DISASTER PLAN ATAT THE FIELD LEVEL

DISASTER
Event which generates
more patients at one time
than locally available resources can manage using routine procedures.
It requires exceptional emergency arrangements and additional or extraordinary assistance.

Examples
Plane crash
Traffic accident
Flooding
Forest fire
Armed conflict
Civil war
Bomb attack
Earthquake

THE CHAIN OF CASUALTY CARE
The path followed by a casualty
from the point of injury
all the way
to specialized care
as his condition dictates:

THE CHAIN OF CASUALTY CARE
1. on the scene
2. collecting point
3. surgical hospital
4. specialized centre (including rehabilitation)
5. a transport system (e.g. ambulances) for
evacuation from one level to another.
6. A coordination centre

Chain of casualty care at the field level

On the spot
The collecting point
Transportation

The collecting point
The hospital
Transportation
?

FIRST STEP
Get an overview of the scene:
- Security conditions
- Potential number of patients
- Severity of the injuries
Initial report:
- Location, type of incident, approx number of victims
- Type of assistance required

2ND STEP: TRIAGE
Definition
A process of prioritizing patients
based on the severity of their condition
to treat as many as possible
when resources are insufficient for all to be treated immediately

CLASSIFICATION

RED 10%
Priority 1 ? Good chance of survival if immediate surgical intervention
* Thoracic trauma and respiratory distress
* Abdominal trauma and shock
* Open fracture with active bleeding
* Incomplete amputation, vascular damage with ischemia
* Burns 2nd - 3 degree 15 to 50% TBS

RED 10%

YELLOW 30%
Priority 2 ? Surgical intervention required but non urgent
* Stable abdominal trauma (open or blunt)
* War wound requiring debridment
* Maxillo-facial wound without respiratory trouble
* Open fracture without ischemia – without haemorrhage
* Spinal trauma with or without paralysis

YELLOW 30%

GREEN 60%
No surgical intervention required
* Superficial or minor wound
* Burns < 15% TBS
* Sprains,…
* Psychological trauma

GREEN (60%)

GREEN (60%)

TRIAGE
1. Initial examination
2. Live-saving technique
3. Classification
4. Regular reassessment

What’s your call
Triage Assessment Exercise
A plane has crashed at BEIRUT Airport. There are many causalities. A call has been made for an MCI alert.
You are asked to assist with triage

What’s your call?
A 32 y/o man is found lying on the runway 10 m from the plane.
R- 10/min
P- Good distal pulse
M- Groans to painful stimuli

What’s your call?
A 42 y/o female is bleeding quite a lot from a neck injury..
R >30
P- Radial pulse +
M- Obeys commands

What’s your call?
A screaming woman is found in the grass at the side of the runway.
R-28
P- Good distal pulse
M- Asks you to help her
Has a partial amputation of the foot without active bleeding.

What’s your call?
An adult male lies inside the plane.
R- none -apneic
Remains apneic after lifting the chin

What’s your call?
An older man found sitting outside the plane .
R: 28
P: Good distal pulse
M: Groggy but will slowly follow commands but won’t get up and walk.

What’s your call?
An adult male lies on the ground
R 20
P Good distal pulse
M Obeys commands but cries that he can’t move his legs

What’s your call?
A young woman has a large head wound with brain matter showing
R absent
P absent
M unconscious

What’s your call?
An adult kneels at the side of the road, shaking his head. He says he’s too dizzy to walk.
R 20
P CRT 2 sec
M Obeys commands

What’s your call?
30 y/o male with shrapnel in chest, short of breath, dusky and can’t walk
R 36
P radial pulse present
capillary refill < 2 sec
M confused

What’s your call?
28 y/o with foreign body protruding from thigh
R 28
P present
M follow commands

Initial examination
A.B.C.D.E.
- Long lasting process
- Supposed a broad experience
- Inappropriate for multiple victims
S.T.A.R.T.
- Takes less than 30 seconds
- Every rescuer can do it

S.T.A.R.T.
Clear the walking wounded
- Use verbal instructions
- Direct them to the treatment areas for detailed assessment and treatment
- Tag These as MINOR
Now check RPMs

Respiration’s
- None? Open the Airway
- Still None? DECEASED
- Restored? IMMEDIATE
- Present?
- Above 30 (or < 10) IMMEDIATE
- Below 30
CHECK PERFUSION
S.T.A.R.T.

Perfusion
- Radial Pulse Absent
- Capillary Refill time > 2 secs
IMMEDIATE
- Radial Pulse Present
- Capillary Refill time < 2 secs
CHECK MENTAL STATUS
S.T.A.R.T.

Mental Status
- Can Not Follow Simple Commands
(Unconscious or Altered LOC)
IMMEDIATE
- Can Follow Simple Commands
DELAYED
S.T.A.R.T.

S.T.A.R.T.

S.T.A.R.T.

LIFE-SAVING TECHNIQUE

LIFE-SAVING TECHNIQUE
If patient is immediate upon initial assessment, only attempt to correct
- airway blockage
- uncontrolled bleeding
before moving on to next patient.

Airway
Open the airway
Tilt the forehead back
Lift the chin forward
Be careful in case of cervical spine injury

Airway
2. Remove all objects/obstructions from the mouth

You can
Hear it
See it
Feel it
Breathing

Uncontrolled bleeding
Control Haemorrhage :
Compressive Dressing : Large volume of material /gauze placed over or in the wound and held in place securely by a bandage
Elevated position
Tourniquet

OK
> 30/min
> > 2/sec
X
Blunt abdominal trauma
Retroperitoneal haematoma?
Shock
Mamadou
OK
14h30

The triage card

Respiration restored?
Haemorrhage controlled?
Patient is tagged?
Dispatch immediately to the appropriate zone

What’s your call?
A 32 y/o man is found lying on the runway 10 ft from the plane.
R- 10/min
P- Good distal pulse
M- Groans to painful stimuli
red

What’s your call?
A 42 y/o female is bleeding quite a lot from a neck injury..
R >30
P- Radial pulse +
M- Obeys commands
red

What’s your call?
A screaming woman is found in the grass at the side of the runway.
R-28
P- Good distal pulse
M -asks you to help her
Has a partial amputation of the foot without active bleeding.
yellow

What’s your call?
An adult male lies inside the plane.
R- none -apneic
Remains apneic after lifting the chin
black

What’s your call?
An older man found sitting outside the plane .
R: 28
P: Good distal pulse
M: Groggy but will slowly follow commands but won’t get up and walk.
yellow

What’s your call?
An adult male lies on the ground
R 20
P Good distal pulse
M Obeys commands but cries that he can’t move his legs
yellow

What’s your call?
A young woman has a large head wound with brain matter showing
R absent
P absent
M unconscious
black

What’s your call?
An adult kneels at the side of the road, shaking his head. He says he’s too dizzy to walk.
R 20
P CRT 2 sec
M Obeys commands
yellow

What’s your call?
30 y/o male with shrapnel in chest, short of breath, dusky and can’t walk
R 36
P radial pulse present
capillary refill < 2 sec
M confused
red

What’s your call?
28 y/o with foreign body protruding from thigh
R 28
P present
M follow commands
yellow

Questions
True or False
1. A large majority of injuries are minor
2. Minor injuries will often arrive at the hospital first
3.The goal of mass casualty triage is to the best for the most
4. The most commonly used form of triage allows only 2 interventions- reposition airway and pressure to external hemorrhage
5. Triage is a dynamic process and is usually done more than once.