Exit Drills In The Home.

72 Hours Worth.

• Natural
• Man Made
• Technological

Gloves, Goggles, Mask, Helmet, and Boots.

The EOP is a document that:

• Assigns responsibility to organizations and individuals for carrying out specific actions at projected times and places in an emergency that exceeds the capability or routine responsibility of any one agency (e.g., the fire department).
• Sets forth lines of authority and organizational relationships, and shows how all actions will be coordinated.
• Describes how people and property will be protected in emergencies and disasters.
• Identifies personnel, equipment, facilities, supplies, and other resources available, within the jurisdiction or by agreement with other jurisdictions, for use during response and recovery operations.

In short, the EOP describes how the community will do business in an emergency.

Heat, Fuel, Oxygen

What Are The Classes Of Fire and or Extinguishers?

Class A, B, C, D, and K

Tangles Of Electrical Cords or Overloaded Electrical Outlets.

What Does The Acronym LIES Stand For?  What does it refer to?

Limit, Isolate, Eliminate, Separate.

Chemicals, Paints and Solvents in the Home.

• Pull
• Aim
• Squeeze
• Sweep

Portable fire extinguishers, Wet standpipes, Confinement And “Creative”

What Are Hazardous Materials?

• Corrode other materials
• Explode or are easily ignited
• React strongly with water
• Are unstable when exposed to heat or shock
• Are toxic to humans, animals, or the environment

• Airway obstruction
• Excessive bleeding
• Shock

• Direct Pressure Method
• Elevation of limb
• Use of Pressure Points

What Is Triage?

• Walking Wounded
• Delayed
• Immediate
• Dead

• Wash hands frequently using soap and water.
• Wear latex gloves; change or disinfect after each patient.
• Wear a mask and goggles.
• Keep dressings sterile.
• Avoid contact with body fluids.

Where Should A Treatment Area Be?

• In a safe area.
• Close to (but upwind and uphill from) the hazard. Accessible by transportation vehicles.
• Expandable

• Bruising
• Swelling
• Severe pain
• Disfigurement

• First degree
• Second degree
• Third degree

• Locating victims.
• Documenting location.

• Rescue greatest number in shortest amount of time
• Rescue lightly trapped victims first

• Time of event and day of week.
• Type of structure.
• Construction type.
• Weather.
• Hazards.

Look For Kings Rows And Support Plates.

What Are 4 Types Of Voids?

• Pancake - floors collapse diagonally onto each other, creating voids in the areas where the floors remain attached to the walls.
• Lean-to - a collapsed wall or floor leans against an outside wall, creating a void where the floor remains attached to the wall.
• V - floor or wall collapses at or near the center, creating voids on either end next to the walls.
• Individual - spaces into which the victim may have crawled for protection. Examples of individual voids include bathtubs and the space underneath desks. Children may seek shelter in smaller spaces like cabinets.

Any Space a Person May Take Shelter For Safety During An Event. (i.e. Under a desk or in a cabinet)

• Know your limitations
• Follow safety procedures.
• Remove debris by: Leveraging, Cribbing.

Pieces Of Wood That Are Similar In Size And Shape Stacked In Layers Of Two To Support An Object.

What Are Two Types Of Victim Removal?

• Self-removal or assist.
• Lifts and drags.

What Is The Purpose Of On-Scene Management?

• Ensure safety of disaster workers
• Provide clear leadership for rescuers
• Improve effectiveness of rescue efforts

• Command
• Operations
• Logistics
• Planning
• Administration

• Impact - Survivors do not panic and may, in fact, show no emotion.
• Inventory - Survivors assess damage and try to locate other survivors.
• Rescue - Emergency services personnel (including CERTs) are responding and survivors are willing to take their direction from these groups without protest.
• Recovery - survivors appear to pull together against their rescuers, the emergency services personnel.

• Situation Status
• Incident Locations
• Access Routes
• Identified Hazards
• Support Locations

How Do We Help Survivors Deal With Stress?

