**Chapter IV**

**Disaster Medical OperationsPart 2**

***Introduction***

***Overview***

Chapter III described triagethe evaluation and prioritizing of patients
into treatment groups and the provision of immediate life-saving
measures. From triage, live patients are transported to the immediate
and delayed treatment areas as needed, and the dead are transported to
the morgue. As patients are brought to the treatment areas, medical
operations personnel:

 Perform additional triage as needed.

 Give patients a thorough head-to-toe assessment to determine the
extent of injuries.

 Render all possible first aid until professional care can be obtained.

 Take appropriate sanitation measures.

This chapter will introduce disaster medical operations and describe the
factors involved in establishing treatment areas. It will also present
the processes to follow for completing a head-to-toe assessment and
train you to provide immediate treatment for:

 Burns.

 Open wounds.

 Fractures, sprains, and strains.

 Hypothermia.

 Frostbite.

***Overview** (Continued)*

This chapter will also describe public health considerations surrounding
disaster medical operations and provide basic information that you will
need to prepare for medical operations in a disaster. Your instructor
may present additional information during the classroom session. Be sure
to take careful notes.

***Organization Of Disaster Medical Operations***

Within medical operations, there are five major subfunctions:

 Triage

 Transport

 Treatment

 Morgue

 Supply

These functions are shown in the figure on the next page.

***Organization Of Disaster Medical Operations** (Continued)*

![](media/image1.emf){width="8.996527777777779in"
height="3.926388888888889in"}

**Figure IV-1. Disaster Medical Operations Organization**

***Major Causes Of Injury***

Injury, or *trauma*, can result from the body being hit by flying debris
or collapsing building materials, being thrown against an object, or
falling onto a surface. The energy of impact may cause damage to soft
tissues, bones, organs, and other body structures.

Injuries may include the following:

 *Penetrating injury* (an injury that breaks the skin at a small point
of contact). Penetrating injuries include lacerations (open wounds) and
impaled objects.

 *Blunt trauma* (damage to deeper tissues by impact over a larger
area). Blunt trauma can cause internal bleeding, organ rupture,
bruising, fractures, brain injury, and other injuries.

 *Crushing injury* (force applied to the body over a relatively long
period of time).

As a worker in disaster medical operations, you may give first aid to
victims with a wide range of injuries.

***Conducting Head-To-Toe Assessments***

***Objective***

Among the first steps when a patient is receiving medical treatment is
to conduct a triage for airway, bleeding, and shock. Then do a
size-upthat is, conduct a thorough head-to-toe assessment. This can be
done in place in a lightly damaged building. If the building is more
heavily damaged, the victim should be moved to a safe zone for the
head-to-toe assessment. The objectives of this assessment are to
determine, as clearly as possible, the extent of injuries and the type
of treatment that is needed, and to document the injuries.

This section will provide you with the basic information you need to
conduct head-to-toe assessments under emergency conditions.

***Assessment Procedures***

Head-to-toe assessments must be performed for all victims, even those
that are awake. Assessments should be both *verbal* (if the patient is
able to speak) and *hands-on.* Whenever possible, ask the person about
any injuries, pain, bleeding, or other symptoms that he or she is aware
of. If the victim is conscious, ask permission to conduct the
assessment. Pay careful attention. Look, listen, and feel for anything
unusual.

***Assessment Procedures** (Continued)*

When conducting triage during a disaster, it is essential to document
the number of victims in each category of triage (immediate, delayed,
and dead) and where these victims are located in the treatment area. See
the figure below for an example of this kind of documentation. Such a
record can be given to professional responders when they arrive so that
no time is lost getting immediate care to those who need it.

![](media/image2.emf){width="5.21875in" height="3.0118055555555556in"}

**Figure IV-2. Sample Triage Documentation**

*What To Check*

Perform the assessment systematically (always in the same order),
checking body parts from the top to the bottom. Always assess the victim
by examining the:

1\. Head

2\. Neck

3\. Shoulders

4\. Chest

5\. Arms

6\. Abdomen

7\. Pelvis

8\. Legs

9\. Back

Completing your assessment in the same way every time will allow you to
complete your assessment more quickly and accurately. Always perform an
entire assessment before beginning any treatment. Treat victims as if
they have a spinal injury until you are certain they do not.

