[Unit 4: Disaster Medical Operations---Part 2]{.smallcaps}

In this unit you will learn about:

-   **Public Health Considerations:** How to maintain hygiene and
    sanitation.

-   **Functions of Disaster Medical Operations:** How to conduct the
    four major subfunctions of disaster medical operations.

-   **Disaster Medical Treatment Areas:** How to establish them and what
    their functions are.

-   **Patient Evaluation:** How to perform a head-to-toe patient
    evaluation to identify and treat injuries.

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-   **Basic Treatment---How To:**

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```
-   Treat burns.

-   Dress and bandage wounds.

-   Treat fractures, dislocations, sprains, and strains.

-   Apply splints to hands, arms, and legs.

-   Treat hypothermia.

-   Control nasal bleeding.

# Unit 4: Disaster Medical Operations---Part 2

+-----------------------------------------------------------------------+
| # Introduction and Unit Overview                                      |
+-----------------------------------------------------------------------+
| This unit will cover:                                                 |
|                                                                       |
| -   Public health concerns related to sanitation, hygiene, and water  |
|     purification.                                                     |
|                                                                       |
| -   Organization of disaster medical operations.                      |
|                                                                       |
| -   Establishing treatment areas.                                     |
|                                                                       |
| -   Conducting head-to-toe assessments.                               |
|                                                                       |
| -   Treating wounds, fractures, sprains, and other common injuries.   |
+-----------------------------------------------------------------------+
| ## Objectives                                                         |
+-----------------------------------------------------------------------+
| At the end of this unit, you should be able to:                       |
|                                                                       |
| -   Take appropriate sanitation measures to protect the public        |
|     health.                                                           |
|                                                                       |
| -   Perform head-to-toe patient assessments.                          |
|                                                                       |
| -   Establish a treatment area.                                       |
|                                                                       |
| -   Apply splints to suspected fractures and sprains, and employ      |
|     basic treatments for other wounds.                                |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Public Health Considerations                                        |
+-----------------------------------------------------------------------+
| When disaster victims are sheltered together for treatment, public    |
| health becomes a concern. Measures must be taken, both by CERT        |
| members and programmatically, to avoid the spread of disease.         |
+-----------------------------------------------------------------------+
| The primary public health measures include:                           |
|                                                                       |
| -   Maintaining proper hygiene.                                       |
|                                                                       |
| -   Maintaining proper sanitation.                                    |
|                                                                       |
| -   Purifying water (if necessary).                                   |
+-----------------------------------------------------------------------+
| ## Maintaining Hygiene                                                |
+-----------------------------------------------------------------------+
| Maintenance of proper hygiene is critical even under makeshift        |
| conditions.                                                           |
+-----------------------------------------------------------------------+
| Some steps that individual workers can take to maintain hygiene are   |
| to:                                                                   |
|                                                                       |
| -   [Wash hands frequently]{.underline} using soap and water. Hand    |
|     washing should be thorough (at least 12 to 15 seconds) with an    |
|     antibacterial scrub if possible.                                  |
|                                                                       |
| -   [Wear latex gloves at all times]{.underline}. Change or disinfect |
|     gloves after examining and/or treating each patient. As explained |
|     earlier, under field conditions, workers can use rubber gloves    |
|     that are sterilized between treating victims using bleach and     |
|     water (1 part bleach to 10 parts water).                          |
|                                                                       |
| -   [Wear a mask and goggles]{.underline}. If possible, wear a mask   |
|     that is rated "N95."                                              |
|                                                                       |
| -   [Keep dressings sterile]{.underline}. Do not remove the overwrap  |
|     from dressings and bandages until use. After opening, use the     |
|     entire dressing or bandage, if possible.                          |
|                                                                       |
| -   [Avoid contact with body fluids]{.underline}. Thoroughly wash     |
|     areas that come in contact with body fluids with soap and water   |
|     or diluted bleach as soon as possible.                            |
+-----------------------------------------------------------------------+
| ## Maintaining Sanitation                                             |
+-----------------------------------------------------------------------+
| Poor sanitation is also a major cause of illness, disease, and death. |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Public Health Considerations (Continued)                            |