• Establish Rapport
• Listen
• Empathize
• Provide Confidentiality

• Make disaster plans together
• Ensure everyone understands CERT
• Include everyone in the household

1. Gather the facts
2. Assess and communicate the damage
3. Consider the probabilities
4. Assess your situation
5. Establish priorities
6. Make Decisions
7. Develop and action plan
8. Take Action
9. Evaluate progress

• Time of event/day of the week
• Type of structure
• Construction type
• Weather
• Hazards

• Light - Superficial damage, broken windows, fallen or cracked plaster, minor damage to interior contents
• Moderate - Visible signs of exterior damage, Decorative work damaged or fallen, many visible cracks in plaster, major damage to interior contents
• Heavy - Partial/total collapse, tilting/structural instability, heavy smoke/fire, gas leak/hazardous materials, rising/moving water

What will probably happen (based on the current facts gathered)

What could happen ("What if" the situation changes, apply "Murphy's Law")

Is it safe?

What are the risks if we continue the operation or task?

What do we need to conduct the operation safely?

• Personnel
• Equipment
• Tools

What should be done

In what order should it be done

• Safety of CERT members
• Safety of victims
• Protection of environment
• Protection of property

Specifies how the team will conduct the operation/task.

• Helps focus the operation on priorities and decisions
• Provides documentation to responding agencies when they arrive (turnover)
• Provided documentation to be used after the incident (lessons learned)

Once the action plan is executed, how should you evaluate its progress?  What should you do if the situation changes?

By continuous size-up!  you should maintain an ongoing evaluation of the problem, safter risks and resources available.

If the situation changes, you should adjust the action plan/strategy as required.

What is the goal of Triage?

Green - Walking Wounded

Yellow - Delayed

Red - Immediate

Black - Dead (expectant)

What three conditions will result in a Red tag (Immediate)?

• Airway Obstruction
• Excessive Bleeding
• Shock

How much time should you spend with each patient during

triage?

Less than 30 seconds.

Heat Tilt/Chin Lift to open the airway.  If after two attempts, patient is unable to maintain an open airway, what should you do?  Tag them as "Black" and move to the next victim.

Test for capillary refill (less than 2 seconds).

True or False?  Everyone gets a Triage tag.

True

What are some triage pitfalls?

True or False? 

Treat all red tag victims for shock.

• Rapid and shallow breathing
• Capillary refill of greater than 2 seconds
• Failure to follow simple commands
• Changes in skin color - pale
• Sweaty, but cool to the touch

How long it takes for the color to return to the skin.  Also called the "blanch test."

• Lay the person on his/her back.
• Elevate the feet above their heart.
• Maintain an open airway.
• Control obvious bleeding.
• Maintain body temperature.
• Avoid rough or excessive handling.

No, if no other gloves are available you can sterilize gloves in a 1 to 10 bleach to water solution.

No, we bury it

When does a treatment area get established?

Assist with verbal communication, share resources, easy transfer of victims.

So when you finish examining one victim you can turn around to the head of the next to save time.

What do you doucment in the treatment area?

• Available identifying info
• Description
• Clothing
• Injuries
• Treatment
• Transfer location

• Bruising
• Swelling
• Severe pain
• Disfigurement
• Bleeding

• Determine the extent of injuries
• Type of treatment needed
• Document injuries

Spinal Injury.

• Remove source of heat
• Cool
• Cover
• Elevate

Direct pressure, elevation, and pressure points.

• Swelling
• Discoloration
• Discharge
• Red Striations from wound

• Imobilize the body part
• Do not remove the object
• Control bleeding at the entrance
• Clean and dress wound

Do not put bones back in (draw back into dissue), do not irrigate

Cover with sterile dressing, place a moist 4x4 on end of bone to prevent it from drying, splint.

Circulation

What are the four functions of Medical?