*What To Look For*

As you conduct your assessment, look for anything that might indicate an
injury. The most common injuries include lacerations, fractures, and
bruises, but anything out of the ordinary might indicate an injury. Look
especially for:

 How the person may have gotten hurt (the mechanism of injury), to help
determine injuries.

 Signs of shock.

 Airway obstructions.

 Labored, shallow, or otherwise difficult breathing.

*What To Look For (Continued)*

 Excessive bleeding.

 Bruising.

 Swelling.

 Severe pain.

 Disfigurement.

Be sure to check your own hands during the assessment for any signs of
patient bleeding.

Once you have completed your assessment, *provide immediate treatment*
for victims tagged "I." During treatment, reclassify victims if
necessary. Also, as you record medical information, try to document who
the person is.

***Closed Head, Neck, And Spinal Injuries***

If, during a head-to-toe assessment, you encounter a victim with a
suspected closed head, neck, or spinal injury, your main objective is to
*do no harm*. Minimize movement of the head and spine, while treating
any other life-threatening conditions (airway, bleeding, or shock).

Injuries to the head, neck, and spine often occur when victims fall, are
hit by flying debris, or have objects fall on themsituations that are
common when there is structural collapse. Closed head, neck, and spinal
injuries may be life-threatening. They can also cause paralysis, affect
speech and memory, and disable the victim in other ways. Any time a
head, neck, or spinal injury is even suspected, it should be treated as
a head, neck, or spine injury. Talk to the victim to determine symptoms,
and to keep the victim calm and still. All unconscious trauma patients
should be suspected as having a head, neck, or spinal injury.

*Symptoms*

If the rescuer is not in immediate danger, check the victim for signs of
injury to the head, neck, or spine before moving the victim. The main
signs of closed head, neck, or spinal injury are:

 Change in consciousness: unconscious, dizzy, or confused

 Inability to move one or more body parts

 Severe pain or pressure in head, neck, or back

 Tingling or numbness in extremities

 Difficulty breathing or seeing

 Heavy bleeding, bruising, or deformity (e.g., bump or depression) of
head or spine

 Blood/fluid in nose or ears

 Bruising behind the ears

 "Raccoon" eyes (bruising around eyes)

 Seizures

 Nausea, vomiting

 Victim found under collapsed building material or heavy debris

*Stabilizing Head, Neck, Or Spinal Injuries*

The process for immobilizing head, neck, or spinal injuries is called
in-line stabilization. In-line stabilization means to *keep the spine in
a straight line.* Ideally, this is done by carefully fitting a cervical
collar on the victim's neck, placing the victim on a back board, and
securing the victim so movement is impossible. However, in a disaster
situation, ideal equipment and materials are seldom available. Spinal
immobilization devices are not intended to be used for lifting or
carrying.

*Stabilizing Head, Neck, Or Spinal Injuries (Continued)*

Head, neck, and spine treatment under emergency conditions may require
creativity and will most likely involve:

 *Looking for materials that can be used as a backboard.* For example,
a door, table, desktop, or building materials such as sheetrock or
lumber can be used as a backboard when necessary.

 *Looking for items that can be used to stabilize the head on the
board.* A towel, blanket, clothing, drapery material, or sandbags tucked
snugly on either side of the head will immobilize it in an emergency.

Your instructor will demonstrate in-line stabilization during class.
Whenever possible, defer closed head, neck, and spinal injuries to
trained emergency medical personnel. Remember the goal when you suspect
such injuries: *do no harm*.

The next sections of this chapter will provide you with the information
you will need to establish a treatment area, provide treatment, and make
the patient more comfortable (through splinting, applying dressings, or
providing other treatment). You will also have the opportunity to
practice some of the most common treatment techniques during class.

***Establishing Treatment Areas***

Because time is critical after a disaster, CERT medical operations
personnel will need to select a site and set up a treatment area as soon
as casualties are confirmed. The treatment area is the location where
the most advanced medical care possible will be given to victims. The
site selected should be:

 In a safe area, free of hazards and debris.