+-----------------------------------------------------------------------+
| CERT medical operations personnel can maintain sanitary conditions    |
| by:                                                                   |
|                                                                       |
| -   Controlling the disposal of bacterial sources (e.g., latex        |
|     gloves, dressings, etc.).                                         |
|                                                                       |
| -   Putting waste products in plastic bags, tying off the bags, and   |
|     marking them as medical waste. Keep medical waste separate from   |
|     other trash, and dispose of it as hazardous waste.                |
|                                                                       |
| -   Burying human waste.                                              |
+-----------------------------------------------------------------------+
| ## Water Purification                                                 |
+-----------------------------------------------------------------------+
| Potable water supplies are often in short supply or are not available |
| in a disaster. Purify water for drinking, cooking, and medical use by |
| heating it to a rolling boil for 1 minute, or by using water          |
| purification tablets or unscented liquid bleach.                      |
+-----------------------------------------------------------------------+
| Rescuers should not put anything on wounds other than purified water. |
| The use of other solutions (e.g., hydrogen peroxide) on wounds must   |
| be the decision of trained medical personnel.                         |
+-----------------------------------------------------------------------+
| CERT members [must use latex gloves, goggles, and a mask during all   |
| medical operations]{.underline}, and they must cover all open wounds  |
| as a way of preventing the spread of disease.                         |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Functions of Disaster Medical Operations                            |
+-----------------------------------------------------------------------+
| There are four major subfunctions of disaster medical operations:     |
|                                                                       |
| -   [Triage]{.underline}: The initial assessment and sorting of       |
|     victims for treatment based on the severity of their injuries     |
|                                                                       |
| -   [Treatment]{.underline}: The area in which disaster medical       |
|     services are provided to victims                                  |
|                                                                       |
| -   [Transport]{.underline}: The movement of victims from the triage  |
|     area to the treatment area. If professional help will be delayed, |
|     for efficiency of operations, victims can be transported to the   |
|     treatment area by CERT members                                    |
+-----------------------------------------------------------------------+
| -   [Morgue]{.underline}: The temporary holding area for victims who  |
|     have died as a result of their injuries                           |
+-----------------------------------------------------------------------+
| ![](media/image1.wmf){width="4.329861111111111in"                     |
| height="2.0416666666666665in"}                                        |
|                                                                       |
| ######### Disaster Medical Operations Organization                    |
|                                                                       |
| **Disaster Medical Operations Organization, showing the subfunctions  |
| of disaster medical operations: Transport, Treatment, Morgue, and     |
| Supply.**                                                             |
|                                                                       |
| \* Note that triage is organized under search and rescue.             |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Functions of Disaster Medical Operations (Continued)                |
+-----------------------------------------------------------------------+
| ![](media/image2.wmf){width="3.107638888888889in"                     |
| height="2.821527777777778in"}                                         |
|                                                                       |
| ######### Patient Flowchart                                           |
|                                                                       |
| **Patient Flowchart, which shows how the patients are rescued,        |
| triaged, and sent to the medical treatment areas according to the     |
| extent of their injuries ("I," "D," or "Dead").**                     |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Establishing Treatment Areas                                        |
+-----------------------------------------------------------------------+
| Because time is critical during an emergency, CERT medical operations |
| personnel will need to select a site and set up a treatment area as   |
| soon as injured victims 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 (ambulances, trucks,        |
|     helicopters, etc.).                                               |
|                                                                       |
| -   Expandable.                                                       |
+-----------------------------------------------------------------------+
| ![](media/image3.wmf){width="4.923611111111111in"                     |
| height="1.6159722222222221in"}                                        |
|                                                                       |
| ######### Treatment Area Site Selection                               |
|                                                                       |
| **Treatment Area Site Selection, uphill and upwind from hazard.**     |
+-----------------------------------------------------------------------+
| ## 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.               |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Establishing Treatment Areas (Continued)                            |
+-----------------------------------------------------------------------+
| A clearly marked treatment area will help in transporting victims to  |
