Vol 11-10-12 MCI/Terrorist Response Flashcards by Tim Wilson

The first arriving company at a terrorist incident shall be responsible for:

Size up

initiating the ICS

taking necessary actions appropriate for demands of incident

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The department defines the START system as:

Simple triage and rapid treatment

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On a terrorist incident the HMTF shall be responsible for:

Complete assessment of immediate hazard when a CBRNE agent is suspected or identified

Provide IC with technical assistance

Coordinate activities to minimize the effect of the hazards on life, health, the environment and property

Affect rescue in exclusion zone when not practical for personnel to do so

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On a terrorist incident USAR companies and personnel shall:

Provide IC with technical assistance

Coordinate activities to accomplish the mission objectives when an explosive device or building collapse is involved

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At a terrorist incident, the health hazmat division personnel shall provide:

IC with technical assistance

Authority to identify, mitigate, and remediate CBRNE hazards at scene

Recommend protective actions

Evaluate the effectiveness of decon

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Also sworn personnel shall, at a minimum carry their ______ and one ______into rescue and non-apparent hazmat incidents that may have the potential for terrorist attack as discussed in the 11–10 – 1

APR

Mark 1 auto injector kit

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At a terrorist incident, first responder shall begin FRO procedures involving:

SIN
Safety
Isolate & Deny Entry
Notifications

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On a terrorist incident the first arriving company officer shall conduct _________ which will include:

Initial Size-Up

>Location by address or >intersection
>Type of incident
>Fire or no fire
>Estimated number of victims: (signs and symptoms)
>Special instructions

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Suspected CBRNE Initial Response Operations, first arriving officer shall:

> Size-up
Initiate operational retreat
Begin emergency Decon if victims symptomatic
Anticipate resource needs to address MCI & mitigate event
activate MAC through C&C

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Personnel shall begin emergency decon when victims appears symptomatic:(3)

1) establish exclusion zone and isolate & deny entry line to contain victims
2) establish emergency decon area large enough to encompass the number of victims and the equipment to provide emergency decon.
3) establish an SRA: a firefighter shall become SRA manager

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First priority positions critical to success of an MCI are:

1) IC
2) MedCom Coordinator
3) Triage Unit Leader

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In a terrorist event, if the first arriving company is required to _____________, command shall be passed to the 2nd arriving co. officer.

Begin emergency decon

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Determine the response organization levels required based on the:

Demands of the incident

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Terrorist Event
Assign positions of responsibility by priority:

First priority:

1) Medcom coordinator
2) triage unit leader
3) emergency decon manager, when applicable

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Terrorist Event

Second Priority Assignments:(6)

1) GAC-Ground Ambulance Coord.
2) Triage Personnel
3) Litter teams
4) Medical Group Sup
5) Treatment Unit Leader
6) Staging Manager

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Terrorist Event

Third Priority Assignments:(11)

1) Command Staff (SIL)
2) Ops Section Chief
3) MCI Branch Coordinator
4) Air Ops Branch Director, if need
5) PT Transportation Group Sup.
6) Air Ambulance Coordinator if need
7) Treatment Dispatch Manager
8) Treatment Managers:immed., delayed, minor
9) Medical Supply Officer
10) Morgue Manager
11) Other Branch Directors and/or div or group sups for HazMat, USAR, MCMD, etc

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Terrorist incident

Request the following from command-and-control:

Communication plan

medical caches

additional resources per form 59 (MCI command worksheet)

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Terrorist Incident

The IC shall:(6)

1) determine response organization
2) be responsible for all commanding general staff responsibilities until additional resources arrive
3) assign positions of responsibility by priority
4) request comm plan, medical caches, and additional resources per form 59
5) establish staging and check in, and assign managers to each
6) establish an inner perimeter for control and request law enforcement to establish an outer perimeter

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The START System is designed to be used by personnel with _______.

EMT-1 skills

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There are 3 types of triage performed in the field:

Primary
secondary
tertiary

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Evaluation of the patients relevant to resources, transportation, and available medical facilities

Tertiary

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Rapid patient assessment and tagging that is START system

Primary

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Sorting of patients for medical treatment as that treatment is available

Secondary

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Four color-coded triage classifications of patients based on the severity or need for treatment during the initial triage:

Immediate- Red

Delayed: Yellow

Minor: Green

Deceased: Black

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Patients who require aid, but their injuries are less severe

Delayed-Yellow

Patients requiring rapid assessment and medical intervention for survival

Immediate-Red

Patients who need only simple rudimentary first aid (aka- walking wounded

Minor-Green

Those who have died or not expected survive even with ALS intervention. These victims are also termed expectant or non-salvageable

Deceased-Black

Biological agent contamination usually will not require ___________.

gross decon

It's a chemical or radiological agent contamination is suspected, that area shall be the emergency decon area and victim shall be directed to __________ before being directed to a __________.

self decon safe refuge area

If there is no suspicion of ________, and these victim shall be held in a safe refuge area for further assessment. These victims shall be triage tag as:

contamination Minor (Green Label)

After having walking wounded in a safe refuge area, the remaining victims can now be evaluated through the START system. This should take no more than _______ & shall focus on 3 primary areas or eval. steps:

1 minute per PT RPM 1) Resp. Status 2) Perfusion/Pulse 3) Mental/Neuro Status

RESPIRATORY STATUS If ventilation is inadequate, triage personal attempts to either clear the airway by repositioning the victim to clear debris from the victims mouth. If these attempts were unsuccessful, the victim is classified as follows:(3)

No resp. effort-Expectant(black) Resp. >30/min or unable to maintain airway- Immediate(red) Normal Resp.- proceed to next step

PERFUSION & PULSE: The initial evaluation is determined by measuring the patients ___________.