• Triage
• Treatment
• Transport
• Morgue

• Remove wet clothes
• Wrap victim covering head and neck
• Protect against weather
• Provide warm, sweet drink and food (conscious victims)
• If unconcious, put in recovery postion
• If concious put in warm bath

Do not allow victim to walk around.

1. Gather Facts
2. Assess and Communicate the Damage
3. Consider Probabilities
4. Assess Your Own Situation
5. Establish Priorities
6. Make Decisions
7. Develop Plan of Action
8. Take Action
9. Evaluate Progress

• Red - Describes the material’s flammability.
• Blue - Indicates health hazard.
• Yellow - Indicates reactivity.
• White - The white "special notice" area can contain several symbols related to the type of chemical and or special equipmet/gear needed when handling.

The diamond is divided into four colored quadrants, each with a rating number inside of it, and that number indicates the degree of risk associated with the material. The higher the number, the higher the risk!

Plackard identification system instituted by the National Fire Protection Association. The NFPA 704 Diamond is a concise system for identifying the hazards associated with specific materials. This placard would be found on a fixed facility.

What should a CERT team member do when encountering a NFPA 704 Diamond?

• DOT Warning Placards.
• The United Nations (UN) system.
• The North American (NA) warning placards.

Like the NFPA 704 Diamond, the DOT, UN, and NA placards should be a “stop sign” for CERT members and should evacuate persons who are downwind, as necessary, to an uphill and upwind location.

• Light: To locate, triage, and prioritize removal of victims to designated treatment areas by the medical operation teams.
• Moderate: To locate, stabilize, and immediately evacuate victims to a safe area while minimizing the number of rescuers inside the building.
• Heavy: To secure the building perimeter and warn others about the danger of entering the building.

• Use a buddy system. Always work in pairs, with a third person acting as a runner.
• Be alert for hazards (e.g., power lines, natural gas leaks, hazardous materials, sharp objects, etc.).
  You should never attempt to search an area where water is present.
• Use safety equipment. Wearing gloves and a helmet will protect a rescuer's hands and head. Also, the primary cause of rescuer problems after working in a structural collapse is breathing dust, so a dust mask is essential. (However, a dust mask will not filter out harmful materials.)
• Have backup teams available to allow rotating of teams, prevent fatigue, and ensure help if a team gets into trouble. Have teams drink fluids and eat to keep themselves fresh.

1. Creating a safe rescue environment by lifting objects out of the way, using tools to move objects, and removing debris.
2. Triaging or stabilizing victims.
3. Removing victims in a moderately damaged building. Call in the medical team in a lightly damaged building.

Make a single diagonal slash next to the door just before entering a structure. Make an opposite slash (creating an "X") when all occupants have been removed and search and rescue efforts have been completed. The "X" signals to other potential searchers that the area has already been searched.

Dangerous - DO NOT ENTER

An "X" on the outside of a building enclosed by a box.

Psychological symptoms may include:

• Irritability or anger.
• Self-blame or the blaming of others.
• Isolation and withdrawal.
• Fear of recurrence.
• Feeling stunned, numb, or overwhelmed.
• Feeling helpless.
• Mood swings.
• Sadness, depression, and grief.
• Denial.
• Concentration and memory problems.
• Relationship conflicts/marital discord.

Physiological symptoms may include:

• Loss of appetite.
• Headaches or chest pain.
• Diarrhea, stomach pain, or nausea.
• Hyperactivity.
• Increase in alcohol or drug consumption.
• Nightmares.
• The inability to sleep.
• Fatigue or low energy.

Victim Triage - What Category are They?

Victim Info:

45 Year Old Male

• Bleeding extremities
• Unresponsive
• After two attempts to open airway, still not breathing.

Victim Triage - What Category are They?

Victim Info:

8 Year Old Female

• Crying
• Follows all commands
• Bleeding from head
• Respirations (RR) = 45
• Ambulatory on scene

Victim Triage - What Category are They?