| the correct location.                                                 |
|                                                                       |
| Patients in the treatment area should be positioned in a head-to-toe  |
| configuration, with two to three feet between victims.                |
+-----------------------------------------------------------------------+
| ![](media/image4.wmf){width="5.9631944444444445in"                    |
| height="2.5034722222222223in"}                                        |
|                                                                       |
| ######### Treatment Area Layout                                       |
|                                                                       |
| **Treatment Area Layout, showing the organization for the incident    |
| site, triage, communications, transportation, and morgue.**           |
+-----------------------------------------------------------------------+
| This system will provide:                                             |
|                                                                       |
| -   Effective use of space.                                           |
|                                                                       |
| -   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.)                                             |
+-----------------------------------------------------------------------+
| ## Treatment Area Organization                                        |
+-----------------------------------------------------------------------+
| The CERT team must assign leaders to maintain control in each of the  |
| medical treatment areas. These leaders will:                          |
|                                                                       |
| -   Ensure orderly victim placement.                                  |
|                                                                       |
| -   Direct assistants to conduct head-to-toe assessments.             |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Establishing Treatment Areas (Continued)                            |
+-----------------------------------------------------------------------+
| Thoroughly document victims in the treatment area, including:         |
|                                                                       |
| -   Available identifying information.                                |
|                                                                       |
| -   Description (age, sex, body build, height, weight).               |
|                                                                       |
| -   Clothing.                                                         |
|                                                                       |
| -   Injuries.                                                         |
|                                                                       |
| -   Treatment.                                                        |
|                                                                       |
| -   Transfer location.                                                |
+-----------------------------------------------------------------------+
| ## Treatment Area Planning                                            |
+-----------------------------------------------------------------------+
| Remember to plan before disaster strikes, including:                  |
|                                                                       |
| -   Roles of personnel assigned to the treatment area.                |
|                                                                       |
| -   Availability of setup equipment needed, such as ground            |
|     covers/tarps and signs for identifying divisions (immediate,      |
|     delayed, morgue).                                                 |
+-----------------------------------------------------------------------+
| Take part in practice exercises so that you can develop a good        |
| operational plan and practice rapid treatment area setup.             |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Conducting Head-to-Toe Assessments                                  |
+-----------------------------------------------------------------------+
| The first steps that you will take when working with a victim will be |
| to conduct a triage and rapid treatment. After all victims in an area |
| have been triaged CERT members will begin a thorough head-to-toe      |
| assessment of the victim's condition.                                 |
+-----------------------------------------------------------------------+
| During triage, you looked for "the killers."                          |
|                                                                       |
| -   Airway obstruction.                                               |
|                                                                       |
| -   Excessive bleeding.                                               |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Signs of shock.                                                   |
+-----------------------------------------------------------------------+
| A head-to-toe assessment goes beyond the "killers" to try to gain     |
| more information to determine the nature of the victim's injury.      |
| During a head-to-toe assessment, look for the following:              |
|                                                                       |
| -   Bruising.                                                         |
|                                                                       |
| -   Swelling.                                                         |
|                                                                       |
| -   Severe pain.                                                      |
|                                                                       |
| -   Disfigurement.                                                    |
+-----------------------------------------------------------------------+
| A head-to-toe assessment can be done in place in a lightly damaged    |
| building. If the building is moderately damaged, the victim should be |
| moved to a safe zone or to the treatment area for the head-to-toe     |
| assessment.                                                           |
+-----------------------------------------------------------------------+
