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Major incidents/CBRN Flashcards

1
Q

What acronym is used to give structure to a MI?

A

CSCATT

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2
Q

Describe the components of CSCATTT

A

Command
Safety
Communications
Assessment
Triage
Treatment
Transportaion

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3
Q

Describe the Command part of CSCATT? (3)

A
  1. Ambulance Incident Commander (Tactical) will appoint:
    - Operational Commander
    - Primary Triage Officer
    - Ambulance Parking Officer
    - Loading Officer
  2. Co-locate
  3. Action cards
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4
Q

Describe the aspects of Safety in CSCATT (4)

A
  1. Safety of yourself - PPE
  2. Safety of scene - cordons/barrier tape
  3. Survivors - move to place of safety
  4. Remember STEP 123 +
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5
Q

Describe Communication in terms of CSCATTT? (3)

A
  1. METHANE
  2. Talk groups
  3. Start a log
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6
Q

Describe the Assessment aspect of CSCATTT (3)

A
  1. Jointly understand risk
  2. Carry out assessment
  3. Request resources via METHANE to EOC
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7
Q

Describe the Triage, Treatment and Transportation part of CSCATTT

A

Triage
1. TST -best to work in pairs
2. Set up casualty clearing station (with medical advisor)

Treatment
Commence extended treatment once TST completed

Transportation

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8
Q

Describe METHANE

A

MI standy/declare
Exact location
Type of incident
Hazards
Access/egress
Number of casualties/severity
Emergency services on scene/required

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9
Q

Describe the command structure within the ambulance service at a MI

A
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10
Q

What tabard does the fire incident commander wear?

A

White with ‘Fire Incident Commander’ (sometimes red/white check top part)

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11
Q

What colour tabard does a fire operations commander wear?

A

All red

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12
Q

What colour tabard does the police incident commander wear?

A

Blue/white check top part and white bottom

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13
Q

What colour do the various agencies incident commanders tabards have in common?

A

White bottom half

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14
Q

What colour tabard is the Ambulance Incident Commander (Tactical commander)

A

Green/white check top
White bottom

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15
Q

What colour is the ambulance operational commander (and most of the other tabards for ambulance service e.g. section commanders/parking officer)

A

Green white check top
Yellow bottom

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16
Q

What colour are the Coastguard tabards for:
1. Incident commander
2. Officer in charge (operational commander)

A

Both have a yellow/block block pattern bottom and tops halves are
1. white
2. red

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17
Q

What colour are the check pattern on MI tabards for:
1. Fire
2. Police
3. Ambulance s

A
  1. Red/white
  2. Blue/white
  3. Green/white
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18
Q

What colour is the bottom part (top is normal yellow/green check) of the tabard for:
- doctors
- safety officer
- decontamination officer?
- Tactical advisor/NILO

A
  1. Red
  2. Blue
  3. Purple
  4. Green
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19
Q

Describe Ten Second Triage

A
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20
Q

Describe MITT

A
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21
Q

What is the difference between TST and MITT?

A

TST designed to be quick and used by anyone, wheres MITT generally requires healthcare staff and is longer.

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22
Q

What is POWER used for and what does it mean?

A

Safety at scene at railway

Power off - should be confirmed in person, EOC if any doubt

Off tracks unless patient appears viable

Wear PPE

Ensure EOC and ambulance commander know you are entering/leaving trackshide

Rapidly move patients off trackside and treat where is safe

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23
Q

Who are the 3 groups that need to be aware of any incident occurring on the rail network at all times?

A
  1. Network Rail Control
  2. British Transport Police (will be told by network rail)
  3. EOC
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24
Q

Following identification of an incident occuring trackside, what will Network Rail Control / EOC do initially? (3)

A
  1. Agree site identification name
  2. Agree incident number
  3. Network rail will send RIO and give ETA
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25
Q

Who should emergency services wait for ideally following an incident on the tracks?

A

Rail Incident officer (RIO)

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26
Q

When might emergency services act before RIO arrives?

A

To save life

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27
Q

How do ambulance personel request trains caution/stop/power off?

