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FCA 0912 MCI's and START
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FCA 0912 MCI's and START

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RMH Field Care Audit with drill

RMH Field Care Audit with drill

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  • The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
  • The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
  • The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
  • The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
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  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
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  • The wreckage of a Cessna 177 in which trainee pilot  Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
  • The wreckage of a Cessna 177 in which trainee pilot  Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
  • The wreckage of a Cessna 177 in which trainee pilot  Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
  • The wreckage of a Cessna 177 in which trainee pilot  Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
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FCA 0912 MCI's and START FCA 0912 MCI's and START Presentation Transcript

  • How to save a life…
  • OFF TO A GOOD S.T.A.R.T. Trauma Triage and Mass Casualty Incidents Veronica Bonales, M.D. RMH PreHospital Care Medical Director HCEMCC Paramedic Coordinator
  • Mass Casualty IncidentAny incident that overwhelms the available resources 9/11 Two person EMS crew arriving at scene with three victims
  • Mass Casualty IncidentFirst unit on scene declares MCIWhen additional units start en route, first unit starts triageUsually involves setting up an Incident Command SystemTriage, Treatment, Transport
  • Mass Casualty IncidentTriage everyone according toSTARTTreatment of manageableinjuriesTransport in order of priorityand for definitive care
  • - Assess and control the accident scene- Tamponade external hemorrhage with direct pressure - Protect the spine after blunt trauma - Extricate the patient - Supplement inspired O2 - Stabilize long bone fractures
  • S.T.A.R.T.SimpleTriageAndRapidTreatment/Transport
  • Triage Principles
  • Triage Principles
  • Triage Principles Triage – Fr. trier = to sort
  • Triage Principles Triage – Fr. trier = to sortNapoleon’s surgeon Larrey established the ambulance corps and a method of setting priorities for the evacuation of war casualties
  • Triage Principles Triage – Fr. trier = to sortNapoleon’s surgeon Larrey established the ambulance corps and a method of setting priorities for the evacuation of war casualties- he picked up the war wounded that could be saved by quick intervention (ie. amputation)
  • Triage Principles Triage – Fr. trier = to sortNapoleon’s surgeon Larrey established the ambulance corps and a method of setting priorities for the evacuation of war casualties- he picked up the war wounded that could be saved by quick intervention (ie. amputation) - other surgeons quickly bandaged those that could go back and fight
  • Triage Principles
  • Triage Principles Civil War:
  • Triage Principles Civil War:Formal establishment of military field ambulance service
  • Triage Principles Civil War: Formal establishment of military field ambulance serviceSurgeons continued the practice of collecting those who could benefit from immediate medical intervention
  • Triage Principles
  • Triage Principles WWI and WWII Increased use of field medics and the “buddy system” Increased use of antibioticsAid stations and surgical hospitals moved closer to the front
  • Triage Principles
  • Triage Principles Korean WarMASH units and helicopters helped to further decrease the number of battlefield casualties This was further improved upon in the Vietnam conflict where death rates decreased from 30% to 24% Afghan and Iraq war casualty rates now 10%
  • Triage Principles
  • Triage Principles
  • Triage Principles
  • Triage Principles
  • Triage Principles
  • Triage PrinciplesSTART Triage Team of two can assess an average of one patient every 30 seconds. 40 casualties, two triage teams will take approximately 10 minutes to accurately assess Only treatment rendered by the triage team open a patient’s airway by head tilt /neck lift by insertion of an OPA apply direct pressure to stop an obvious bleed or by elevating the extremities.
