Emergency Care
And
Treatment
- ECAT -
in Disasters
Emergency Care
And
Treatment
- ECAT -
in Disasters
© Pan American Health Organization (PAHO), 2004
A publication of the Area on Emergency Preparedness and Disaster Relief (PED).
The views expressed, the recommendations made, and the terms employed in this publication, do not necessarily reflect the current criteria or policies of PAHO/WHO or of its Member States.
The Pan American Health Organization welcome requests for permission to reproduce or translate, in part or in full, this publication. Applications and inquiries should be addressed to the Area on Emergency Preparedness and Disaster Relief (PED), Pan American Health Organization, 525 Twenty-third Street, N.W., Washington, D.C. 20037, USA; fax: (202) 775-4578; email: .
This publication has been made possible through the financial support of the Canadian International Development Agency (CIDA), the Office for Foreign Disaster Assistance of the United States Agency for International Development (OFDA/USAID), and the United Kingdom’s Department for International Development (DFID).
We also aknowledge the contributions of Ron Mobley, Roslyn Bacombe Adams, Dana Van Alphen and others who provided support.
Emergency Care and Treatment (ECAT) in Disasters
CONTENTS
Page
Preface………………………………………………………………………………3
Introduction…………………………………………………………………………4
Procedure, Requirements, Assessments and Grading………………………………5
Things You Should Know or Find Out……………………………………………..6
Lesson 1: Incident Size-up and Personnel Safety…………………………………..7
Lesson 2: Kinematics of Trauma …………………………………………………...15
Lesson 3: Airway and Breathing with Spinal Management ………………………...19
Lesson 4: Patient’s Head to Toe Exam and What Vital Signs Mean ……………….25
Lesson 5: Lifting and Moving Patients ………………………………………………36
Lesson 6: Basic Injuries and Treatment ………………………………………………40
Lesson 7: Injuries to the Head, Face and Neck………………………………………..48
Lesson 8: Injuries to the Chest and Back ……………………………………………..54
Lesson 9: Injuries to the Abdomen and Pelvis …………………………………………57
Lesson 10: Injuries to the Extremities …………………………………………………61
Lesson 11: Medical Concerns in the Field……………………………………………..65
Lesson 12: Problem-Solving in the Field ……………………………………………...69
Emergency Care and Treatment (ECAT) in Disasters
PREFACE
International statistics show that major accidents and disasters have become significantly more common in recent decades, parallel to and generated by social developments.
Increased and more rapid transportation of people and goods and higher capacity modes of transport
Concentration of a larger number of people in a limited areas, occasionally or permanently
Growth of chemical and technical industries involving production and transportation of ever-increasing amounts of explosive and toxic agents often in and through densely populated areas with insufficient safety measures.
Terrorists exploiting these risks for personal and political reasons
Increase in armed conflicts.
Therefore, despite measures, we know that such major accidents will continue to occur and cost, in addition to material damage, human lives, permanent disablement, and considerable physical and mental suffering.
Education and training are not merely important, but essential for disaster management services. Good planning and equipment may be of little or no use if the staff has not received appropriate instruction in the function of the organization or the use of the equipment.
Education and training must be undertaken at many levels
- The general population
- Rescue workers (police and fire and army services)
- Ambulance staff
- Nurses, with scanty knowledge of pre-hospital care
- Doctors, with scanty knowledge of pre-hospital care
- Specialists, with scanty knowledge of pre-hospital care
- Disaster Coordinators
Instruction of the general population in basic first aid and response to major accidents is important, as members of the public often are the first on scene. Such instruction should be the responsibility of every community.
-Excerpts from the Scientific Committee of the International Society of Disaster Medicine-
Emergency Care and Treatment (ECAT) in disasters
INTRODUCTION
This manual is developed to be a support module for persons receiving instruction in the PAHO/WHO ” ECAT in Disasters” Course. It will provide forty (40) hours of skills-based training designed to improve the participant’s ability to provide some level of emergency medical care and treatment in a non-hospital environment. Attempts have been made to simplify this presentation in order to maximize the number of persons who may benefit. The BRADY First Responder (6th Edition) Manual will be an excellent adjunct to this course; references to it will be made throughout this manual.