 Close to, but upwind and uphill from, the hazard zone(s).

 Accessible by transportation vehicles, such as ambulances, trucks, and
helicopters.

 Able to grow.

![](media/image3.emf){width="6.958333333333333in"
height="1.9993055555555554in"}

**Figure IV-3. Treatment Area Site Selection**

***Treatment Area Layout***

The treatment area must be protected and clearly delineated using a
ground cover or tarp, and signs should identify the subdivisions of the
area: "I" for Immediate care, "D" for Delayed care, "DEAD" for the
morgue.

The "I" and "D" divisions should be relatively close to each other, to
allow:

 Verbal communication between workers in the two areas.

 Shared access to medical supplies (which should be cached in a central
location).

 Easy transfer of patients whose status has changed.

The morgue site should be secure, and away from and not visible from the
medical treatment areas.

Patients in the treatment area should be positioned in a head-to-toe
configuration, with two to three feet between victims. This system will
provide effective use of space, and effective use of available
personnel. (As a worker finishes one head-to-toe assessment, he or she
turns around and finds the head of the next patient.)

![](media/image4.emf){width="6.459027777777778in"
height="2.3958333333333335in"}

**Figure IV-4. Treatment Area Layout**

***Treatment Area Organization***

The CERT team must assign division leaders to maintain control in each
of the medical treatment areas. Among the tasks of these division
leaders will be ensuring orderly victim placement, and directing
assistants to conduct head-to-toe assessments.

Thorough documentation of victims in the treatment area is essential.
Documentation should include:

 Available identifying information.

 Description (age, sex, body build, height, weight).

 Clothing.

 Injuries.

 Treatment.

 Transfer location.

***Treatment Area Planning***

Clearly, advance planning for how treatment areas will be established is
crucial. Before disaster strikes, team members should consider:

 Roles of personnel assigned to the treatment area.

 The availability of setup equipment, such as ground covers/tarps and
signs for identifying divisions (immediate, delayed, morgue).

***Treating Burns***

The objectives of first aid treatment for burns are to stop the burning
and cover to reduce pain and infection.

Burns may be caused by heat, chemicals, electrical current, and
radiation. The severity of a burn depends on many factorsthe
temperature of the burning agent, the period of time that the victim was
exposed, the area of the body that is burned, how much area is affected,
the age of the victim, and the burn depth.

***Burn Classifications***

The skin contains three layers:

 *Epidermis.* The outer layer of the skin. The epidermis contains nerve
endings and is penetrated by hairs.

 *Dermis.* The middle layer of skin. The dermis contains blood vessels,
oil glands, hair follicles, and sweat glands.

 *Subcutaneous layer.* The innermost layer of skin. The subcutaneous
layer contains blood vessels and overlies the muscle and skin cells.

Depending on the severity, burns may affect all three layers of skin.

The critical areas of the body for burns are the:

 Face

 Hands

 Feet

 Genitalia

***Burn Classifications** (Continued)*

Burns are classified as first-, second-, or third-degree depending on
their severity. Burn classifications, the skin layers affected, and
signs are shown in the table below.

+-----------+----------------------------+----------------------------+
| **        | ***Skin Layers Affected*** | ***Signs***                |
| *Classifi |                            |                            |
| cation*** |                            |                            |
+-----------+----------------------------+----------------------------+
| 1^st^     |  Epidermis (superficial)  |  Reddened, dry skin       |
| Degree    |                            |                            |
|           |                            |  Pain                     |
|           |                            |                            |
|           |                            |  Swelling (possible)      |
+-----------+----------------------------+----------------------------+
| 2^nd^     |  Epidermis                |  Reddened, blistered skin |
| Degree    |                            |                            |
|           |  Partial destruction of   |  Wet appearance           |
|           | dermis                     |                            |
|           |                            |  Pain                     |
|           |                            |                            |
|           |                            |  Swelling (possible)      |
+-----------+----------------------------+----------------------------+
| 3^rd^     |  Complete destruction of  |  Whitened, leathery, and  |
| Degree    | epidermis and dermis       |                            |
|           |                            | charred (brown or black)   |
| (Full     |  Possible subcutaneous    |                            |
| Thickness | damage                     |  Painful or relatively    |
|           |                            |                            |
| Burns)    | (destroys all layers of    | painless                   |
|           | skin and                   |                            |
|           |                            |                            |
|           | some or all underlying     |                            |
|           | structures)                |                            |
+-----------+----------------------------+----------------------------+

