1) Organize Team
2) Size Up - Recon Scene
3) Traige - victims
4) Stabilize victims and remove to Casualty Collection Point
Use memonic "SAFE" to remember:
SEARCH - Safely, systematic, buddy system
ATTACH Tag - Triage first, rescue later
FIX - Life threatening injury
EXTRICATE - Remove victims from danger
Incident Management Purpose - to produce effective results safely!
1) Do the most good for the most people
2) Account for rescuers, victims, resources
1) Identify SCOPE
2) Determine STRATEGY
3) DEPLOY resources
4) DOCUMENT actions and results
Use memonic CALM to remember CERT command structure:
Remember the robot from the movie Star Wars - "R2D2":
RECON > RANK > DISENTANGLE > DOCTOR
Maintain situational awareness
Check surroundings frequently
Stop, Think, Observe, Plan, Act
Sizeup - hazard identification, damage assessment
No wall, no roof, no enter!
Heavy damage don't enter to rescue - danger tape
Moderate Damage - non structural, in/out quickly
Light damage - Go for it!
RANK: aka (triage in-place prior to rescue)
Respirations <30/min, not "panting like a puppy"
Perfusion blanch test nail bed<2secs
Mental status - awake, aware, understands simple commands
DISENTANGLE - Rescue decision based upon Risk to Rescuers!
Rescue greatest number in the shortest exposure
Remove injured from immediate danger
Rescue lightly trapped first
Work safe, use PPE, Time, Distance, Shielding
DOCTOR - Traige First - Rescue Later
Affix TAG before rescue.
Treat for shock
"RECON" - For Hazards and SEARCH for Victims
Document hazards and search findings
SLOW DOWN - perform an adequate SIZE-UP
Before entering walk building perimeter, Mark building using duct tape strips
placed to left of door as you enter:
"RECON" - SEARCH METHOD:
1) As you enter call out: "Search Team, Is Anyone In Here?"
"Are You Hurt?" "Can you walk to me?"
If hurt or trapped say "STAY PUT we'll come to you."
2) Physical Search Interior - systematic, top down or bottom up
3) Stop frequently to LISTEN
4) Triangulate using flashlight
5) Mark searched areas, document results
6) Report by radio to Command, hazards, victims requiring extraction:
"RANK" - Triage begins with size-up.
Stop, Look, Listen, and Think. Stop and look and listen. THINK about how you will approach the task at hand. Continue size up as you work.
Conduct Voice Triage. Call out. "Come to the sound of my voice." Instruct survivors who are ambulatory to remain at a safe location, and continue with the triage operation.
Follow a Systematic Route. Start with victims closest to you and work outward in a systematic fashion.
Conduct Triage Evaluation. Evaluate victims and tag either RED (immediate), YELLOW(delayed), or BLACK (DEAD). Also evaluate any GREEN walking wounded. Everyone gets a tag.
Treat RED Victims Immediately. Airway management, bleeding control, and/or treatment for shock for RED (immediate) victims.
Document Results for:
Effective deployment of resources.
Information on locations of victims
Record number of casualties by degree of severity
Perfusion blanch test nail bed<2secs
Mental status understands simple commands
"DISENTANGLE" - RESCUE Purpose - Create safe environment for victim
1) LIFT OBJECTS - don't step on, step over or around.
2) USE TOOLS - simple machines
3) BE SAFE - Ensure object free and people clear before moving.
Beware of pinch points.
4) TRIAGE - victim before moving.
5) DOCUMENT RESULTS
LIFTS AND CARRIES
Fireman's carry - Only if victim if 80# or less
Solo extraction methods:
Log roll and Blanket drag
Army (Rope/Webbing) Drag*
*Roll casualty onto back, thread rope or webbing under small of back, slide across top of buttocks, loop rope or webbing under, through and around belt at hips, "X" across chest and under armpits. Attach snap link and drag to safety.
Team carry methods:
Log roll and blanket carry - advantage through doorways, around corners or up and down stairs (requires minimum four people)
Door, table, surf board or other long-wide board 2"x6" or wider - (best with four rescuers) if victim small can do with two people over short distance.
