Incident Management

Incident Management

Chapter 21: Incident Management National EMS Education Standard Competencies (1 of 3) EMS Operations Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety. Incident Management

Establish and work within the incident management system. National EMS Education Standard Competencies (2 of 3) Mass-Casualty Incidents Triage principles Resource management Hazardous Materials Awareness Risks and responsibilities of operating in a

cold zone at a hazardous material or other special incident. National EMS Education Standard Competencies (3 of 3) Mass-Casualty Incidents due to Terrorism and Disaster Risks and responsibilities of operating on the scene of a natural or man-made disaster.

Introduction You should be able to identify the signs of a hazardous materials incident. It is important for you to understand The purpose of an incident management system The framework of the National Incident Management System (NIMS) Basic triage

Hazardous Materials Incidents Hazardous materials are substances that are toxic, poisonous, radioactive, flammable, or explosive and can cause injury or death with exposure. During a hazardous materials incident, your top priority is to protect yourself and bystanders from exposure and contamination.

Response to Hazardous Materials Incidents (1 of 5) Identify the substances involved. Federal law requires that all vehicles containing certain quantities of hazardous materials display a hazardous materials placard. The placard should include a four-digit identification number.

Response to Hazardous Materials Incidents (2 of 5) Courtesy of the U.S. Department of Transportation. Response to Hazardous Materials Incidents (3 of 5) Emergency Response Guidebook lists:

Courtesy of the U.S. Department of Transportation. Most common hazardous materials Their four-digit identification numbers Proper emergency actions to control the scene Emergency care of patients who become ill or injured

after exposure Response to Hazardous Materials Incidents (4 of 5) Unless you have received training, keep away from the contaminated area. Notify the dispatcher of the suspected presence of hazardous materials. Identify victims who have sustained an acute injury as a result of exposure.

Remove them from the contaminated area and have them decontaminated. Give necessary care and transport. Response to HazMat Incidents (5 of 5) Very few specific antidotes or treatments exist for most hazardous materials injuries. Emergency treatment usually consists of

supportive care. Emergency medical responders (EMRs) should receive specific additional training in hazardous waste operations and emergency response (HAZWOPER). Mass-Casualty Incidents (1 of 3)

Situations with more than one sick or injured individual Require a very different method of operation from other emergency medical calls Mass-Casualty Incidents (2 of 3) Variables in mass-casualty incidents Severity of the crash

Access routes Available resources Response times Levels of emergency training Overall experience of the EMS system Mass-Casualty Incidents (3 of 3) Your goal should be to

Provide the greatest medical benefit for the greatest number of people. Match patients medical needs with appropriate treatment and transportation. The Visual Survey (1 of 2) As you are on the way to the scene, prepare yourself mentally for what

you may find. David Crigger, Bristol Herald Courier/AP Photo. Where will additional help come from? How long will it take for help to arrive?

The Visual Survey (2 of 2) When you arrive at the scene, force yourself to stay calm. Make a visual assessment of the scene. Number of potential patients Severity of their injuries How much and what kind of help you will need Your Initial Radio Report (1 of 3) Use clear language, be concise, be calm,

and do not shout into the microphone. The key points to communicate are Location of the incident Type of incident Any hazards Approximate number of patients Type of assistance required Your Initial Radio Report (2 of 3) Good rule of thumb: Request one

ambulance for every five patients. When calling for additional resources Determine the perimeters for emergency vehicles only. Establish a one-way route for emergency traffic to approach the scene and a separate one-way route for emergency traffic to exit. Your Initial Radio Report (3 of 3) When calling for additional resources

(contd) Allow adequate room for emergency vehicles that need to be close to the scene. Keep vehicles and personnel who are not needed at the scene at a staging area nearby. Casualty Sorting (1 of 13) Triage is the sorting of patients into groups according to their need for treatment. Should be simple and fast

Do not worry about diagnosing patients. START triage system Lets EMRs triage each patient in 60 seconds or less, based on breathing, circulation, and mental status Casualty Sorting (2 of 13) Triage tagging

Jones & Bartlett Learning. Courtesy of MIEMSS. Patients are tagged so that other rescuers can easily recognize their triage level. Tagging uses colored surveyors tape or colored

paper tags. Casualty Sorting (3 of 13) Triage tagging (contd) Priority One (red tag): immediate care; injuries are life threatening. Priority Two (yellow tag): urgent care; can delay up to 1 hour. Priority Three (green tag): delayed care; can delay up to 3 hours.

Priority Four (gray or black tag): patient is dead; no care is required. Casualty Sorting (4 of 13) First step in START: get up and walk Tell all the people who can get up and walk to move to a specific area. If patients can walk, they rarely have lifethreatening injuries. These patients are the walking wounded, designated as Priority Three (green tag).