**Table IV-1. Burn Classifications**

***Burn Treatment***

First aid treatment for burn victims involves removing the source of the
burn, cooling the burn, and covering it. Guidelines for treating burns
include:

 Remove the victim from the burn source. Put out any flames and remove
smoldering clothing.

 If skin or clothing is still hot, cool them by immersing in cool water
for not longer than 1 minute or covering with clean compresses that have
been wrung out in cool water. Possible cooling sources include water
from the bathroom or kitchen; garden hose; and soaked towels, sheets, or
other cloths. Use clean water. For third-degree burns, do not apply
water except to put out flames. Treat all victims of third-degree burns
for shock.

 Cover loosely with dry, sterile dressings to keep air out, reduce
pain, and prevent infection.

 Elevate burned extremities higher than the heart.

When treating burns:

 [Do not]{.underline} use ice, which can cause hypothermia.

 [Do not]{.underline} apply antiseptics, ointments, or other remedies.

 [Do not]{.underline} remove shreds of tissue, break blisters, or
remove adhered particles of clothing. (Cut burned-in clothing around the
burn.)

With younger people, older people, and people with severe burns, use
caution when applying cool dressings. These people are susceptible to
hypothermia. A rule of thumb is do not cool more than fifteen percent of
body surface area (the size of one arm) at once, to prevent hypothermia.

***Wound Care***

The objectives of first aid treatment for wounds are to control bleeding
and prevent secondary infection. Methods for controlling bleeding were
described in Chapter III of this Participant Handbook. Cleaning and
bandaging help to prevent infection.

Clean the wound by irrigating with water, flushing with a mild
concentration of soap and water, then irrigating with water again. *Do
not scrub.* A bulb syringe or hypodermic syringe is useful for
irrigating wounds.

After thoroughly cleaning the wound, you will need to apply a dressing
and bandage to help to keep the wound clean.

A *dressing* is applied directly to the wound. A *bandage* is used to
hold the dressing in place.

To dress and bandage the wound, clean the wound area as described above,
place a sterile dressing directly over the wound, and apply a bandage to
hold it in place. If the wound is still bleeding, the bandage should
place enough pressure on the wound to help control bleeding without
interfering with circulation. Check for color, warmth, and sensation to
determine if the bandage is too tight. If capillary refill is slow,
loosen the dressing.

Your instructor will demonstrate how to apply dressings and bandages.

Use the following rules for dressings and bandages:

 In the absence of active bleeding, dressings must be removed and the
wound flushed and checked for signs of infection at least every 4 to 6
hours. Signs of possible infection include:

\- Swelling around the wound site.

\- Discoloration.

\- Discharge (pus) from the wound.

\- Red striations from the wound site.

 If there is active bleeding (the dressing is soaked with blood),
redress [over]{.underline} the existing dressing and maintain pressure
and elevation.

***Amputations***

In an emergency situation, an amputation is the traumatic severing of a
limb or other body part. To treat the victim, control bleeding, watch
for signs of shock, and treat for shock as necessary.

If a part of the body is severed and can be found, save tissue parts,
wrapped in clean material, in a plastic bag if available, and keep the
tissue parts cool. Keep the severed part with the victim.

***Impaled Objects***

You may encounter some victims who have foreign objects lodged in their
bodiesusually as the result of flying debris during the disaster event.
When a foreign object is impaled in a patient's body:

 Immobilize the affected body part.

 Do *not* attempt to move or remove the object unless the object is
occluding the airway.

 Try to control bleeding at the entrance wound without placing undue
pressure on the foreign object.

 Clean and dress the wound. Wrap bulky dressings around the object to
keep it from moving.