Capillary refill

Normal Cap. Refill is _______. Proceed to next step

<2sec

Blood return delayed: >2 sec. Or Pt appears cyanotic:

Immediate

If unable to obtain cap refill due to PT color or poor lighting, ___________.

Check radial pulse

No radial pulse:

Immediate (red)

Radial pulse present: assume BP is adequate at ____________.

Approximately 80 systolic- proceed to next step

MENTAL STATUS: FINAL ASSESSMENT. DEPENDING ON THE LEVEL OF CONSCIOUSNESS, THE FOLLOWING ACTION IS TAKEN:

Unconscious – immediate (red) ALOC- immediate (red) Change of mental status- immediate Normal mental resp: delayed(yellow)

Nerve agents:

Sarin Soman Tabun VX

Pt's exposed to nerve agents will display these Signs/symptoms:

Severe respiratory distress with spontaneous breathing or one who has been apneic for less than five minutes Unconscious or compulsive casualties or those with major disorders of two or more bodily functions as exhibited by SLUDGE

Rapid intervention for patients exposed to nerve agents will result in improved outcome. Immediate treatment should include:

Antidote administration airway management oxygen therapy via bag valve mask

Minor casualties are those who are:

Walking wounded (green tag)

MUSTARD AGENTS: Pt's exhibiting moderate to severe pulmonary distress and exhibiting chemical burns of 5 to 50% BSA and/or eye involvement will be:

Immediate(red)

MUSTARD AGENTS: These are casualties with chemical burns of 5% to 50% of BSA or eye involvement. They shall be observed for worsening conditions.

Delayed(yellow)

MUSTARD AGENTS FOR THOSE CASUALTIES WITH CHEMICAL BURNS OF LESS THAN 5% BSA

Minor(green)

MUSTARD AGENTS For those casualties with chemical burns greater than 50% BSA and or no respiration or pulse.

Deceased/Expectant(black)

When exposed to ________, few signs & symptoms are exhibited except at higher doses.

Cyanides

CYANIDE EXPOSURE CASUALTIES WITH CONVULSIONS (30 SECONDS AFTER ACUTE EXPOSURE), JUST TWEET RESPORATORY ARREST 5 MINUTES AFTER ACUTE EXPOSURE

Immediate(Red)

CYANIDE EXPOSURE Casualties with lower dose exposure exhibiting headaches, dizziness, nausea, vomiting, and hyperventilation. These patients conditions deteriorate if exposure continues.

Delayed(yellow)

CYANIDE EXPOSURE Casualties exposed with no apparent signs and symptoms

Minor(green)

CYANIDE EXPOSURE Casualties that are dead after 6 to 10 minutes of acute exposure

Deceased/expectant(black)

Choking agents:(2)

Phosgene Chlorine

CHOKING AGENTS EXPOSURE Those who develop non-cardiac pulmonary edema within 6 hours after exposure and an ICU is readily available

Immediate(red)

CHOKING AGENTS EXPOSURE Those who develop a cough and dyspnea after 6 hours of exposure. There's a chance that these patients will develop pulmonary edema

Delayed(yellow)

CHOKING AGENTS EXPOSURE CASUALTIES EXPOSED WITH NO APPARENT SIGNS AND SYMPTOMS

Minor(green)

CHOKING AGENTS EXPOSURE Those who develop non-cardiac pulmonary edema within 6 hours after exposure & an ICU is NOT available

Deceased/expectant (black)

RADIOLOGICAL EXPOSURE Patients with traumatic injuries, severe burns to the face and upper respiratory tract and difficulty breathing due to mechanical problems.

Immediate(red)

RADIOLOGICAL EXPOSURE Victims with traumatic injuries that are not life-threatening second and third-degree burns less than 25% BSA

Delayed(yellow)

RADIOLOGICAL EXPOSURES VICTIMS WITH BURNS LESS THAN 10% OF BSA, BUT NOT INVOLVING CRITICAL AREAS OF THE BODY OR IF VICTIM HAD RECEIVED SHORT-TERM IONIZING RADIATION OF 100 TO 150 RADIOACTIVE ABSORBED DOSE(rad)

Minor(Green)

RADIOLOGICAL EXPOSURES Victims having severe burns greater than 30% BSA, critical injuries to the respiratory and nervous system, or having received lethal doses of total body radiation as indicated by signs and symptoms of high fever, disorientation, bloody diarrhea, and vomiting

Deceased/expectant (black)

The MCI kit contains the following:

12 packets containing position vests w/responsibility cards ICS forms & clipboards 4 16'x20' disposable tarps Red/yellow/green/black

Each tarp is designed to accept ___ patients

12 packets containing position vests with responsibility cards:

``` Medcom leader Medical group/division sup. Triage unit leader Treatment unit leader Immediate treatment mgr Delayed treatment mgr Morgue manager Medical supply coordinator Pt transport. group sup. Treatment dispatch mgr Air/ground ambulance coordinator ```

``` Victims PM EMT Ambulance 5-10 11-15 16-20 21-30 31-50 51+ ```

``` 5-10 23 24 35 11-15 3 5 57 16-20 3 6 710 21-30 4 68 1012 31-50 56 8 1215 51+ 6+ 8+ 15+ ```