Disaster Medicine Flashcards
What does the incident controller do?
- Usually from fire or police
- Establishes an overall management team and is responsible for this
- Does not provide medical oversight
- Located uphill and upwind from the incident site
What does the initial “sieve and sort” triage involve?
Sieve: Airway patency (if not patent, considered dead)
HR
RR
Cap refill time
Sort: Order of transportation out and where on scene interventions will be performed
What are the 4 triage tags?
Black = Dead or unlikely to survive
Red= Critical injury requiring immediate care
Yellow= Significant but not immediately life threatening injuries
Green= Walking wounded
Who are the important stake holders that should be contacted for a mass casualty event?
ED director
ED nursing director
Bed co-ordinator
Blood bank
Heads of anaesthesia/surgery
Hospital CEO
Head of ICU
Head of radiology
Security
Media department
What actions should be included in the ED disaster plan?
Call in extra staff
Ask current staff to stay late
Discharge as able current patients
Move other patients to the ward
Setup up a large triage bay
Minimise any investigations
Rationalise interventions
Empower nursing staff to initiate treatment without Dr oversight
Take stock of equipment/drugs
Activate hospital code brown
Contact important stake holders
What actions should be included in a hospital wide disaster plan?
No new surgical cases
Activate all theatres
Call in extra staff
Ask current staff to stay late
Inpatient teams discharge as able
Clear outpatients, use for walking wounded
All hospital visitors leave
Establish central point of contact aka a command centre
Notify morgue for potential need to house multiple bodies
Hospital security team notified
Blood bank activation
What are the most common major disasters in Australia?
- Floods are number 1 overall
- Transport accidents are the most common man-made major incident
How do patients typically present post a disaster?
The majority leave the scene spontaneously and arrive at hospital on their own
- These are often the walking wounded and are discharged
- However many of these patients have psychological/psychiatric trauma and symptoms far outweighing their organic issues
- The critically unwell patients arrive later via ambulance/retrieval
How does the Casualty Based classification determine the severity of a disaster?
> 25 injured is minor
100 injured is moderate
1000 injured is Major
Doesn’t take into account the size and capability of receiving hosptals
How does the disaster scale rank disasters?
Level 1: Escalated response from EMS
Level 2: Regional response level
Level 3: National or international response required
What is the aim of disaster management?
Achieving the greatest good for the greatest number of survivors
What are the 3 stages of hospital disaster notification
Stage A
- Standby phase, hospital advised
- All staff remain, no new surgery starts
- ED transfer admitted patients to the wards
- bed co-ordinator make appropriate discharges
- Equipment/triage areas prepared
Stage B
- Activation phase, confirmation of details of numbers/types casualties
- Visitors/outpatients asked to leave
- New and old ED arrivals asked to leave if able
Stage C
- Patients arrive and triaged/retriaged
- Large triage area required, often use the ambulance bay
- Identification labels attached to wrist and neck
- ID card to go to patient information centre
What does the CSCATTT mnemonic for Disaster RESPONSE stand for?
Command/control
- Each service at the scene has a commander who moves vertically in that service
- There is an overall controller at the scene who moves horizontally between the services
Safety
- Self, scene and survivors
- PPE
- Preventing those arriving at the scene becoming part of the incident
Communication
- The commonest failing is communication
- Radios, overall controller
- Declare major incident to the relevant services (ie hospital)
- METHANE acronym
Assessment
Triage
Treatment
Transfer
What does the METHANE mnemonic for Disaster COMMUNICATION stand for?
Major incident
- Confirm call sign and major incident declared
Exact location
- Grid reference, road names and landmarks
Type of incident
- Rail, chemical, road, terrorist etc
Hazards
- Actual and potential
Access/Egress
- Safe directions to approach and to depart
Number
- An estimate of the number and then the type/severity of casualties
Emergency services
- Present and/or required
What is the definition of a major incident?
Any incident where the location, number, severity or type of live casualties requires extraordinary services
What are the the differences between major, mass and catastrophic incidents?
What is the 1-2-3 rule for scene saftey?
1- Self safety
2- Scene safety
3- Survivors safety
Most important this is to not become a casualty yourself
Not only does this deplete the manpower pool but adds extra stress on the overstretched system
What are steps that can be taken for a safe approach to a scene?
