Alexander ch33 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 33
Trauma Systems and
Incident Command

• Applies fundamental knowledge to provide basic
and selected advanced emergency care and
transportation based on assessment findings for
an acutely injured patient.
• Applies knowledge of operational roles and
responsibilities to ensure patient, public, and
personnel safety.
Advanced EMT
Education Standards

1. Define key terms introduced in this chapter.
2. Describe the epidemiology and significance of trauma.
3. Explain the importance and components of injury
prevention programs in reducing trauma morbidity and
mortality.
4. Describe each of the components of a comprehensive
trauma care system.
5. Identify the characteristics of each level of trauma center
as designated by the American College of Surgeons
Committee on Trauma.
Objectives (1 of 4)

6. Explain the importance of having an understanding of
how to manage situations in which there are multiple
patients.
7. Explain the importance of immediately identifying the
number of patients at a scene.
8. Compare the needs of an event to the resources
available to identify multiple-casualty incidents in a
given EMS system.
9. Differentiate between the management goals of
single-patient and multiple-patient incidents.
Objectives (2 of 4)

10.Discuss some common issues with communications in
multiple-casualty incidents and disaster situations.
11.Prioritize your actions as the first provider on the scene of
a multiple-casualty incident.
12.Describe the principles of an incident command system.
13.Identify the roles and responsibilities that may be
assigned to EMS units at a multiple-casualty incident.
14.Describe the principles of a triage system.
15.Given a scenario with multiple patients, categorize
patients according to a color-coded triage system.
Objectives (3 of 4)

16.Explain the principles used in the START triage system.
17.Describe adaptations of START triage to JumpSTART for
pediatric patients.
18.Explain the principles used in the SALT triage system.
19.Perform primary and secondary triage in a multiple-
casualty incident.
20.Use triage tags to document assessment and care of
patients in a multiple-casualty incident.
21.Describe considerations in determining the transport
destination for patients in a multiple-casualty incident.
Objectives (4 of 4)

• Unintentional injury leading cause of death.
• Organized trauma systems are key in reducing
trauma morbidity and mortality by providing
accessible surgical care for trauma patients.
• Trauma systems play role in injury prevention
through community education programs.
• AEMTs must understand and be able to operate
within incident command system (ICS).
Introduction

Think About It
• What does the information provided tell you about
the potential for a multiple-casualty incident?
• What are Steve and Jason’s primary
responsibilities once on scene?
• What is the importance of knowing the number
and capabilities of hospitals in the immediate
area?

Injury Prevention (1 of 2)
• Three Es of injury prevention provide strategies
for reducing injuries.
– Education
– Enforcement
– Engineering

Injury Prevention (2 of 2)
• Public health approach to injury prevention: who,
what, when, where, and why
– Define the problem.
– Identify risk and protective factors.
– Develop prevention strategies.
– Implement, evaluate, and share.
• “Children Can’t Fly” campaign: example of how
public health approach utilized

Trauma Systems (1 of 2)
• Trauma system: components/services to provide
definitive care for patients with serious injuries
– Leadership
– Professional resources
– Education and advocacy
– Information management
– Finances
– Research
– Technology

Trauma Systems (2 of 2)
• Hospitals that are part of trauma system have
specific trauma center designation.
• Trauma systems include
– Specialized emergency departments
– Surgical specialties
– Rehabilitation facilities
– Pediatric trauma specialists
– Critical and intensive care units

Table 33-1
Trauma Center Levels
Level Designation Capabilities
Level I regional
trauma center
Capable of managing any type of traumatic injury 24 hours a day,
365 days a year
Level II area trauma
center
Capable of managing most traumatic injuries 24 hours a day, 365 days a year.
Capable of stabilizing trauma patients who cannot be managed and transferring
them to a Level I trauma center
Level III community
trauma center
Capable of providing some surgical care and specially trained ED staff to
manage trauma. The focus is on stabilization of the trauma patient and
transferring to a higher-level center
Level IV trauma
facility
Capable of stabilizing trauma patients for transfer to a higher-level center; these
are smaller hospitals located in remote areas
Level V trauma
facility
Capable of providing initial evaluation, stabilization, and diagnostic testing, and
preparing patients for transfer to a higher-level Center
Source: American Trauma Society. n.d. “Trauma Center Levels Explained.” Trauma Resources.
http://www.amtrauma.org/?page=traumalevels

Managing Multiple-Casualty Incidents
(1 of 3)
• Multiple-casualty incident (MCI): event in which
number of patients exceeds capabilities of
resources on scene
• What are some events that would qualify as an
MCI?