Victim Info:

36 Year Old Female

• Ambulatory on scene
• Responds to voice triage
• Bleeding from left arm
• Normal Blanch test
• Respirations (RR) = 25

Victim Triage - What Category are They?

Victim Info:

15 Year Old Female

• Ambulatory on scene
• Responds to voice triage
• Bleeding from left leg
• Blanch test > 4 seconds

Victim Triage - What Category are They?

Victim Info:

41 Year Old Male

• Bleeding from head
• Does not follow commands
• Non-ambulatory
• Respirations (RR) = 34

Victim Triage - What Category are They?

Victim Info:

25 Year Old Male

• Minor bleeding from left arm
• Conscious but will not follow commands
• Respirations (RR) = 38
• Ambulatory on scene

Victim Triage - What Category are They?

Victim Info:

16 Year Old Male

• Conscious but does not follow commands
• Amputated right hand
• Respirations (RR) = 26
• Blanch test > 4 seconds

Victim Triage - What Category are They?

Victim Info:

82 Year Old Female

• Unconscious
• After two attempts to open airway, still not breathing
• Bleeding from the torso

Victim Triage - What Category are They?

Victim Info:

74 Year Old Male

• Responds to voice triage
• Bleeding from right arm and left leg
• Blanch test > 3 seconds
• Respirations (RR) = 26
• Ambulatory on scene

Victim Triage - What Category are They?

Victim Info:

21 Year Old Female

• No bleeding noted
• Follows commands
• Blanch test < 2 seconds
• Respirations (RR) = 31

Victim Triage - What Category are They?

Victim Info:

44 Year Old Male

• Bleeding from head
• Follows all commands
• Respirations (RR) = 22
• Blanch test < 2 seconds
• Ambulatory on scene

Victim Triage - What Category are They?

Victim Info:

29 Year Old Male

• Respirations (RR) = 23
• No bleeding
• Deformity to right wrist
• Blanch test < 2 seconds
• Ambulatory on scene

Victim Triage - What Category are They?

Victim Info:

12 Year Old Male

• Bleeding extremities with left leg deformity
• Respirations (RR) = 29
• Blanch test < 2 seconds
• Non-ambulatory on scene
• Follows all commands

Victim Triage - What Category are They?

Victim Info:

55 Year Old Female

• Complaining of back pain
• Respirations (RR) = 20
• No bleeding
• Follows all commands
• Blanch test > 3 seconds

Victim Triage - What Category are They?

Victim Info:

41 Year Old Male

• Respirations (RR) = 26
• Bleeding from right hand with deformity
• Blanch test > 3 seconds
• Responds to voice triage

Victim Triage - What Category are They?

Victim Info:

28 Year Old Male

• Abrasions to torso area
• Respirations (RR) = 27
• Blanch test > 5 seconds
• Does not follow commands

Victim Triage - What Category are They?

Victim Info:

3 Year Old Male

• Bleeding from head
• After two attempts to open airway, victim is still not breathing
• Unconscious

Victim Triage - What Category are They?

Victim Info:

6-mo Old Male

• Bleeding from head
• Unresponsive
• After two attempts to open airway, the victim is still not breathing

Victim Triage - What Category are They?

Victim Info:

88 Year Old Male

• Non ambulatory
• Responds to voice triage
• Deformity to right leg
• Respirations (RR) = 29
• Blanch test < 2 seconds

Victim Triage - What Category are They?

Victim Info:

91 Year Old Female

• Ambulatory on scene
• Does not follow commands
• Respirations (RR) = 22
• No bleeding found

Victim Triage - What Category are They?

Victim Info:

67 Year Old Male

• No signs of bleeding
• Does not follow commands
• Blanch test > 2 seconds
• Non ambulatory on scene

Victim Triage - What Category are They?

Victim Info:

25 Year Old Female

• Minor bleeding from left arm
• 9 months pregnant
• Respirations (RR) = 26
• Blanch test < 2 seconds
• Ambulatory on scene

Victim Triage - What Category are They?