Casualty Sorting (5 of 13) Second step in START: begin where you stand Move through the remaining patients. Stop at each patient to provide a quick assessment and tagging. Find and tag the Priority One patients. Examine them, correct life-threatening airway and breathing problems, tag them with a red

tag, and move on. Casualty Sorting (6 of 13) The START triage system is based on three observations: Breathing Circulation Mental status Casualty Sorting (7 of 13)

Jones & Bartlett Learning. Casualty Sorting (8 of 13) Breathing Patients with breathing rates of greater than 30 breaths per minute: Priority One Patients with breathing rate of less than 30 breaths per minute: move on to the next step Patients who need help maintaining an open

airway: Priority One If you are in doubt as to the patients ability to breathe: Priority One Casualty Sorting (9 of 13) Breathing (contd) Patients who are not breathing and do not start breathing with airway maneuvers: Priority Four Circulation

Check the patients carotid pulse. Weak or irregular pulse: Priority One Strong pulse: move on to the next step Casualty Sorting (10 of 13) Circulation (contd) Weak pulse: treat for shock Absent pulse: Priority Four Casualty Sorting (11 of 13)

Mental status Determine whether the patient responds to verbal stimuli. Patients who can follow simple commands and have adequate breathing and circulation: Priority Two Unresponsive patients: Priority One Casualty Sorting (12 of 13) START is designed to help rescuers find the

most seriously injured patients Injured patients do not always remain in the same condition. The process of shock may continue. Some conditions become more serious as time goes by. If possible, recheck the condition of Priority Two and Priority Three patients. Casualty Sorting (13 of 13)

Courtesy of Los Angeles Fire Department - Disaster Preparedness Section. Working at a Mass-Casualty Incident (1 of 2) If you are not the first person to arrive, report to the incident commander. If you are the first on the scene Make the initial overview. Clearly and accurately report the situation to the

dispatcher. Conduct the initial START triage. Working at a Mass-Casualty Incident (2 of 2) As more highly trained personnel arrive, report your findings to the person in charge by noting Approximate number of patients Number of patients whom you have triaged

Additional assistance required Other important information National Incident Management System (1 of 3) Developed by the US Department of Homeland Security Provides a consistent and unified approach to handling emergency incidents Used to handle the immediate response,

mitigation, and long-term recovery of small and massive natural and man-made incidents National Incident Management System (2 of 3) Five major areas are addressed within the scope of NIMS. Jones & Bartlett Learning.

National Incident Management System (3 of 3) EMRs fall within the first category. Recommended courses: ICS-100: Introduction to ICS FEMA IS-700: NIMS, An Introduction Terrorism Awareness (1 of 2) Terrorism is the systematic use of violence

by a group to intimidate a population or government to achieve a goal. Terrorist acts may be instigated by a countrys citizens or by people from other countries. Terrorism Awareness (2 of 2) Methods used to incite terror Guns Explosives

Fire Chemicals Viruses Bacteria Radiation Weapons of Mass Destruction Any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure

Include explosive, chemical, biologic, and nuclear weapons The preferred weapons of mass destruction (WMD) to date has been explosive devices. Potential Targets and Risks (1 of 3) Potential terrorist targets Bridges, tunnels, pipelines, and harbors

National monuments Housing developments and automobile dealerships Computer networks and data systems Farms and agricultural installations Schools, government buildings, churches, and shopping centers Potential Targets and Risks (2 of 3)

Susan Tansil/Shutterstock Steve Allen/Brand X Pictures/Alamy phdpsx/Shutterstock Galina Barskaya/Shutterstock. Potential Targets and Risks

(3 of 3) Jones & Bartlett Learning. EMRs should always be alert for hazards. Although you should be prepared for terrorist events,

most of your emergency medical calls will not be for these events. Agents and Devices (1 of 11) Explosives and incendiary devices Courtesy of Captain David Jackson, Saginaw Township Fire Department .

Explosives produce a concussion that destroys property and inflicts injury and death. Incendiary devices are designed to start fires. The first indication that such a device is present is the explosion or fire

from its deployment. Agents and Devices (2 of 11) WMD safety considerations Be alert for safety hazards. Do not enter an area that may be unsafe until properly trained personnel assess the risks. Be alert for the possibility of a second explosive device. Use the same safety skills you developed for

other types of emergency situations. Staging should occur upwind and uphill. Agents and Devices (3 of 11) Chemical agents Pulmonary agents Gases that cause immediate distress and injury Cause intense coughing, gasping, shortness of breath, and difficulty breathing

Metabolic agents Affect the bodys ability to use oxygen at the cellular level Most common metabolic agents: cyanides Agents and Devices (4 of 11) Chemical agents (contd) Jones & Bartlett Learning.

