Airway Obstructed By The Tongue

Opening The Airway (Continued)

When the victim is not breathing, use the Head-Tilt/Chin-Lift method of opening the airway.  The Head-Tilt/Chin-Lift method involves following the six steps shown in the table below. 

              Table III-1.  Head-Tilt/Chin-Lift Method For Opening An Airway

If the victim does not start breathing using the Head-Tilt/Chin-Lift method, try the procedure one more time.  If the victim does not respond the second time, move on to the next victim.  Remember, the CERT team’s mission is to do the greatest good for the greatest number of victims possible.  Although it may be difficult to leave the victim, it is necessary to do so under disaster circumstances. 

If the victim begins breathing, the airway must still be maintained.  Try to get a volunteer to hold the head back to maintain the open airway, or place something (such as a shoe or soft object) under each of the victim’s shoulders to slightly elevate the shoulders, which will keep the airway open.

Controlling Bleeding

Uncontrolled bleeding initially causes weakness.  If bleeding is not controlled within a short period, the victim will go into shock (described in the next section), and finally die.  The average adult has about 5 liters of blood.  Because the loss of just 1 liter poses a risk of death, it is critical that excessive bleeding be controlled in the shortest amount of time possible.

There are three main types of bleeding.  The type can usually be identified by how fast the blood flows.

$              Arterial Bleeding.  Arteries transport blood under high pressure.  Therefore, bleeding from an artery is spurting bleeding.

$              Venous Bleeding.  Veins transport blood under low pressure.  Bleeding from a vein is flowing bleeding.

$              Capillary Bleeding.  Capillaries also carry blood under low pressure.  Bleeding from capillaries is oozing bleeding.

Use one or more of the procedures on page III-10 to control bleeding.  If you cannot control the bleeding using one method, try another, or a combination of methods.

Controlling Bleeding (Continued)

              Table III-2.  Procedures For Controlling Bleeding

Ninety-five percent of bleeding can be controlled by direct pressure combined with elevation.

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