Victim Info:

46 Year Old Male

• Respirations (RR) = 22
• No signs of bleeding
• Does not follow commands
• Blanch test < 2 seconds

Victim Triage - What Category are They?

Victim Info:

16 Year Old Female

• Crying, Does not follow commands
• Bleeding from head
• Deformity to left leg
• Respirations (RR) = 26
• Blanch test < 2 seconds

Victim Triage - What Category are They?

Victim Info:

9-mo Old Female

• Respirations (RR) = 0 After two attempts to open airway
• No bleeding noted

Victim Triage - What Category are They?

Victim Info:

34 Year Old Female

• Responds to voice triage
• Follows all commands
• Blanch test < 2 seconds
• Respirations (RR) = 29
• Ambulatory on scene

Victim Triage - What Category are They?

Victim Info:

30 Year Old Female

• Severe burns to the left and right arms
• Follows all commands
• Blanch test > 6 seconds
• Respirations (RR) = 36

Victim Triage - What Category are They?

Victim Info:

52 Year Old Male

• Complaining of chest pain
• Follows all commands
• Respirations (RR) = 28
• Blanch test < 2 seconds
• Non-ambulatory on scene

Victim Triage - What Category are They?

Victim Info:

30 Year Old Female

• Minor bleeding from head
• Does not follow commands
• Respirations (RR) = 22
• Blanch test < 2 seconds

Victim Triage - What Category are They?

Victim Info:

2 Year Old Female

• Crying
• Follows all commands
• Deformity to right leg
• Blanch test <2 seconds
• Respirations (RR) = 28

Critical Incident Stress Debriefing (CISD) is one type of interventions within a more comprehensive, multicomponent crisis intervention system that is based on a careful assessment of the needs of a group or individual.

What are the Seven Phases of a CISD?

A CISD has seven phases:

• Introductions and a description of the process, including assurance of confidentiality
• Review of the factual material about the incident
• Sharing of initial thoughts/feelings about the incident
• Sharing of emotional reactions to the incident
• Review of the symptoms of stress experienced by the participants
• Instruction about normal stress reactions
• Closing and further needs assessment

The U.S. Department of Justice’s definition of terrorism is:

. . .the unlawful use of force or violence committed by a group or individual against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.

The weapons thought to be available to at least some terrorist groups include:

• Biological weapons
• Nuclear weapons and radiological dispersal devices
• Incendiary devices
• Chemical weapons
• Explosive devices

The acronym B-NICE will help you to remember.

• Blister agents cause blisters, burns, and other tissue damage.
• Blood agents are absorbed into the bloodstream and deprive blood cells of oxygen.
• Choking agents attack the lungs.
• Nerve agents affect the central nervous system.
• Riot-control agents cause respiratory distress and tearing and are designed to incapacitate rather than kill.

• Multiple casualties without obvious signs of trauma.
• Multiple victims who are exhibiting similar symptoms.
• Large numbers of persons seeking medical attention with similar symptoms that are not characteristic of the season.

• Sick or dead animals, fish, or birds.
• Unscheduled spraying or abandoned spray devices.
• Vapor clouds or mists
• Absence of crops, wildlife, or insects.
• Out of place and unattended packages, boxes, or vehicles.
• Packages that are leaking.
• Materials or equipment that are unusual for the area.
• Small explosions.
• Unusual odors or tastes.

• Time - Limiting the amount of time in the area of an incident limits exposure.
• Distance - Evacuate the area. Professional responders suggest maintaining distance of between 1,000 and 1,500 feet from the incident. Move upwind and uphill from the incident site.
• Shielding - The shielding provided by a sturdy building or even a wall can increase protection from contamination, radiation, or blast effects.

• Remove everything
• Wash hands
• Flush entire body with cool water
• Blot dry, DO NOT rub the skin
• Put on clean clothes