TOR, Mass Gathering, ICS, Mass Casualty Flashcards
Universal TOR rule
Arrest not witnessed by EM
No shock delivered
No ROSC prior to transport (any ROSC)
EtCO2 with cardiac arrest
Better outcomes with >20
Worse outcomes with < 10
But no definite numbers to go on
Exceptions to transport for pediatric cardiac arrest
Obvious death
Crime scenes (or potential for crime scene, think SIDS)
Better prognosis in traumatic arrest
- Isolated stab wound to chest
- Signs of life when EMS arrives
- Thoracotomy within 15 minutes
Who to withhold in blunt traumatic arrests
Apneic
Pulseless
No organized electrical activity
Who to withhold on penetrating cardiac arrests
Apneic
Pulseless
No other signs of live (movement, electrical activity, PUPILLARY response)
penetrating - pupils
NAESMP-ASCOT recs in traumatic arrest
Consider if no ROSC after “appropriate filed treatment”
15 minute of CPR
Needs physician oversight
Advanced directives
Written document expressive future wishes for care decisions
Living will expresses
Wishes of patient in the event of permanent coma or terminal illness
POLST delineates
If resuscitation should be initiated
When to transport
Desired intensity of interventions
Main goal of mass gathering medicine
To spare existing system
Cardiac arrest response time for event
Within 5 minutes
Level of care at mass gathering
At least commensurate with level of care at surrounding community
Who should pay for medical equipment at a mass gathering
Event provider
Who should staff on site treatment facility
At least one medical provider at highest level
Facility for large mass gathering
Off site treatment facility - receive patients from prehospital system
Basically free standing hospital
Where to place docs at events
Bounded - central medical facility
Unbounded - may need to move with event
Most vulnerable part of mass gathering
Communications
Where is a 911 call received
Public Safety Answering Points
Radio as mass gathering should be what
P25 compliant
What implemented NIMS
PPD 5 after 911
NIMS does what
Guides all levels of government, NGOs and private sector to prevent, protect against, recover from, and mitigate disasters
Unity of command
Each member of team only responds to one person
Span of control
No leader is directly responsible for more than 3-7 personnel or functions
Unified command
Senior representatives from each agency form the IC and speak as one voice
4 Sections of ICS
Operations
Planning
Logistics
Finance
Operations in ICS is what
The Doers
Planning in ICS
Thinkers
Logistics in ICS
Getters (people or stuff)
Sections led by who in ICS
Chief
Operations responsible for
Tactical decisions and maintain situational awareness
Includes staging manager who coordinates available resources waiting on assignment
Planning responsible for
Incident action plan
Documentation
After action report
Continual monitoring of situation
2 Branches of logistics
Service branch: communications, food and water, medical support
Support branch: fuel, maintenance, access to fixed facilities
3 positions not in span of control
Safety officer
Public information officer
Liaison officer
IC role until they delegate
Only role that can violate span of command in ICS
Safety officer
What are branches in ICS
Used when number of divisions or groups exceed the recommended span of control
usually in operations
Division vs Group in ICS
Divisions: Geographic
Groups: Functional
Medical branch vs Unit
Medical branch: Under operations
Medical unit: within logistics, supporting responders
Units in ICS
Functional responsibility for a specific activity
Divisions led by
Supervisors
Groups/Units led by
Leader
What is the Model Uniform Core criteria
What a MCI triage should contain
24 criteria, 5 triage levels
Only MUCC compliant triage tool
SALT
5 triage categories
Immediate
Delayed
Minimal
Dead
Expectant
First step in SALT
Sort - Walk, Wave, Still
Start first step
Ambulatory vs Not (ambulatory minor)
Second step in Start
Breathing or not
If not breathing open airway
If still not breathing, dead, otherwise immediate
Third step in Start
Respiratory rate - if greater than 30 immediate, if not delayed
4th step in Start
Perfusion: if more than 2 seconds immediate, if less delayed
5th step in Start
Mental status: responding to commands
No: immediate
Yes: delayed
2 systems for secondary triage
Secondary assessment and victim endpoint (SAVE) and System of risk triage (SORT)
Waves intervention of benefit against resources
What is tertiary triage
triage of scare resources (as we move down the line after first and 2nd triage)
What is population triage
Management of ongoing incidents due to infrastructure loss or disease
Balances risk of harm to person vs community
(think weather vs disease)
Focal point of local disaster
EOC
Emergency management assistance compact between what groups
States
4 phases of emergency management
- Mitigation
- Preparedness
- Response
- Recovery