DISASTER and EMERGENCY

EMERGENCY• A serious situation or occurrence that

happens unexpectedly and demands immediate action.

• A condition of urgent need for action or assistance.

TYPES OF EMERGENCY

1. DANGERS TO LIFE2. DANGERS TO HEALTH3. DANGERS TO PROPERTY4. DANGERS TO ENVIRONMENT

What is Triage?

• Is sorting of patients into categories of priority for care and transport based on the severity of injuries and medical emergencies.

• From the French word “trier”, meaning “to sort out”.

Important Reminder:The initial report is the most

important message one can relay to a first aider of an accident or illness, because it sets the emotional and operational stage for everything that follows: The one giving the first vital report or caller should:

Remain Calm.Use clear language.Be precise and concise.

Key points to be mentioned:

1. Location of the accident (specific).2. Type of illness/accident (give brief

description). How many are injured; What happened?

3. Age and sex of the patient.4. Any hazards.5. Type of assistance required.

START (Simple Triage and Rapid Treatment)

Is a method used by first responders to effectively and efficiently evaluate all of the victims during a mass casualty incident (MCI).

The START triage system relies on making a rapid assessment (taking less than a minute) of every patient, determining which of four categories patients should be in, and visibly identifying the categories for rescuers who will treat the patients.

The Tags

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

Detailed Flowchart

The How To...

• Remember this simple formula to guide your START assessment. RPM stands for 

RESPIRATIONPERFUSIONMENTAL STATUS

Sequentially use this assessment system for every patient.

Entering the scene As always, make sure the scene is safe for you

to enter. If it is not, wait until it has be made safe.

Next, ask those who are not injured or who have only minor injuries to identify themselves. Tag those with minor injuries as MINOR.

Minor Injuries - Tag MINOR Ask several uninjured victims to stay close to

assist you, direct the others to a designated spot away from the immediate scene to wait for additional personnel.

Respiration

First, determine if the patient is breathing. If yes, immediately check the respiration rate.

If not, reposition the patient. If the patient does not start breathing spontaneously, DO NOT start CPR.

Patient not breathing after repositioning head- Tag DECEASED

Move on to the next victim. (Not starting CPR may be the hardest thing you

must do at a multiple casualty scene, but if you perform CPR on one patient, many others may die.)

C-spine injury

You will have to position the airway without manually stabilizing the cervical spine. This is counter to what you have been taught and may result in worsening a cervical spine injury. But if you don’t reposition the victim immediately, the person will die in the field. You won’t have the personnel to carefully stabilize the C-spine and you can’t afford to let other victims die while you take time to do it yourself.

If the patient begins breathing spontaneously after repositioning, tag the person IMMEDIATE and move on. If necessary, ask an uninjured victim to help maintain the open-airway position.

• Patient begins breathing after repositioning the head - Tag IMMEDIATE

If the victim is breathing when you approach, but has a respiratory rate of more than 30, tag IMMEDIATE and move on. Don’t take time to formally count the respirations. If the rate seems too fast, tag the victim IMMEDIATE and move on.

• Respiratory rate greater than 30 - Tag IMMEDIATE

Perfusion

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

If you can’t feel it, tag the patient IMMEDIATE, have an uninjured victim put direct pressure on any visible, serious bleeding and move on to the next patient.

No Radial Pulse - Tag IMMEDIATE 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, serious bleeding and move on to the next patient.

No Radial Pulse - Tag IMMEDIATE 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, serious bleeding and move on to the next patient.

Capillary refill greater than 2 seconds - Tag IMMEDIATE If capillary refill is less than 2 seconds, move to MENTAL

STATUS. Mental Status If the victim is unconscious or can’t follow simple commands,

tag them IMMEDIATE and move on to the next victim. Unconscious or cannot follow commands - Tag

IMMEDIATE If the victim can follow simple commands, tag them DELAYED

and move on to the next victim.

History of HEICS• The Incident Command System

(ICS) developed for use by fire protection agencies in response to incidents ranging from day-to-day operations to disasters.

• ICS was later adapted into a model specifically for hospitals by the Hospital Council of Northern California.

Why is HEICS Important?• Medical disaster can quickly lead to chaos and

confusion.

• Standard disaster plans typically are not universal or realistic.

• HEICS provides medical facilities with an organized management structure that promotes immediate, focused direction of activities during a disaster.

• Allows for prompt resumption of normal operations.

When Do Hospitals Use HEICS?

• The HEICS plan is flexible.

• Full activation in the case of a major emergency such as a bioterrorist attack.

• Partial activation in the event of a smaller emergency such as a fire.

Understand Command Terminology

• Unified Command• Unity of Command• Chain of Command• Span of Control• Resource Management• Resource Status

Unity of CommandA 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.

Chain of Command

Ranked positions of authority and responsibility within an organization in a clearly understood and agreed upon order.

Incident Commander

Section Chief

Director

Supervisor

Unit Leader

Officer

Span of Control

Ineffectiveand

PossiblyDangerous

EffectiveSpan of Control

• Ideally, each commander should only responsible for a maximum of three to seven subordinates, 1: 5 command ratio is ideal.

Resource Management in HEICS

SINGLE RESOURCES

INCLUDES PERSONNEL AND EQUIPMENT

STRIKE TEAMCOMBINATION OF SAME

KIND AND TYPE

TASK FORCESCOMBINATION OF EQUIPMENT

AND/OR PERSONNEL

Resource Status in HEICS

“AVAILABLE”

“ASSIGNED”

“OUT OF SERVICE”

Know Key Positions & Functional Responsibilities

Purpose of HEICS Structure• Limits span of control

• Distributes work

• System of documentation & reporting

• Lessens liability

• Promotes financial recovery

Primary HEICS Management

Functional Responsibilities• COMMAND = OVERALL RESPONSIBILITY

• LOGISTICS = PROVIDE SUPPORT

• PLANNING = COLLECT/ANALYZE DATA, PREPARE ACTION PLAN

• FINANCE = COST ACCOUNTING & PROCUREMENT

• OPERATIONS = DIRECT TACTICAL ACTIONS

Logistics Section• Responsible for acquisition & maintenance

of:• Facilities• Services• Personnel• Equipment• Materials

Planning Section• Collect, analyze, display

information

• Prepare incident action plan

• Maintain situation & resource status

• Maintain incident documentation

• Prepare demobilization

• Promote continuity of operations

Finance Section• Monitors incident

costs

• Maintains financial records

• Administers procurement contracts

• Performs time recording

Operations Section• Carry out the medical

objective to the best of their ability.

• Can consist of:– Single Resources, Task

Forces and Strike Teams– In hospital, may be:

• Emergency Department

• Intensive Care Units• Operating Rooms• Discharge planning

Overview of ICS Principles• Be usable for managing all routine or planned

events, 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 effectively address issues and delegate responsibilities.

• Provide needed logistical and administrative support to operational personnel.

• Ensure key functions are covered.