The manual is intended to guide the user through the important aspects and skills necessary to begin assessing and caring for a patient at the scene of injury, illness or catastrophe during the first few minutes following an emergency.
Objectives
At the end of the course, participants will be able to:
- Conduct an initial rapid needs assessment of the incident scene
- Safely move an injured patient at and from the incident scene
- To recognize critical or urgent versus non-urgent patients
- To work in tandem with local health resources
- Conduct training activities with the assistance of standardized teaching materials provided
The trainee, in essence, performs the role of a First Responder in situations or communities where no organized immediate pre-hospital medical help exists, or when inadequate numbers exists. It is important that he/she develops the attitude that allows him/her to work under the direction of the more senior health care providers, thus helping to provide informed and concerted patient care.
All emergency response personnel likely to be first at the scene of an incident, such as police, firefighters or defense force will benefit from this course. It is well-established that quick and appropriate interventions on the scene will save lives, leading to better overall outcome with less mortality and morbidity.
Communities are encouraged to adapt the scope of this manual to better suit their local method of organization. The ECAT in Disasters-trained individual must still be considered part of your EMS (Emergency Medical Services) system and they should be guided to function accordingly.
Prior training in the following will be an asset and should be strongly encouraged:
1. BLS (Basic Life Support) i.e. By-stander CPR (Cardio-pulmonary Resuscitation)
2. Basic First-Aid
Both listed courses are usually accessible through the local Red Cross agencies or hospitals.
Other related PAHO/WHO disaster management courses include:
MCM (Mass Casualty Management) or Medical Management of Disasters
Incident Command System (ICS)
SMID (Stress Management in Disasters)
Emergency Care and Treatment (ECAT) in disasters
PROCEDURES, REQUIREMENTS, ASSESSMENTS AND GRADING
Procedures
This Manual will be made available to all participants to serve as a guide through the lessons.
The Brady Manual should be used to assist the participant in preparing for each lesson. Frequent references are made to Brady’s Sixth edition in this manual. Reading ahead in preparation for each lesson will accelerate successful completion of this course material.
Lessons will utilize lecture methods, class discussions, in-class exercises, audiovisuals materials and field exercises. Group work will be emphasized.
Requirements
Active participation in forty hours of skills-based class activity is mandatory.
A timely completion of all tests and assignments is indicated.
Participants are required to attend all sessions in order to successfully complete this course.
Assessments
Exams will be utilized to evaluate the learner’s ability to understand, retain and apply the material presented. Exams will usually be standardized objective type consisting of true/false, multiple choice, completion and matching, but may include essay or short answer type. Your instructor will indicate what type of exam you will be given. Exams may include material discussed, presented or assigned in the class. Make-up exams will not be given. You may be given a mid-course (mid-term) exam and a final exam or just one final exam. Your instructor will inform you of all the relevant details about the exams.
Quizzes may be utilized to evaluate learning. If in-class quizzes are given, participant must be present. Students who are not present may not make up an in-class quiz that is missed.
A pretest sample quiz will be provided to assist participants in preparing for the exams. Your instructor will tell you if your point system will be presented in a letter grade or a pass-fail basis.
Grading
Class drills100 points25%
Mid-course Exam100 points25%
Final Exam200 points50%
TOTAL 400 points
Grade Distribution
A + = 96 – 100 %A = 90 – 95%A- = 84 – 89 %
B+ = 78 – 83%B = 72 – 77%B- = 66 - 71 %
C+ = 60 - 65%C = 55 - 59%C- = 50 - 54%
D+ = 45 - 49%F = 0 - 44%P = pass = >60%
Emergency Care and Treatment (ECAT) in disasters
THINGS YOU SHOULD KNOW OR FIND OUT
What is the Emergency access telephone number in your area? If there is none available, what is the direct line to your Emergency Department?