Insecticides Class of poisonous chemicals that are inhaled or absorbed through the skin Absorption produces salivation, sweating, lacrimation, urination, diarrhea, gastric upset, and emesis

(SLUDGE-like) symptoms. Agents and Devices (5 of 11) Chemical agents (contd) Nerve agents Among the most deadly chemicals developed Cause SLUDGE-like symptoms Sarin, soman, tabun, and V agent (VX) Blister agents

Produce burn-like blisters, pain, skin irritation, severe shortness of breath, and severe coughing Include sulfur mustard and Lewisite Agents and Devices (6 of 11) Safety considerations when dealing with chemical agents Anytime multiple people experience unexplained symptoms, suspect a common

agent as the cause. Your primary role is to recognize that a problem exists and to avoid contaminating yourself, other rescuers, and bystanders. Stay upwind and call for assistance. Agents and Devices (7 of 11) Jones & Bartlett Learning.

Agents and Devices (8 of 11) Biologic agents Naturally occurring substances that produce diseases Incubation period: the time from exposure to the time the person shows symptoms of the disease The first awareness of a biologic incident would likely come from hospital emergency departments.

Agents and Devices (9 of 11) Safety considerations when dealing with biologic agents Be alert for unusual patterns of diseases with flulike symptoms. Practice appropriate standard precautions. Call for specially trained assistance and wait in a safe location. Patients need to be decontaminated.

Agents and Devices (10 of 11) Radiologic agents Ionizing radiation is a kind of energy that is formed by the decay of a naturally occurring or human-made radioactive source. Jones & Bartlett Learning. Agents and Devices (11 of 11) Radiologic agents (contd)

Courtesy of Atomex Scienti c and Production Enterprise (www.atomex.com). Radiation cannot be seen, felt, or detected without special instruments. A dirty bomb is an explosive device containing a small amount

of radioactive material. Stay away from the blast site until specially trained teams check for radiation. Your Response to Terrorist Events (1 of 3) In all emergencies, the same safety rules apply

Good scene safety Diligent use of standard precautions Courtesy of FEMA. Your Response to Terrorist Events (2 of 3) Be prepared and know the limits of your

training. Many types of terrorist events require you to stay a certain distance away to avoid contaminating additional people. Be alert for secondary devices. Your Response to Terrorist Events (3 of 3) Establish an incident command system (ICS) as soon as possible.

Know your role in working within the ICS. Treat these incidents as mass-casualty situations. Establish good working relationships with appropriate local, state, and federal agencies. Summary (1 of 5) During a hazardous materials incident, your top priority is to recognize that a hazard is present and to protect yourself and

bystanders from exposure and contamination from the hazardous materials. Summary (2 of 5) The START system is a simple triage system that you can use at mass-casualty incidents. It sorts patients in groups so that the most serious patients are treated and transported first.

NIMS is designed to provide a unified approach to emergency incidents of any size. Summary (3 of 5) The goal of terrorists is to intimidate a population or government so as to achieve a goal. Terrorists may use many approaches to incite terror, including the use of explosives, fire, chemicals, viruses,

bacteria, and radiation. Summary (4 of 5) Chemical agents are man-made substances that can have devastating effects on living organisms. They include pulmonary, metabolic, nerve, and blister agents and insecticides. Biologic agents are organisms that cause disease.

Summary (5 of 5) Radiologic weapons can create a massive amount of destruction. They include radiologic dispersal devices, also known as dirty bombs. EMRs need to consider their safety, the safety of other rescuers, and the safety of bystanders whenever dealing with a terrorist-related event.

Review 1. The first step in the START triage process involves A. quickly determining who is most injured. B. asking all the people who can get up and walk to move to a specific area. C. opening the airway of unconscious victims. D. calling dispatch.

Review Answer: B. asking all the people who can get up and walk to move to a specific area. Review 2. Which of the following patients would be tagged as a Priority One (red tag)? A. The patient who cannot maintain an open airway

B. The patient with a strong carotid pulse C. The patient who does not start breathing with airway maneuvers and does not have a pulse D. The patient with a broken femur Review Answer: A. The patient who cannot maintain an open airway

Review 3. The function of the National Incident Management System (NIMS) is to A. assist EMS providers in managing natural disasters. B. oversee the operations of all EMS and fire agencies in the United States. C. provide a consistent and unified approach to handling emergency incidents. D. educate city governments regarding foreign

terrorist attacks. Review Answer: C. provide a consistent and unified approach to handling emergency incidents.

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