***Treating Fractures, Sprains, And Strains***

The objective when treating a suspected fracture, sprain, or strain is
to immobilize the injury and the joints immediately above and
immediately below the injury site.

Because there are several different types of injuries, however, and your
actions depend in part on the type of injury encountered, this section
will describe the different types of injuries possible next.

***Fractures***

A fracture is a complete break, a chip, or a crack in a bone. Fractures
are classified as:

 *Closed.* A broken bone with no associated wound. First aid treatment
for a closed fracture may require only splinting.

 *Open.* A broken bone with some kind of wound that allows contaminants
to enter into or around the fracture site. Open fractures are more
dangerous because of the risk of severe bleeding and infection. They
are, therefore, a higher priority injury and should be checked more
frequently. When treating an open fracture:

\- Do *not* draw the exposed bone ends back into the tissue.

\- Cover the wound with a sterile dressing. Do not irrigate the wound.

\- Cover the exposed bone with a moist 4 x 4 bandage to keep it from
drying out.

\- Splint the fracture without disturbing the wound.

***Fractures** (Continued)*

Examples of open and closed fractures are shown in Figures IV-5 and
IV-6.

![](media/image5.emf){width="3.0in" height="2.0in"}2
![](media/image6.emf){width="3.0in" height="2.0in"}3

**Figure IV-5. Closed Fracture Figure IV-6. Open Fracture**

Closed fractures may be described by the degree of displacement of the
bone fragments. If the limb is angled, then there is a *displaced
fracture*. A displaced fracture may be detected by seeing and feeling
the deformity. A *nondisplaced fracture* is difficult to identify
without x-rays. The main indicators are usually pain and swelling, which
could also indicate a strain or sprain. Therefore, treat areas where
there is pain and swelling as a suspected fracture until professional
diagnosis and care can be obtained.

***Fractures** (Continued)*

Examples of displaced and nondisplaced fractures are shown in Figures
IV-7 and IV-8.

![](media/image7.emf){width="3.0in" height="2.0in"}4
![](media/image8.emf){width="3.0in" height="2.0in"}5

**Figure IV-7. Displaced Fracture Figure IV-8. Nondisplaced Fracture**

***Dislocations***

Another common injury in emergency situations is a dislocation. A
dislocation is an injury to the ligaments around a joint that is so
severe that it results in separation of the bone from its normal
position at a joint. Once dislocated, the bones lock in their new
position. The joints most commonly dislocated are fingers, shoulders,
elbows, hips, and ankles. The signs of a dislocation are similar to
those of a fracture, so treat a suspected dislocation like a fracture.

When a dislocation is a possibility, do *not* attempt to relocate the
joint. Immobilize the joint until it can be treated by trained medical
staff.

***Sprains And Strains***

A *sprain* is the stretching or tearing of ligaments at a joint and is
usually caused by stretching or extending the joint beyond its normal
range of motion. A sprain is considered a partial dislocation, although
(unlike a full dislocation) the bone is able to fall back into place
after the injury. The joints most easily sprained are the ankle, knee,
wrist, and fingers. Common symptoms of sprains include:

 Tenderness at the site of the injury.

 Swelling and/or bruising.

 Restricted use, or loss of use of the joint.

Because the signs of a sprain are similar to those of a nondisplaced
fracture, do *not* attempt to treat the injury beyond immobilization and
elevation.

A *strain* is the stretching and tearing of muscles or tendons. Strains
most often involve the muscles in the neck, back, thigh, or calf. In
some cases, a strain is indistinguishable from a sprain or fracture
without x-rays or other, more sophisticated diagnostic methods. In these
cases, treat the injury as a fracture.

***Nasal Injuries***

Bleeding from the nose may be caused by:

 Facial injuries (blunt force to the nose).

 Skull fracture.

 Non-trauma-related conditions such as sinus infections, high blood
pressure, and bleeding disorders.

A large blood loss from a nosebleed can lead to shock. The actual blood
loss may not be evident because some blood goes down the throat and is
swallowed. A victim who swallows a lot of blood may become nauseated and
vomit. Vomitus that is inhaled into the lungs will result in serious
complications.

