DISASTER and EMERGENCY

Aserioussituationoroccurrencethat
happensunexpectedlyanddemands
immediateaction.

Aconditionofurgentneedforactionor
assistance.
OFEMERGENCY

1. DANGERSTOLIFE
2. DANGERSTOHEALTH
3. DANGERSTOPROPERTY
4. DANGERSTOENVIRONMENT
WhatisTriage?
Issortingofpatientsintocategoriesof
priorityforcareandtransportbasedonthe
severityofinjuriesandmedical
emergencies.

FromtheFrenchwordtrier,meaningto
sortout.

ImportantReminder:
Theinitialreportisthemostimportant
messageonecanrelaytoafirstaiderofan
accidentorillness,becauseitsetstheemotional
andoperationalstageforeverythingthatfollows:
Theonegivingthefirstvitalreportorcaller
should:

RemainCalm.
Useclearlanguage.
Bepreciseandconcise.
Keypointstobementioned:
1. Locationoftheaccident(specific).
2. Typeofillness/accident(givebrief
description).Howmanyareinjured;
Whathappened?
3. Ageandsexofthepatient.
4. Anyhazards.
5. Typeofassistancerequired.

START(SimpleTriageandRapid
Treatment)

Isamethodusedbyfirstresponderstoeffectively
andefficientlyevaluateallofthevictimsduringa
masscasualtyincident(MCI).

TheSTARTtriagesystemreliesonmakingarapid
assessment(takinglessthanaminute)ofevery
patient,determiningwhichoffourcategories
patientsshouldbein,andvisiblyidentifyingthe
categoriesforrescuerswhowilltreatthepatients.
TheTags

Red - Immediate shock or a severe head

injury.
Yellow - Delayed respirations were under
30 per minute ,capillary refill was under 2
seconds and they could follow simple
commands.
Green Minor injuries, frightened and in
pain.
Navy-Deceased

DetailedFlowchart

TheHowTo...

RememberthissimpleformulatoguideyourSTART
assessment.RPMstandsfor

RESPIRATION
PERFUSION
MENTALSTATUS

Sequentiallyusethisassessmentsystemforevery
patient.

Enteringthescene

Asalways,makesurethesceneissafeforyou
to enter. If it is not, wait until it has be made
safe.
Next, ask those who are not injured or who
haveonly minorinjuries to identify themselves.
TagthosewithminorinjuriesasMINOR.
MinorInjuries-TagMINOR
Ask several uninjured victims to stay close to
assist you, direct the others to a designated
spotawayfromtheimmediatescenetowaitfor
additionalpersonnel.

Respiration

First, determine if the patient is breathing. If yes,

immediatelychecktherespirationrate.
Ifnot,repositionthepatient.Ifthepatientdoesnotstart
breathingspontaneously,DONOTstartCPR.
Patient not breathing after repositioning head- Tag
DECEASED
Moveontothenextvictim.
(NotstartingCPRmaybethehardestthingyoumustdo
atamultiplecasualtyscene,butifyouperformCPRon
onepatient,manyothersmaydie.)

C-spineinjury

You will have to position the airway without manually

stabilizingthecervicalspine.Thisiscountertowhatyou
havebeentaughtandmayresultinworseningacervical
spine injury. But if you dont reposition the victim
immediately, the person will die in the field. You wont
havethepersonneltocarefullystabilizetheC-spineand
you cant afford to let other victims die while you take
timetodoityourself.
If the patient begins breathing spontaneously after
repositioning,tagthepersonIMMEDIATEandmoveon.
If necessary, ask an uninjured victim to help maintain
theopen-airwayposition.

Patientbeginsbreathingafterrepositioningthehead-
TagIMMEDIATE
Ifthevictimisbreathingwhenyouapproach,buthasa
respiratoryrateofmorethan30,tagIMMEDIATEand
moveon.Donttaketimetoformallycountthe
respirations.Iftherateseemstoofast,tagthevictim
IMMEDIATEandmoveon.
Respiratoryrategreaterthan30-TagIMMEDIATE

Perfusion

If you can feel a radial pulse, move on to the Mental

Statusassessment.
Ifyoucantfeelit,tagthepatientIMMEDIATE,havean
uninjured victim put direct pressure on any visible,
seriousbleedingandmoveontothenextpatient.
NoRadialPulse-TagIMMEDIATE
Next check for capillary refill. If capillary refill is more
than 2 seconds, tag the patient IMMEDIATE, have an
uninjured victim put direct pressure on any visible,
seriousbleedingandmoveontothenextpatient.

