# Disaster Management



## FTRPO (Sep 1, 2009)

Hello to everyone, 

I wanted to ask if anyone had any suggestions or tips on dealing with disasters such as a train wreck. I know thats pretty broad. I specifically wanted to know about triage tips but anything is helpful. How would you handle being the first unit on during a disaster? Thanks in advance for your time and responses.


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## Jinx (Sep 1, 2009)

The clinical guidelines for the service here is as follows (Hope it all makes sense?):

- Raise alarm, reconnoitre, report and take command
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  >Move victims from danger and give basic field treatment
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  >Move patients through triage point and label
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       >Walking ----Yes---------> Green label
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            No
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       >Airway ---No----------> White label (Dead, Leave in field)
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           Yes
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       >Resp Rate--------Below 10 or over 30/min--->Red Label (Life Threatening, Need urgent rescue)
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Between 10-30/min
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       >Capillary Refill-------Over 2sec-------->Red Label
             |                 
------Under 2sec------->Orange Label (Non life threatening, treat after red labels)


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## FTRPO (Sep 1, 2009)

Thanks jinx, thats pretty much the same thing that our book teaches as well.


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## Smash (Sep 1, 2009)

That is from the MIMMS course, the Sieve/Sort triage system which is widely used throughout the world.

General ideas: communication, communication, communication, communication, communication. Scenes typically turn bad because of poor communication.

Practice. Scenarios with simulated patients, tabletop exercises, whatever you can arrange.

Teach the the crews on the ground. Lots of services have specialist response groups or supervisors who have training in MCI management. Unfortunately many of these same services do not train up the grunts. Scenes generally only go as well as the initial crews make them, and that typically won't be a supervisor. Scenes are very hard to get back on track once they have gone south. 

Communication, communication, communication, communication, communication, communication.


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## TripsTer (Sep 8, 2009)

The first thing you need to do is a scene size up. Determine what you need and how much you need. If you have an MCI, start triaging and calling additional ambulances. If you got a HazMat scene, get the proper resources notified, etc. Like stated above,* communication is key.*

You might be interested in taking a NIMS ICS course through FEMA. They're free and you can do them online. They go over the universal system of Incident Command, which is pretty much the system used in the US at large scale incidents like Hurricane Katrina. It allows intercompatability through multiple agencies/departments. I know many EMS agencies/fire departments require or encourage their members to take these courses as they get grants from the goverment for doing so. Even if your agency doesn't require it, you should check it. Alot of useful information is in those classes.

http://www.fema.gov/emergency/nims/


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## mycrofft (Sep 8, 2009)

*Use SEARCH tool for more info.*

You are not the first unit "to the disaster", you are the first unit to your little piece of it. Like a short guy in a football scrum, you will not know what is happening except what is around you and whatever you hear on the radio, which will probably be overwhelmed shortly. Your cell phone system will be swamped.
1. Get the word out quickly as to who you are, what you have (ambo, personal car, EMT, nurse, whatever), where you are, and what you actually know. Follow the dispatcher's instructions.
2. SAFETY SAFETY SAFETY. If it is a train, get upwind and uphill. No flares. If you are not an extrication vehicle and manned for it, do not enter the wreckage, call to people to come to you and start your triage ops on a level surface by a road if possible so backup can arrive.
3. THINK FORCE MULTIPLICATION AND SAFETY: If you have volunteers, use one trained person to direct them in first aid and etc..Keep trying to get the word out where you are, how to get there and what your status is. Get help. If told to relocate, do it.
4.Use your triage as taught everywhere, and do not get so wrapped up in one case that you lose others. CPR is not part of a mass casualty situation unless/until you get enough help...by then, the most-critical will ahve died anyway.
5. Go get trained. Join your local CERT.


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## falcon-18 (Sep 8, 2009)

FTRPO said:


> Hello to everyone,
> 
> I wanted to ask if anyone had any suggestions or tips on dealing with disasters such as a train wreck. I know thats pretty broad. I specifically wanted to know about triage tips but anything is helpful. How would you handle being the first unit on during a disaster? Thanks in advance for your time and responses.



I saw this link here in emtlife but I forget in which thread anyway this is good for you.

http://www.citmt.org/start/background.htm

good luck 


falcon-18


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## medicnick (Sep 12, 2009)

Smash said:


> That is from the MIMMS course, the Sieve/Sort triage system which is widely used throughout the world.
> 
> General ideas: communication, communication, communication, communication, communication. Scenes typically turn bad because of poor communication.
> 
> ...



I'm one of the writers involved with the SALT Triage project. You can google it for more information. We published the consensus whitepaper last year and will be working on next steps in the upcoming months.

We have the practical application of triage tools in mind... do the best you can with what you've got.

Cheers,
Nick


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## mycrofft (Sep 13, 2009)

*Flip us a URL, Nick! And, a next-level-up note.*


If you are planning for mass casualties/disasters, logistics and communication are your big tools as well as people who will not buy into the panic and excitement. There are never enough normal saline, blankets, litters, bandages, batteries, toilets, etc., except at the warehouse.

("Disaster preparedness" is a misnomer; an emergency beomes a disaster when it exceeds planning and preparation, so by definition planning is not possible, unless it is the disaster itself you are planning).

The new buzzword emerging is "resilience", and I like it. Shorter than the older military term "organic capacity". Means that response capability (physical, mental, training) is built in, not in a CONEX somewhere.


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## mycrofft (Sep 13, 2009)

*Here's a SALT link*

http://www.mcw.edu/Releases/2008Releases/NatlGuidelineMassCasualtyTriage.htm

Interesting concept, sort of military in flavor, but complicated and uses treatments which would require a level of use higher than a first-level triage station or individual triageur.
Maybe we need a new triage thread.


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## medicnick (Sep 13, 2009)

mycrofft said:


> http://www.mcw.edu/Releases/2008Releases/NatlGuidelineMassCasualtyTriage.htm
> 
> Interesting concept, sort of military in flavor, but complicated and uses treatments which would require a level of use higher than a first-level triage station or individual triageur.
> Maybe we need a new triage thread.



Actually it is intended to be very uncomplicated. Once the training materials are produced it will make more sense. We discussed all known triage methods before deciding on the course that we did.
Thanks
Nick


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## mycrofft (Sep 13, 2009)

*We await with bated breath.*

It seems to point the way to functional rather than clinically defined triage, which is what we were getting into with the military since our priorities were MIDE, not IDME (Minimal, Delayed, Immediate and Expectant; we treated minimals first to put them back to work or back on the defense or to work supporting us or whatever).


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