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Key Response Tasks
• Assessment• Personal Protection• Control of Situation• Casualty Management• Communication• Call for Additional Resources
Assessment
• Recognize was the expectation at the Basic Level
• Analyze and intervention is the expectation at the Intermediate Level
Personal Protection
• At the Basic Level we avoided rushing in, remained uphill and upwind and avoided contact with contaminated victims
• At the Intermediate Level we will make carefully considered entry, and decontaminate and treat contaminated victims
Personal Protection
Level A – Fully Encapsulating Air Tight – SCBA insideLevel B – Splash Protection with SCBALevel C – Splash Protection with APRActive Carbon Garment with APR
Control of Situation
• At the Basic Level, you establish inner and outer perimeters, safe gathering points, use bullhorn techniques, and conduct emergency wash down
• At the Intermediate Level, you establish full control zones, control access/egress corridors, forward treatment areas, handle patients, and perform technical decontamination
Cold Zone
Warm Zone
WindOuter (Security)
Perimeter
Inner (Safety) Perimeter
Protective Action Zone
Hot (Initial
Isolation) Zone
Wind
Protective Action ZoneProtective Action Zone
Hot (Initial
Isolation) ZoneWarm Zone
Cold Zone
Outer (Security) Perimeter
Inner (Safety) Perimeter
Principles of Decontamination
• Minimize Contamination• Minimize Spread of Contamination• Reduce Contamination to Safe Level• Use PPE Until Safe to Remove• Arrange Disposal of Contaminated Items
Principles of Decontamination
Minimize Contamination
• Avoid/minimize direct contact with contaminant
• Establish decontamination line uphill, upwind
• Avoid cross contamination
Principles of Decontamination
Minimize Spread of Contamination
• Use controlled access/egress corridors• Perform gross decon as early as possible• Control runoff, secure contaminated
equipment/PPE• Delineate and control movement in decon
Principles of Decontamination
Reduce Contamination to Safe Level
ALARA
• Use appropriate decon measures… (absorbents, adsorbents, vacuuming, evaporation, chemical degradation, clothing removal)
• Measures with vary according to contaminant
Principles of Decontamination
Use PPE until safe to remove
• No PPE should be doffed until it is assured safe to do so• Use an appropriate decon process prior to doffing PPE• Doff PPE in a safe, systematic manner • Secure removed PPE appropriately
Principles of Decontamination
Arrange Disposal of Contaminated Items
• Appropriate arrangements must be made of site remediation/clean-up
• Ongoing site security must be arranged• Site security must be maintained until transition to
appropriate agency/agencies
Casualty Management
• At the Basic Level we were unable to handle contaminated casualties or enter the area of gross contamination, thus decon and treatment of non-ambulatory patients might not be possible
• At the Intermediate Level we will be able to effect rescue, decon and treatment of the non-ambulatory patients
Triage
• Definition: A dynamic, on-going process of sorting casualties throughout an event
• Goal: Establishes medical priorities, organizes chaos and plans treatment
• ****Do the greatest good for the greatest number****
Able to Walk NoYes
Delayed AssessVentilation
Step 1
VentilationPresent Yes
< 30/min> 30/min
Immediate Assess CapRefill
No
PositionAirway
Ventilation Present?
No Yes
ImmediateExpectantor Dead
Step 2
CapillaryRefill
< 2 sec> 2 sec
Immediate
ControlBleeding Assess
MentalStatus
Mental Status
Follows SimpleCommands
Fails to FollowSimple Commands
Immediate Delayed
Step 3
Step 4
Treatment Area
• Definition: A casualty collecting point • Goal:
– organize casualties by acuity– initiate treatment/mitigate life threat until
the casualty can be decontaminated (if needed) and transported
Communications
• Basic Level involves relaying scene information, estimating numbers affected, alerting hospitals and calling for additional resources (specialists)
• At the Intermediate Level we confirm numbers affected and expand the communications network
Call for Additional Resources
• You are the additional resources
• If you are not enough (Canadian Examples)• :
– CANUTEC Phone: 1-613-996-666– DRDC Suffield Phone: 1-403-544-4000– Joint National CBRNT Team via RCMP National
Operations Center Phone: 1-613-993-4460