Where are the hospitals and fire stations in your area?
How many ambulances work in your area, if any, and what is their average response time to various areas in your community?
How can you most effectively communicate with the available ambulance service while en route?
Is there a coastguard service in your area? If so, how can it be accessed?
What are the common risks in your communities based on terrain, available vehicles, typical local habits and social trends?
Do you have any health risks or challenges that would prohibit or prevent you from giving care to others? Discuss this with your ECAT-in-Disasters Instructor.
ALSO see glossary of important words and terms at the beginning of each chapter.
Emergency Care and Treatment (ECAT) in disasters
Lesson 1 – Incident Size-up and Personnel Safety
Reference: Brady 6th Ed, Chapters 1, 2 and 15.
OBJECTIVES:
Upon completion of this lesson, you shall be able to:
- Describe how your local command structure and response system works and how to perform within it.
- Recognize the potential hazards in the emergency response and what can be done to remain safe.
- Identify danger signs that may be observed at an emergency scene.
- Describe several actions that may be taken to prevent injuries of the responder.
SKILLS:
You shall be able to perform the following
Assess and initiate control at an accident/incident scene.
Evaluate a scene in terms of safety and possible cause of an accident.
Gather information from patients and by-standers
Properly use all personal protective gear available.
Incident Size-up and Personnel Safety1
IMPORTANT WORDS AND PHRASES FOR THIS LESSON
AIDS: A viral disease affecting the body’s ability to fight off normal infections.
BSI: Body Substance Isolation: a form of infection control based on the presumption that all body fluids are infectious. (See personal protective gear, universal precautions.)
CISM: See SMID
Confidentiality: The privacy of a patient’s information, including details of their behaviour and care used strictly in health professional circles.
Contagious: Can infect others, either by close contact (touching), respiratory (breathing same air), sexually (requiring sexual contact) or by blood (blood on broken skin).
Hazard: A situation, object or event which can cause harm to you, patients or by-standers.
Hepatitis: A disease that inflames and damages the liver, commonly caused by viruses. Some hepatitis viruses can cause lifelong illness or death.
Personal protective gear: Supplies such as gloves, masks, goggles or similar eye wear, gowns or helmets which protect the rescuer from infection and or exposure to hazardous materials. These may also be referred to as Personal Protective Equipment (PPE).
SMID: A stress management technique. Adapted from the (CISM) Critical Incident Stress Management program and is well-established in many communities. See page 590 of Brady 6th Ed.
Scene size-up: The first steps in rescue safety and patient assessment. An assessment of the scene conditions, number of patients, mechanism of injury and/or nature of the illness, and the resources needed.
Triage: A method of sorting patients for care and transport based on the severity of their injuries or illness and the likelihood of survival.
Tuberculosis: Also known as “TB”, is an infection of the lungs, spread by the air.
Universal precautions: A recommendation to use all personal protective gear to provide a barrier from a patient’s blood and body fluids.
Incident Size-up and Personnel Safety1
List all the hazards likely to be found at each of the following scenes:
How many other hazards you can think of that were not reflected in the above scenes? List them below.
Incident Size-up and Personnel Safety1
I.Communication
A.First Impressions
You should appear confident, calm and reassuring.
- Develop a professional appearance and attitude.
- The victim will look to you for reassurance and you must win their trust.
B.Communication Tools
- Be appropriate to the individual or situation. Use eye contact.
- Watch out for non-verbal cues you may be giving off, i.e. your body language.
- Be honest, especially with children, explaining simply what is happening and what you are trying to do for them. It helps to bend down to their level so you do not appear too formidable.
C.Interview Techniques
- Try to get as much information as possible from any eye witnesses at the scene
- Use open-ended questions.
- The Conscious patient who is able to speak can give valuable information
II.Driving and Traffic Safety
A.Driving for Safety
1.Basic Safety Tips.
- High speed must always be a last resort.