(2 of 3)
• Request additional resources early.
• Properly stage vehicles.
• Place triage and treatment areas.
• Provide care and transport patients from scene
in efficient manner.
• Learn how to prioritize patients (triage) and
provide treatment.

(3 of 3)
• An MCI—any event where number of patients
exceeds capabilities
• An MCI in a relatively small community, where
limited resources are available, may not
necessarily be an MCI in a larger city, where more
resources are available.

Communications
• Responders need to communicate with each other
effectively.
– Radio or cell phone communication may be affected.
– Normal communication may be nonexistent.
• Use portable radios, satellite phones, self-
contained mobile command centers, portable
repeaters.

National Incident Management
System (NIMS) (1 of 2)
• NIMS is designed for use by all agencies during a
disaster.
– Different agencies work together under same
organizational structure using same terminology.
– Compliance requires all responders to obtain
certification in basic incident command systems.
– Organizations must participate in disaster drills.

National Incident Management
System (NIMS) (2 of 2)
• All agencies that may be called to respond to a
disaster must become NIMS compliant.
• All responders must obtain certification in basic
incident command systems.
• Disaster drills help identify strengths and
weaknesses of their plan.

Figure 33-3
Basic ICS organization used for smaller-scale responses.

Incident Command System (1 of 4)
• Incident Command System (ICS)
– C: Command
– F: Finance/administration
– L: Logistics
– O: Operations
– P: Planning
• Complexity of command structure depends on
size and scope of incident.

• Command
– Most important section of ICS.
– Incident commander (IC): individual responsible for
coordination of entire response
– Singular command
– Unified command

• Finance/administration
– Used in large-scale response; accounting and
administrative activities
• Logistics
– Acquiring and distributing essential supplies and
equipment needed during response

• Operations
– Triage, treatment, and transportation of patients
from MCI
• Planning
– Analyzes data collected from responses; makes
recommendations to change response plans to
improve future responses

Think About It
• What should be Steve and Jason’s next
immediate action?
• Who will assume the role of incident commander?
• What additional resources are needed?

On the Scene (1 of 9)
• Estimate number of patients and resources
needed at the scene.
• You will be assigned to an aspect of patient care.
– Triage, treatment, or transport.
• MCI response and ICS system:
– Specialization of resources to prevent duplication of
effort while maximizing resource capabilities

• Triage
– Process of categorizing patient’s priority for later
treatment
– Primary triage
– Secondary triage

Figure 33-4
Triage tag, front and back.

• Primary triage categories
– Immediate
– Delayed
– Minor
– Expectant
– Delayed: do not require immediate attention, but
should be seen as soon as possible
– Minor: require little or no care

• Triage tags: colored tags that correspond to the
various categories
– Red (immediate)
– Yellow (delayed)
– Green (minor)
– Black (expectant)
• Place tag on extremity so that other responders
can find it and document.

Figure 33-5
The START triage system.

• START triage
– Simple Triage and Rapid Treatment (START):
commonly accepted form of triage in the United States
– Prioritize treatment and transport of patients according
to specific signs and symptoms.

• START triage (continued)
– Step 1
▪ Individual who can follow command is placed on lowest
treatment priority.
– Step 2
▪ Check for adequate breathing; categorize as appropriate
based on results.
– Step 3
▪ Determine patient’s ventilation rate and level of perfusion.
– Step 4
▪ Assess patient’s mental status.

• START triage (continued)
– Initial triage is not the time for interventions.
– Expect patient conditions to change.
– May be assigned to secondary triage.

• JumpSTART triage
– Physiologic differences between adult and pediatric
patient that make START system inappropriate for
pediatric triage
– Based on the same categories (respiratory status,
perfusion status, mental status)

• Treatment and transport
– Do not start treatment until patient has gone through
triage.
– Minimal treatment on scene
– Hospitals receiving patients from MCI can become
overwhelmed quickly.
– Some illnesses or injuries require specialized care.

Chapter Summary (1 of 2)
• As an Advanced EMT, you will participate in
aspects of the trauma system.
• Key element in trauma system:
– Injury prevention education and advocacy
• At some point, you will participate in an MCI.
• Establishing command is the first step.

Chapter Summary (2 of 2)
• After command is established at MCI, START and
JumpSTART triage on scene must begin in order
to determine number and acuity.
• Remain focused and task oriented to provide
greatest chance of survival to greatest number of
patients.

Alexander ch33 lecture

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