A

Via EOC to Network Rail Control

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28
Q

What do some tracks have that can lead to additional risk?

A

Third conductor energised to 650-750 V DC

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29
Q

With regards to electricity on underground, what different to overground trains?

A
  • all rails carry power
  • main ‘positive’ power rail is 420 V DC and furthest away from platform edge
  • middle rail is ‘negative’ live rail and is 200V DC
30
Q

What are the issues with regards to overhead line equipment on the railways? (2)

A
  1. Not routinely switched off
  2. 25,000 V AC
31
Q

How far away should we keep of overhead lines on the rail network?

32
Q

How many lanes should be shut following an RTC?

A

Lane involved and lane either side (unless it is the outside lane ie. lane 3 just needs lane 2 + 3 shutting)

33
Q

In relation to pre-determined response to an airport incident was is a category:
1. A
2. B
3. C

A
  1. Planes that fall into CAA category 5,6,7,8,9 + 10 e.g. large passenger aircraft
  2. CAA category 3 +4 - smaller aircraft or large passenger carrying helicopter
  3. CAA category 1 + 2 - light aircraft, gliders, small helicopterW
34
Q

What is the difference in the initial response of the ambulance service to the different category airport incidents?

A

Category A + B send 1 x DCA + 1 x manager + 1 x HART, in addition to making NILO/tactical advisor aware

Category C HART don’t get sent automatically

35
Q

What are the 4 categories of crowd density in the NARU guidelines?

A

V = very low density (4 persons to 4m2)
L = low density (8 persons to 4m2) (can move freely but some movement maybe limited)
M - medium density (16 persons to 4m2) - difficult to move through crowd
H = high density crowds (24 persons to 4m2), almost impossible to move through crowd

36
Q

What are the 5 crowds types described by NARU

A
  1. Casual = not organised, will accept authority
  2. Cohesive = crowd together for specific purpose, no leadership
  3. Expressive - common purpose, loose leadership. Some mild anti-social elements, may need involvement of authorities
  4. Anti-social = some elements involved in civil disobedience and direct action.
  5. Incident = crowd reacting to, or retreating from, a dangerous situation. Panic.
37
Q

What is at the:
1. top
2. middle
3. bottom

of hazard warning panels?

A
  1. Emergency Action Code (tells FRS/police what initial actions to take)
  2. UN number
  3. 24 hour telephone helpline
38
Q

What are the parts of a hazard warning panel?

A
  1. Emergency Action Code (tells FRS/police what initial actions to take)
  2. UN number
  3. 24 hour telephone helpline
  4. Hazard warning diamond
  5. Company logo
39
Q

What are the different hazard warning diamonds?

40
Q

Describe the 3 zones in a CBRN incident

A
  1. Hot zone = contaminated area, HART and life saving tx only
  2. Warm zone = decontaminating area
  3. Cold zone = clean area, no PPE
41
Q

What is the plus part of STEP 1,2,3 +? (5)

A
  1. Follow first responder CBRN flow chart
  2. Evacuate
  3. Communicate (reassure) and advise
  4. Disrobe
  5. Decontaminate (dry = default)
42
Q

When should dry decontamination be done ideally?

A

At scene concurrently i.e. as cutting off clothes

43
Q

How should management of suspected gas contamination be managed?

A
  1. Disrobe and place in sealed bag (can ‘off gas’ over time leading to secondary poisoning
  2. Face upwind
44
Q

How should liquid and solid contamination be decontaminated?

A

Disrobe and dry decontamination

If caustic then copious irrigation (can be done at hospital)

45
Q

What is the percentage decontamination achieved at various stages?

A

Initial = 100% contaminated
Following disrobing = 10%
Following dry decon = 1 %
Following gross decontamination = 0.1%

46
Q

When should wet decon ideally be performed and why?

A

If caustic then ideally at hospital as slower and more dangerous

47
Q

How do organophosphates act?

A

Inhibit acetycholinesterase which breaks down acetylcholine leading to increased parasympathetic activation/CNS affects and progressive paralysis

48
Q

What is SLUDGEM used for and what does is mean?