| The objectives of a head-to-toe assessment are to:                    |
|                                                                       |
| -   Determine, as clearly as possible, the extent of injuries.        |
|                                                                       |
| -   Determine what type of treatment is needed.                       |
|                                                                       |
| -   Document injuries.                                                |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Conducting Head-to-Toe Assessments (Continued)                      |
+-----------------------------------------------------------------------+
| Wear safety equipment when conducting head-to-toe assessments.        |
|                                                                       |
| Head-to-toe assessments should be:                                    |
|                                                                       |
| -   Conducted on all victims, even those who seem alright. Everyone   |
|     gets a tag.                                                       |
|                                                                       |
| -   Verbal (if the patient is able to speak).                         |
|                                                                       |
| -   Hands-on.                                                         |
+-----------------------------------------------------------------------+
| Whenever possible, you should ask the person about any injuries,      |
| pain, bleeding, or other symptoms. If the victim is conscious, CERT   |
| members should always ask permission to conduct the assessment. The   |
| victim has the right to refuse treatment. Then:                       |
|                                                                       |
| -   Pay careful attention.                                            |
|                                                                       |
| -   Look, listen, and feel for anything unusual.                      |
+-----------------------------------------------------------------------+
| Conduct head-to-toe assessments systematically, checking body parts   |
| from the top to the bottom for continuity of bones and soft tissue    |
| injuries in the following order:                                      |
|                                                                       |
| 1.  Head                                                              |
|                                                                       |
| 2.  Neck                                                              |
|                                                                       |
| 3.  Shoulders                                                         |
|                                                                       |
| 4.  Chest                                                             |
|                                                                       |
| 5.  Arms                                                              |
|                                                                       |
| 6.  Abdomen                                                           |
|                                                                       |
| 7.  Pelvis                                                            |
|                                                                       |
| 8.  Legs                                                              |
|                                                                       |
| 9.  Back                                                              |
+-----------------------------------------------------------------------+
| Completing the assessment in the same way every time will make the    |
| procedure quicker and more accurate.                                  |
|                                                                       |
| Check your own hands for patient bleeding as you complete the         |
| head-to-toe assessment.                                               |
|                                                                       |
| Perform an entire assessment before beginning any treatment. Also,    |
| treat all unconscious victims as if they have a spinal injury.        |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Conducting Head-to-Toe Assessments (Continued)                      |
+-----------------------------------------------------------------------+
| ## Closed-Head, Neck, and Spinal Injuries                             |
+-----------------------------------------------------------------------+
| When conducting head-to-toe assessments, rescuers may come across     |
| victims who have or may have suffered closed-head, neck, or spinal    |
| injuries.                                                             |
+-----------------------------------------------------------------------+
| The main objective when CERT members encounter suspected injuries to  |
| the head or spine is to [do no harm]{.underline}. You should minimize |
| movement of the head and spine, while treating any other              |
| life-threatening conditions.                                          |
+-----------------------------------------------------------------------+
| The signs of a closed-head, neck, or spinal injury most often         |
| include:                                                              |
|                                                                       |
| -   Change in consciousness.                                          |
|                                                                       |
| -   Inability to move one or more body parts.                         |
|                                                                       |
| -   Severe pain or pressure in the head, neck, or back.               |
|                                                                       |
| -   Tingling or numbness in extremities.                              |
|                                                                       |
| -   Difficulty breathing or seeing.                                   |
|                                                                       |
| -   Heavy bleeding, bruising, or deformity of the head or spine.      |
|                                                                       |
| -   Blood or fluid in the nose or ears.                               |