  • Triage PrinciplesSTART by those who STARTed it…
  • START Triage
  • START Triage
  • START Triage
  • START Triage
  • START Triage
  • Assess, Treat, (use bystanders) When you have a color STOP - TAG - MOVE ON Move Walking Wounded NO RESPIRATIONS after head tilt* Breathing but UNCONSCIOUS Perfusion Capillary refill > 2 or NO RADIAL PULSE Control bleedingminor decease Mental Status Unable to follow simple commands d immedi ate Otherwise delaye d REMEMBER: Respirations < 30 Perfusion < 2 Mental Status - Can Do
  • Triage Principles· Evaluate patient using START· Tear off the bottom of the tag· Tear off a tracking slip and place it in the kit· Attach tag to the patient with a tie· Give tracking slips to the Triage Officer
  • Triage PrinciplesA lot of GREEN helps… but goes fast.
  • Triage PrinciplesBe like Visine…… Get the Red OUT!
  • Triage PrinciplesDon’t let YELLOW mellow… re-assess!!
  • Triage PrinciplesIMMEDIATE-by-mechanism Depending on their injury Age Medical history
  • Triage Principles16 year old with 17 year old with 35 year old with 47 year old withbleeding scalp lac. no spontaneous foreign body open tib-fib respirations or fracture pulse
  • Triage Principles16 year old with 17 year old with 35 year old with 47 year old withbleeding scalp lac. no spontaneous foreign body open tib-fib respirations or fracture pulse
  • Triage Principles16 year old with 17 year old with 35 year old with 47 year old withbleeding scalp lac. no spontaneous foreign body open tib-fib respirations or fracture pulse
  • Triage Principles16 year old with 17 year old with 35 year old with 47 year old withbleeding scalp lac. no spontaneous foreign body open tib-fib respirations or fracture pulse
  • Triage Principles16 year old with 17 year old with 35 year old with 47 year old withbleeding scalp lac. no spontaneous foreign body open tib-fib respirations or fracture pulse
  • Triage Principles30 year old with 5 year old who 24 year old with 38 year old withdislocated ankle seems confused broken finger no heartbeat and and won’t talk no spontaneous respirations
  • Triage Principles30 year old with 5 year old who 24 year old with 38 year old withdislocated ankle seems confused broken finger no heartbeat and and won’t talk no spontaneous respirations
  • Triage Principles30 year old with 5 year old who 24 year old with 38 year old withdislocated ankle seems confused broken finger no heartbeat and and won’t talk no spontaneous respirations
  • Triage Principles30 year old with 5 year old who 24 year old with 38 year old withdislocated ankle seems confused broken finger no heartbeat and and won’t talk no spontaneous respirations
  • Triage Principles30 year old with 5 year old who 24 year old with 38 year old withdislocated ankle seems confused broken finger no heartbeat and and won’t talk no spontaneous respirations
  • Triage Principles19 year old with 29 year old with 7 year old with no 36 year old withburns to soles of no visibile injuries pulses and no penetratingfeet spontaneous trauma and a breaths after 2 swelling belly rescue breaths
  • Triage Principles19 year old with 29 year old with 7 year old with no 36 year old withburns to soles of no visibile injuries pulses and no penetratingfeet spontaneous trauma and a breaths after 2 swelling belly rescue breaths
  • Triage Principles19 year old with 29 year old with 7 year old with no 36 year old withburns to soles of no visibile injuries pulses and no penetratingfeet spontaneous trauma and a breaths after 2 swelling belly rescue breaths
  • Triage Principles19 year old with 29 year old with 7 year old with no 36 year old withburns to soles of no visibile injuries pulses and no penetratingfeet spontaneous trauma and a breaths after 2 swelling belly rescue breaths
  • Triage Principles19 year old with 29 year old with 7 year old with no 36 year old withburns to soles of no visibile injuries pulses and no penetratingfeet spontaneous trauma and a breaths after 2 swelling belly rescue breaths
  • Assess, Treat, (use bystanders) When you have a color STOP - TAG - MOVE ON Move Walking Wounded NO RESPIRATIONS after head tilt* Breathing but UNCONSCIOUS Perfusion Capillary refill > 2 or NO RADIAL PULSE Control bleedingminor decease Mental Status Unable to follow simple commands d immedi ate Otherwise delaye d REMEMBER: Respirations < 30 Perfusion < 2 Mental Status - Can Do
  • Questions??