- Stabilize the patient as much as is possible before transport. This allows a safer transport to take place.
- Seat Belts
- Wearing seatbelts can saves lives.
Incident Size-up and Personnel Safety1
B.Staying Safe in Traffic on Foot
1.Park for Maximum Safety
- Your vehicle should not provoke further incident.
- Avoid bending where other vehicles may be reversing.
- Assign someone to, or take control of, Crowd and Traffic flow
2.Get out of the Vehicle Safely
- Be especially cautious when working at night. If you are not wearing light-coloured or reflective outer clothing you will not be readily visible to on-coming traffic.
3.Wear Personal Protective Equipment (PPE)
Treat every patient as though they are potentially infectious.
4.Channel Traffic Away from the Scene
- Assign someone to conduct traffic, if necessary
C.Protecting those in the Patient Compartment
You may be called upon to either transport a patient or assist in the transportation of a victim. Each of the following is important:
1.Hanging on and bracing
2.Securing the patient
3.Securing the equipment
4. Performing CPR in a moving ambulance
Incident Size-up and Personnel Safety1
III.Scene Safety
Your own safety is most important. If you are hurt, you will be of no help to anyone.
A.Plan your access carefully.
B.Observe the scene and carefully size- up everything around you.
C.React promptly to any evolving situation. Look for obvious hazards, possible hazards and potential hazards.
1.Retreat form threatening danger
2.Radio or call for help or back-up, if needed
3.Reevaluate the situation continually and act accordingly.
D.Controlling the Scene
1.Introduce yourself effectively to victims, relatives and/or witnesses.
2.Be professional in conduct, appearance and speech.
3. You may need to initiate triage if there are multiple victims.
VI.Take Control of Personal Safety
A.Protecting Yourself from Hostile People
1.The hostile scene
2.Protect your health
Incident Size-up and Personnel Safety1
B.Infectious Disease Precautions
1.The process of transmission
2.Universal precautions
3.Identifying infectious diseases
C.Diseases of Concern
1.Hepatitis B
a)Signs and symptoms include abdominal pain, nausea, jaundice and dark urine in the acute or early phase. In later stages liver failure can develop leading to death.
b)Is transmitted by blood and sex. Barrier protective procedures needed. Immunization is available.
2.Tuberculosis
a)Signs and Symptoms includes cough with a bloody sputum and weight loss.
b)Is transmitted by air droplets from coughing. Barrier protective procedures are needed. Immunization is available.
3.Acquired Immunodeficiency Syndrome (AIDS)
a)Signs and Symptoms are not very specific and include marked weight loss, skin diseases, lung and intestinal infections in the late stages.
b)Is transmitted by blood and sex. Barrier protective procedures needed. No immunization is currently available.
Incident Size-up and Personnel Safety1
D.Preventing Infection
1.CPR and infection: Practice universal precautions whenever possible.
2.Recommended immunizations: Hepatitis B, tuberculosis and tetanus vaccines will be an asset.
3.Hand washing guidelines: Hand washing is your best protection.
4.General guidelines: Be aware of cross contamination from one victim to another.
***********
Discuss how the local command structure and response system works and how best you can perform within it.
***********
Discuss what you should do if you arrive on a scene first and you are not part of the normal response system.
Consider:
- What is the current situation?
- Observe for hazards to you, the exposed population, or the victims.
- Is it a medical situation?
- Is it Trauma? What is the mechanism of injury involved?
- High speed vs. low impact?
- Falls from higher than 3 feet or lower?
- Exposure to fumes?
- Exposure to electrical shock?
- Exposure to dangerous animals?
- Exposure to on-coming vehicles?
- Where is it going?
- What are the possibilities – the obvious, possible and potential hazards?
- How could you control it?
- What resources are needed?
*********
Discuss what is involved in Stress Management in Disasters (SMID) also known as Critical Incident Stress Debriefing (CISD).
Is it available in your area?
How can you access it if you feel the need or you see a colleague who appears to be in need?