To control nosebleeds caused by injuries to the nose:

 Control bleeding by:

\- Pinching the nostrils together.

\- Putting pressure on the upper lip just under the nose (e.g., place
rolled gauze between the upper lip and gum and press against it with the
fingers).

 Have the victim sit with the head slightly forward so that blood
trickling down the throat will not be breathed into the lungs. Do *not*
put the head back.

 Be sure the victim's airway remains open.

 Keep the victim quiet. Anxiety will increase blood flow.

***Splinting***

Splinting is the most common method for immobilization in emergency
conditions. A variety of materials may be used for first aid splinting.
Typically, cardboard is used until professional care can be obtained.
(See Figure IV-9 on the following page.) However, other materials that
may be available can also be used, including:

 *Soft Materials.* A towel can be rolled into a thick tube shape,
placed around the injury, and secured in several places with bandaging
materials or cloth strips. (See Figure IV-10 on page IV-28.) A blanket
can be used in the same way. A pillow can be wrapped around an injured
limb and secured in several places with bandaging materials or cloth
strips. (See Figure IV-11 on page IV-28.)

 *Rigid Materials.* A board, metal strip, folded magazine or newspaper,
or other rigid item may be used to support the injured part and secured
with bandaging materials or strips of cloth. (See Figure IV-12 on page
IV-29.)

 *Anatomical Splint.* A fractured bone can be secured to an adjacent
unfractured bone by binding the two together in several places (for
example, two fingers or two legs).

Your instructor will demonstrate proper techniques for splinting hands
and fingers, the humerus (upper arm), and the tibia or fibula (lower
leg).

Guidelines for placing and checking splints include:

 Support the injured area above and below the site of the injury,
including the joints.

 If possible, splint the injury in the position you find it.

 Don't try to realign bones or joints.

 After splinting, check for proper circulation (warmth, feeling,
color).

***Splinting***

*(Continued)*

![](media/image9.emf){width="7.958333333333333in"
height="2.9993055555555554in"}

**Figure IV-9. Cardboard Splint**

***Splinting***

*(Continued)*

![](media/image10.emf){width="2.834722222222222in"
height="3.9583333333333335in"}![](media/image11.emf){width="3.957638888888889in"
height="2.9993055555555554in"}

**Figure IV-10. Splinting Using A Towel Figure IV-11. Splinting Using A
Pillow**

***Splinting***

*(Continued)*

![](media/image12.emf){width="7.958333333333333in"
height="2.9993055555555554in"}

**Figure IV-12. Splinting Using A Board**

**NOTE:** Fill in gaps between limbs with soft materials.

***Treating Hypothermia***

Hypothermia is a condition that occurs when the body temperature drops
below normal. Hypothermia may be brought on by exposure to cold air or
water or, especially in older people, inadequate food combined with
inadequate clothing and/or heat. The primary signs and symptoms of
hypothermia are:

 A body temperature of 95^^ Fahrenheit (37^^ Celsius) or less.

 Redness or blueness of the skin.

 Numbness accompanied by shivering.

In later stages, hypothermia will be accompanied by slurred speech,
unpredictable behavior, and/or listlessness.

Because hypothermia can set in within only a few minutes, victims who
have been rescued from cold air or water environments should always be
treated for hypothermia. To treat for hypothermia:

 Remove wet clothing, and wrap the victim in a blanket or sleeping bag
covering the head and neck.

 Protect the victim against the weather.

 If the victim is conscious, provide warm, sweet drinks and food. Do
*not* offer alcohol or massage.

 If the victim is unconscious, place him or her in the recovery
position.

 When possible and only when the victim is conscious, place the victim
in a warm bath. Do not rewarm the victim too quickly.

Even when he or she appears to be fully recovered, do not allow the
victim to walk around. Do not move the victim outdoors without covering
the victim's head and face.

***Treating Frostbite***

Frostbite is caused by a constriction of the blood vessels in the
extremities as the body acts to maintain warmth to the vital organs.
Victims who have been exposed to freezing or below-freezing weather may
experience frostbite on exposed areas of skin, and on the extremities
even when they are covered. The main symptoms of frostbite include:

 Coldness, stiffness, and a "prickly" sensation. (As the area becomes
numb, all sensation will disappear.)