|                                                                       |
| -   Bruising behind the ear.                                          |
+-----------------------------------------------------------------------+
| -   "Raccoon" eyes (bruising around eyes).                            |
|                                                                       |
| -   "Uneven" pupils.                                                  |
|                                                                       |
| -   Seizures.                                                         |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Nausea or vomiting.                                               |
|                                                                       |
| -   Victim found under collapsed building material or heavy debris.   |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Conducting Head-to-Toe Assessments (Continued)                      |
+-----------------------------------------------------------------------+
| If the victim is exhibiting any of these signs, he or she should be   |
| treated as having a closed-head, neck, or spinal injury.              |
|                                                                       |
| Keep the spine in a straight line when doing the head-to-toe          |
| assessment.                                                           |
+-----------------------------------------------------------------------+
| In an extreme emergency, ideal equipment is rarely available, so the  |
| CERT members may need to be creative by:                              |
|                                                                       |
| -   Looking for materials that can be used as a backboard---a door,   |
|     desktop, building materials---anything that might be available.   |
|                                                                       |
| -   Looking for items that can be used to stabilize the head on the   |
|     board---towels, draperies, or sandbags---by tucking them snugly   |
|     on either side of the head to immobilize it.                      |
+-----------------------------------------------------------------------+
| ## Exercise: Conducting Head-to-Toe Assessments                       |
+-----------------------------------------------------------------------+
| **[Purpose]{.underline}:** This exercise allows you to practice       |
| conducting head-to-toe assessments.                                   |
|                                                                       |
| **[Instructions]{.underline}:** Follow the steps below to complete    |
| this exercise:                                                        |
|                                                                       |
| 1.  Work in two-person teams of victim and rescuer.                   |
|                                                                       |
| 2.  Victims should lie on the floor on their backs and close their    |
|     eyes.                                                             |
|                                                                       |
| 3.  The rescuer should conduct a head-to-toe assessment on the victim |
|     following the procedure demonstrated earlier.                     |
+-----------------------------------------------------------------------+
| 4.  After the rescuer has made at least two observed head-to-toe      |
|     assessments, the victim and rescuer should change roles.          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Treating Burns                                                      |
+-----------------------------------------------------------------------+
| The objectives of first aid treatment for burns are to:               |
|                                                                       |
| -   Cool the burned area.                                             |
|                                                                       |
| -   Cover with a sterile cloth to reduce the risk of infection (by    |
|     keeping fluids in and germs out).                                 |
+-----------------------------------------------------------------------+
| Burns may be caused by heat, chemicals, electrical current, and       |
| radiation. The severity of a burn depends on the:                     |
|                                                                       |
| -   Temperature of the burning agent.                                 |
|                                                                       |
| -   Period of time that the victim was exposed.                       |
|                                                                       |
| -   Area of the body that was affected.                               |
|                                                                       |
| -   Size of the area burned.                                          |
|                                                                       |
| -   Depth of the burn.                                                |
+-----------------------------------------------------------------------+
| ## Burn Classifications                                               |
+-----------------------------------------------------------------------+
| The skin has three layers:                                            |
|                                                                       |
| -   The [epidermis]{.underline}, or outer layer of skin, contains     |
|     nerve endings and is penetrated by hairs.                         |
|                                                                       |
| -   The [dermis]{.underline}, or middle layer of skin, contains blood |
|     vessels, oil glands, hair follicles, and sweat glands.            |
|                                                                       |
| -   The [subcutaneous layer]{.underline}, or innermost layer,         |
|     contains blood vessels and overlies the muscle and skin cells.    |
+-----------------------------------------------------------------------+
| Depending on the severity, burns may affect all three layers of skin. |
+-----------------------------------------------------------------------+
| Burns are classified as first, second, or third degree depending on   |
| their severity.                                                       |
+-----------------------------------------------------------------------+