"CAT stretcher" - Two folding metal chairs, flat-stacked back-to-back, legs out, wrap or tie securely with duct tape, 550#cord or webbing.
Chair carry problematic - Evac chairs require training.
Control head, open airway, look, listen feel, not breathing - DEAD
12-20 breaths per minute OK, if "Panting Like a Puppy" - RED
Comfort lowers respiration rate - helps calm victim down
Let them sit up if comfortable, don't "make" them lie down.
Cool burns with water only - Don't remove clothing, soak to cool
Burns to face critical, swelling impairs breathing
If victim inhaled hot air tag RED
Perfusion: - Blanch test nail bed > 2 secs.
Head or spinal cord injury causes blood vessel dilation drops BP
Handle GENTLY, elevate feet, keep warm, direct pressure, pressure point
Prevent secondary infection, irrigate only, apply dressing, bandage
Unconscious victim - RED
Semi-Conscious - unaware, can't follow simple commands - RED
Conscious victim, awake and aware can be cared for and made more comfortable, move to a safe place, protected from weather, wind, rain, and tag Yellow.
SAFETY AWARENESS - Disaster Risk Factors
Tool / equipment hazards, risk of hand, eye, head injuries, electric shock, chemical burns
Human factors, stress / fatigue
Structural instability, terrain - Trauma risk, falls, building collapse potential, loose rock, fallen limbs, wet or insecure footing, falls, puncture wounds or d lacerations from debris
Environmental effects: lightning, cold, wet, wind-blown dust, debris, smoke, fumes
Flooding: water rescue:
REACH out to victim with hand, pole, ladder,
THROW victim a rope, life vest, picnic cooler, anything that floats
ROW out to reach them from a boat or raft
GO to CALL 911, do not delay.
Incidental exposures: - If contaminated:
Remove everything, including jewelry
Cut off clothing normally removed over the head
Place contaminated clothing in plastic bag, tie closed
Wash your hands before using them to shower
Flush entire body with cool water
Blot dry with absorbent cloth
Put on clean clothes
Avoid use of affected areas, to prevent re-exposure
Report to responders for thorough decontamination and medical assessment.
Sturdy footwear - Ankle support, traction sole, safety toe
Double-Glove = Work gloves worn over med exam gloves
Safety glasses with side guards
Rain gear and suitable outdoor work clothing
Infection Control Awareness - Potentially Infectious Materials
• Body secretions / excretions
Human: poor sanitation conditions
Animal: livestock, rodents, vermin, insects
• Decayed carcasses
• Hanta virus from contact with rodent feces
• Putrescible materials - Spoiled foodstuff, garbage and refuse
• Allergens - Concentrated fungi, molds
Mechanisms of Transmission
• Direct contact ("portal of entry") Non-intact skin
• Penetrating injury (percutaneous) physical injury, portal of entry
• Vector borne
• Tetanus (no tetanus toxoid booster within 10 years)
• Hepatitis A, B (C much less likely)
• Enteric bacteria (e.g. E. coli, Salmonella)
- Cats: Toxoplasmosis
- Mice, rats: (urine): Leptospirosis; (feces) Hantavirus
- Plague (rat flea)
• Toxins (botulinum) decaying, spoiled foodstuffs
• Vector-borne (Lyme, West Nile, Malaria)
Disaster Worker Protection
• Good personal hygiene
Wash hands, hand sanitizers, double-glove
• DEET containing insect repellants
• Tetanus toxoid booster (every 10 yrs)
• Hepatitis A/B vaccine
• PPE use
Goggles, Gloves, hand sanitizers
N95 respirators, disposable single use, correct sizes, fit testing
• Awareness training
• Medical screening (post event) if confirmed exposure
CERT Actions Upon Exposure to Blood or Body Fluids
• Identify source patient to enable blood testing
• If consent not obtained, public safety must be notified
immediately to initiate legal action permitted under Virginia Code
to obtain source patient's blood for test
• Incident Safety Officer completes Exposure Incident Report in
compliance with CDC guidelines.
• DO NOT DELAY treatment, go direct to nearest hospital
• Record all pertinent information regarding specific exposure
and bring with you to the emergency room.