NoRadialPulse-TagIMMEDIATE
Next check for capillary refill. If capillary refill is more than 2
seconds, tag the patient IMMEDIATE, have an uninjured victim
putdirectpressureonanyvisible,seriousbleedingandmoveon
tothenextpatient.
Capillaryrefillgreaterthan2seconds-TagIMMEDIATE
If capillary refill is less than 2 seconds, move to MENTAL
STATUS.
MentalStatus
Ifthevictimisunconsciousorcantfollowsimplecommands,tag
themIMMEDIATEandmoveontothenextvictim.
Unconsciousorcannotfollowcommands-TagIMMEDIATE
If the victim can follow simple commands, tag them DELAYED
andmoveontothenextvictim.
HistoryofHEICS
TheIncidentCommandSystem(ICS)
developed for use by fire protection
agencies in response to incidents
rangingfromday-to-dayoperationsto
disasters.
ICS was later adapted into a model
specifically for hospitals by the
Hospital Council of Northern
California.

WhyisHEICSImportant?
Medicaldisastercanquicklyleadtochaosand
confusion.

Standarddisasterplanstypicallyarenotuniversalor
realistic.

HEICSprovidesmedicalfacilitieswithanorganized
managementstructurethatpromotesimmediate,
focuseddirectionofactivitiesduringadisaster.

Allowsforpromptresumptionofnormaloperations.

WhenDoHospitalsUseHEICS?
TheHEICSplanisflexible.

Fullactivationinthecaseofamajor
emergencysuchasabioterrorist
attack.

Partialactivationintheeventofa
smalleremergencysuchasafire.

UnderstandCommandTerminology
UnifiedCommand
UnityofCommand
ChainofCommand
SpanofControl
ResourceManagement
ResourceStatus

UnityofCommand
A single commander is vested with the
requisite authority to direct all forces employed
in pursuit of a common goal.
Unity of command: Each person within an
organization reports to only one designated
person, ensuring a clear line of supervision.
ChainofCommand
Ranked positions of
authority and
responsibility within an
organization in a clearly
understood and agreed
uponorder.

Incident Commander
Section Chief
Director
Supervisor
Unit Leader
Officer
SpanofControl
Ineffective
and
Possibly
Dangerous
Effective
Span of Control
Ideally, each commander should only responsible for a
maximum of three to seven subordinates, 1: 5 command
ratio is ideal.
ResourceManagementinHEICS
SINGLERESOURCES
INCLUDESPERSONNEL
ANDEQUIPMENT
STRIKE TEAM
COMBINATION OF SAME
KIND AND TYPE
TASK FORCES
COMBINATION OF EQUIPMENT
AND/OR PERSONNEL
ResourceStatusinHEICS
AVAILABLE
ASSIGNED
OUT OF SERVICE
KnowKeyPositions&Functional
Responsibilities

PurposeofHEICSStructure
Limitsspanofcontrol

Distributeswork

Systemofdocumentation&reporting

Lessensliability

Promotesfinancialrecovery
PrimaryHEICSManagement
INCIDENT
COMMAND
LOGISTICS PLANNING

FINANCE

OPERATIONS
FunctionalResponsibilities
COMMAND = OVERALLRESPONSIBILITY

LOGISTICS = PROVIDESUPPORT

PLANNING = COLLECT/ANALYZEDATA,
PREPAREACTIONPLAN

FINANCE = COSTACCOUNTING&
PROCUREMENT

OPERATIONS = DIRECTTACTICALACTIONS

LogisticsSection
Responsible for acquisition & maintenance of:
Facilities

Services

Personnel

Equipment

Materials
PlanningSection
Collect,analyze,displayinformation

Prepareincidentactionplan

Maintainsituation&resourcestatus

Maintainincidentdocumentation

Preparedemobilization

Promotecontinuityofoperations
FinanceSection
Monitorsincidentcosts

Maintainsfinancial
records

Administersprocurement
contracts

Performstimerecording
OperationsSection
Carryoutthemedical
objectivetothebestof
theirability.
Canconsistof:
SingleResources,Task
ForcesandStrikeTeams
Inhospital,maybe:
EmergencyDepartment
IntensiveCareUnits
OperatingRooms
Dischargeplanning
OverviewofICSPrinciples

Beusableformanagingallroutineorplannedevents,of
any size or type, by establishing a clear chain of
command.
Allow personnel from different agencies or departments
to be integrated into a common structure that can
effectivelyaddressissuesanddelegateresponsibilities.
Provide needed logistical and administrative support to
operationalpersonnel.
Ensurekeyfunctionsarecovered.