 Hardness of the skin.

 Bluish-white discoloration of the affected areas.

To treat victims for frostbite:

 Transport the victim to shelter as soon as possible.

 Remove clothing and jewelry from the affected areas.

 Warm the frostbitten areas with skin-to-skin contact. Do *not* warm
the area by placing the victim in front of a heat source. Do *not*
massage the affected areas.

 When warmth returns to the affected area, it may develop small blood
blisters. Do *not* break the blisters.

 If the frostbitten area is an extremity, elevate it above the level of
the chest to reduce pain and swelling.

***Public Health Considerations***

***Introduction***

When disaster victims are sheltered together for treatment, public
health becomes a concern. Measures must be taken, both by individual
medical workers and on a programmatic basis, to avoid the spread of
disease through proper hygiene, sanitation, and water purification.
Minimizing the spread of disease in the medical operation involves:

 Maintaining proper hygiene.

 Maintaining proper sanitation.

 Purifying water.

Your instructor may add to the guidance suggested in this section. If
so, be sure to take careful notes.

***Maintaining Hygiene***

Maintenance of proper hygiene is critical even under the makeshift
conditions encountered in a disaster. Careful attention must be paid to
hygiene throughout both triage and treatment to avoid contamination,
minimize the risk of infection, and minimize the risk of spreading
disease. Some steps that are central to maintaining hygiene include:

 Washing hands frequently with soap and water.

 Wearing latex gloves at all times.

 Changing gloves after examining and/or treating each patient. Under
extreme field conditions, use rubber gloves, sterilizing them between
victims by washing them in a bleach-and-water solution (1 part bleach to
10 parts water).

***Maintaining Hygiene** (Continued)*

 Wear a mask and goggles.

 Keeping dressings and bandages sterile.

 Avoiding contact with bodily fluids.

Hygiene considerations are an essential part of planning for disaster
medical operations and should be emphasized during exercises.

***Maintaining Sanitation***

Poor sanitation is a major cause of illness, disease, and death.
Maintain sanitary conditions during disaster medical operations by:

 Controlling the disposal of bacterial sources (e.g., latex gloves,
dressings, etc.).

 Putting waste products in plastic bags and burying them in a
designated, well-marked location.

 Burying human waste.

Again, proper sanitation measures should be included in planning and
exercise operations.

***Water Purification***

In the aftermath of a disaster, potable water is often not availableor
not available in the quantities required. If potable water supplies have
been exhausted or are otherwise not available, purify water for
drinking, cooking, and medical use by boiling (rolling boil for 10
minutes), using water purification tablets, or using unscented liquid
bleach (16 drops per gallon of water; 1 teaspoon per 5 gallons. After
adding bleach, shake or stir the water and let it stand 30 minutes
before drinking or other use.).

***Summary***

***Introduction***

Disaster medical operations are organized under the CERT Commander.
Within medical operations, there are five subfunctions:

 Triage

 Transport

 Treatment

 Morgue

 Supply

After completing triage, victims are sent to treatment areas for:

 Additional triage.

 Further assessment.

 Immediate first aid treatment.

***Conducting Head-To-Toe Assessments***

Head-to-toe assessments should be both verbal and hands-on. Always
perform head-to-toe assessments in the same way, beginning with the head
and moving toward the victim's feet.

When conducting head-to-toe assessments, look for anything that might
indicate an injury, including:

 Signs of shock.

 Excessive bleeding.

 Bruising or swelling.

 Severe pain.

 Disfigurement.

Always wear latex gloves during assessments and check your own hands for
signs of victim bleeding.

The main objective in treating suspected closed head, neck, or spinal
injuries is to not cause additional injury. Treat any suspected closed
head, neck, or spinal injury as if it were such an injury by using
in-line stabilization.

***Establishing Treatment Areas***

Treatment areas must be established as soon as casualties are confirmed
and should be:

 In a safe area, free of hazards and debris.

 Close to, but upwind and uphill from, the hazard zone(s).