A

Signs/symptoms of organophosphate poisoning/ cholinergic toxidrome

Salivation
Lacrimation
Urination
Defecation
GI upset
Emesis
Miosis

49
Q

What other signs/symptoms will nerve agent poisoning cause aside from SLUDGEM? (6)

A

Bronchospasm
Bradycardia
Sweating
Progressive paralysis of res muscles
Coma
Death

50
Q

How sho

51
Q

What is the pathophysiology of organophosphate poisoning?

A

Inhibit cholinesterases which leads to build up of acetylcholine at nerve endings

52
Q

What are the features of organophosphate poisoning? (8)

A

S- alivation
L - acrimation
U - rination
D - efecation
G - I upset
E - mesis
M - iosis
M - muscle twitching

Bradycardia, paralysis and resp failure

53
Q

What is the treatment for organophosphate poisoning and what is its mechanism

A

Atropine - blocks affect of acetylcholine at muscarinic receptors
Eases smooth muscle constriction and dries up secretions

54
Q

What is the atropine dose in organophosphate poisoning?

A

2mg- IV adult
0.02mg/kg (20mcg/kg) children
Every 5 mins double dose until atropinisation

55
Q

What is the mechanism of pralidoxime?

A

Reactivate acetylcholinesterase inhibited by organophosphates allowing metabolisation of acetylcholine.

56
Q

What can lead to cyanide poisoning? (3)

A
  1. Polyurethane burning
  2. Fruit kernels
  3. Finger polish remover
57
Q

What are the features of cyanide poisoning? (4)

A
  1. Metabolic acidosis
  2. Seizures
  3. Pulmonary oedema
  4. Arrhythmias
58
Q

What is the antidote for severe cyanide poisoning and what is the risk of giving it?

A
  1. Dicobalt edetate - Kelocyanor
  2. If no cyanide can be fatal
59
Q

What are the treatments for mild cyanide poisoning? (2)

A
  1. Sodium thiosulphate
  2. Sodium nitrate
60
Q

What is the best treatment for inhaled cyanide poisoning?

A

5g hyroxycobalamin IV (Cyanokit)

61
Q

How do vesicants (Mustard, Lewisite) cause injury?

A

Damage DNA leading to cell death in exposed tissue

62
Q

How should vesicant (Mustard, Lewisite) poisonings be managed?

A

Decontamination
Supportive treatment

63
Q

How do pulmonary agents (Chlorine/Phosgene) cause damage?

A

Damage cell membranes in respiratory tract + lungs leading to airway irritation + oedema.

Severe = death

64
Q

What are the 3 parts of the National CBRN Initial Operational Response guideline?

A
  1. React
  2. Recognise
  3. Assess
65
Q

In the National CBRN Initial Operational Response guideline, what does the ‘React’ part entail? (3)

A

Remove - themselves from area and find fresh air. If skin itchy/painful find water source

Remove - outer clothing (not overhead if possible and not if stuck to skin)

Remove - the substance from skin (decon)

66
Q

In the National CBRN Initial Operational Response guideline, what does the ‘Recognise’ part mean? (3)

A

Evaluate the signs/symptoms of patient to identify toxidrome

67
Q

In the National CBRN Initial Operational Response guideline, what does the ‘Assess’ part entail? (5)

A
  1. What CBRN factors are present?
  2. Where are the casualties located?
  3. Where are other people located? (keep seperate and look for evac routes)
  4. Identify unaffected routes for evacuating people
  5. Are there any secondary threats?
68
Q

The National CBRN Initial Operational Response guidelines suggest what acronym should be used for substance assessment ?

A

BADCOLDS

Behaviour
Appearance
Dissemination
Colour
Odour
Likeness
Deliberate
Symptoms

69
Q

The National CBRN Initial Operational Response guidelines suggest what acronym should be used for casualty assessment?

A

CRESS

Consciousness
Respiration
Eyes (may be delayed)
Secreations
Skin

DipIMC (14 decks)

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