 Accessible by transportation vehicles, such as ambulances, trucks, and
helicopters.

 Able to grow.

The treatment area must be clearly delineated. Activities there must be
well organized and thoroughly documented.

***Treating Burns***

Burns are classified as first-, second-, or third-degree depending on
severity and the depth of skin layers affected. Treatment for burns
involves removing the source of the burn, cooling the burn, and covering
it. Do *not* use ice or apply antiseptics or ointments to a burn, and do
*not* remove shreds of tissue or break blisters. For third-degree burns,
always treat for shock.

***Wound Care***

The main emergency treatment for wounds consists of controlling
bleeding, cleaning, and bandaging. Clean the wound with soap and water.
Then apply a dressing on the wound area and secure with a bandage. In
the absence of active bleeding, dressings must be removed and the wound
checked at least every 4 to 6 hours. If there is active bleeding, a new
dressing should be placed [over]{.underline} the existing dressing, and
pressure and elevation should be maintained.

***Treating Fractures, Sprains, And Strains***

Fractures, sprains, and strains may have similar signs, and exact
diagnosis may not be possible without x-rays or other diagnostic
measures. Treat fractures, sprains, and strains by immobilizing the
affected area using a splint.

Splints can be made from soft or rigid materials, depending on what is
available in the immediate treatment area. In some cases, splints may be
made by binding two fingers or legs together in several places to
immobilize them.

***Public Health Considerations***

Public health is always a concern in the aftermath of a disaster event.
To safeguard public health, take measures to maintain proper hygiene and
sanitation and purify water as necessary. All three measures should be
thoroughly planned in advance and practiced during disaster exercises.

***Preparing For Disaster Medical Operations***

In these lessons you have learned some basic lifesaving and first aid
techniques to be used in disaster medical operations. This training is
only a first step. There is much that cannot be covered within the time
constraints of this course. You can enhance your effectiveness as an
emergency response team member through practice and continuing
education.

 *Practice.* Disaster response teams must work effectively as a team,
and each person must know and be comfortable with his or her role. Plan
to participate in refresher course simulations as often as they are
offered.

 *Continuing Education.* First aid training is an area in which
everyone should have a solid foundation of knowledge and skills. This is
especially true of disaster workers. To continue developing into an
effective rescuer, you should seek supplemental training in skills
related to disaster medical operations. Many classes such as Standard
and Advanced First Aid, CPR, and Emergency Medical Technician training
are available at local American Red Cross chapters and community
colleges.

***Assignment***

Before the next session:

 Read and become familiar with Chapter V: Light Search And Rescue
Operations.

***Assignment*** *(Continued)*

Obtain the following search and rescue safety equipment. Be sure all
items have been acquired in time for Session VII.

 Helmet or hardhat

 Goggles

 Leather work gloves

 Sturdy work shoes (preferably steel-toed)

 Clothing appropriate for expected weather conditions (e.g., rain or
cold)

 Dust mask

 Whistle (e.g., Clog rescue whistle)

***Additional Reading***

The references below are available if you would like to know more about
the information in this chapter.

California Specialized Training Institute. [Disaster Medical
Operations]{.underline}. Sacramento, CA: Office Of The State Fire
Marshal, 1987.

Grant, Murry Jr., Bergeron, Brady. [Brady Emergency Care]{.underline},
Fifth Edition. Prentice Hall, Englewood Cliffs, NJ: 1990.

Heckman, James D. (Ed.). [Emergency Care And Transportation Of The Sick
And Injured]{.underline}, Fifth Edition. American Academy of Orthopaedic
Surgeons, Park Ridge, IL: 1992.

[Reader's Digest Action Guide: What To Do In An Emergency]{.underline}.
Reader's Digest Association, Pleasantville, NY: 1988.

U.S. Department Of Mine Safety. [First Aid]{.underline}. U.S. Government
Printing Office, Washington, DC: 1986.

U.S. Department Of The Navy. [Self-Care/Buddy-Care]{.underline}. U.S.
Government Printing Office, Washington, DC: 1988.

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  The American Red Cross also provides resources on this subject. Contact
  your local chapter for information.

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