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

+-----------------------------------------------------------------------+
| Guidelines for treating burns include:                                |
|                                                                       |
| -   Removing the victim from the burning source. Put out any flames   |
|     and remove smoldering clothing unless it is stuck to the skin.    |
|                                                                       |
| -   Cooling skin or clothing, if they are still hot, by immersing     |
|     them in cool water for [not more]{.underline} than 1 minute or    |
|     covering with clean compresses that have been wrung out in cool   |
|     water. Cooling sources include water from the bathroom or         |
|     kitchen; garden hose; and soaked towels, sheets, or other cloths. |
|     Treat all victims of third-degree burns for shock.                |
+-----------------------------------------------------------------------+
| -   Covering loosely with dry (or moist, based on local protocols),   |
|     sterile dressings to keep air out and prevent infection.          |
|                                                                       |
| -   Elevating burned extremities higher than the heart.               |
|                                                                       |
| -   [Do not]{.underline} use ice. Ice causes vessel constriction.     |
|                                                                       |
| -   [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.)                                                 |
+-----------------------------------------------------------------------+
| Infants, young children, and older persons, and persons with severe   |
| burns, are more susceptible to hypothermia. Therefore, rescuers       |
| should use caution when applying cool dressings on such persons. A    |
| rule of thumb is do not cool more than 15 percent of the body surface |
| area (the size of one arm) at once, to prevent hypothermia.           |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Treating Burns (Continued)                                          |
+-----------------------------------------------------------------------+
| In the next section, you will learn to treat other injuries that are  |
| common after disasters:                                               |
|                                                                       |
| -   Lacerations                                                       |
|                                                                       |
| -   Amputations and impaled objects                                   |
|                                                                       |
| -   Fractures, dislocations, sprains, and strains                     |
|                                                                       |
| -   Nasal injuries                                                    |
|                                                                       |
| -   Hypothermia                                                       |
+-----------------------------------------------------------------------+
| # Wound Care                                                          |
+-----------------------------------------------------------------------+
| This section will focus on cleaning and bandaging to control          |
| infection:                                                            |
|                                                                       |
| The objectives of treatment for wounds are to:                        |
|                                                                       |
| -   Control bleeding.                                                 |
|                                                                       |
| -   Prevent secondary infection.                                      |
|                                                                       |
| The focus of this section is on cleaning and bandaging, which will    |
| help to control infection.                                            |
+-----------------------------------------------------------------------+
| Wounds should be cleaned by irrigating with water, flushing with a    |
| mild concentration of soap and water, then irrigating with water      |
| again.                                                                |
+-----------------------------------------------------------------------+
| You should [not]{.underline} scrub the wound. A bulb syringe is       |
| useful for irrigating wounds. In a disaster, a turkey baster may also |
| be used.                                                              |
|                                                                       |
| When the wound is thoroughly cleaned, you will need to apply a        |
| dressing and bandage to help keep it clean and control bleeding.      |
+-----------------------------------------------------------------------+
| The difference between a dressing and a bandage is that:              |
|                                                                       |
| -   A dressing is applied directly to the wound.                      |
|                                                                       |
| -   A bandage holds the dressing in place.                            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Wound Care (Continued)                                              |
+-----------------------------------------------------------------------+
| If a wound is still bleeding, the bandage should place enough         |
| pressure on the wound to help control bleeding without interfering    |
| with circulation.                                                     |
+-----------------------------------------------------------------------+
| Follow these rules:                                                   |
|                                                                       |
| 1.  In the absence of active bleeding, dressings must be removed and  |
|     the wound must be 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 from the wound.                                         |
|                                                                       |
| -   Red striations from the wound site.                               |
|                                                                       |
| 2.  If there is active bleeding (i.e., if the dressing is soaked with |
|     blood), redress [over]{.underline} the existing dressing and      |
|     maintain pressure and elevation to control bleeding.              |
|                                                                       |
| If necessary based on reassessment and signs of infection, change the |
| treatment priority.                                                   |
+-----------------------------------------------------------------------+
| ## Amputations                                                        |
+-----------------------------------------------------------------------+
| The main treatments for an amputation (the traumatic severing of a    |
| limb or other body part) are to:                                      |
|                                                                       |
| -   Control bleeding.                                                 |
|                                                                       |
| -   Treat shock.                                                      |
+-----------------------------------------------------------------------+
| When the severed body part can be located, CERT members should:       |
|                                                                       |
| -   Save tissue parts, wrapped in clean material and placed in a      |
|     plastic bag, if available.                                        |
|                                                                       |
| -   Keep the tissue parts cool.                                       |
|                                                                       |
| -   Keep the severed part with the victim.                            |
+-----------------------------------------------------------------------+
| ## Impaled Objects                                                    |
+-----------------------------------------------------------------------+
| You may also encounter some victims who have foreign objects lodged   |
| in their bodies---usually as the result of flying debris during the   |
| disaster.                                                             |
|                                                                       |
| When a foreign object is impaled in a patient's body, you should:     |
|                                                                       |
| -   Immobilize the affected body part.                                |
|                                                                       |
| -   [Not]{.underline} attempt to move or remove the object unless it  |
|     is obstructing the airway.                                        |
+-----------------------------------------------------------------------+

+-----------------------------------+-----------------------------------+
| # Wound Care (Continued)          |                                   |
+-----------------------------------+-----------------------------------+
| -   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, D           |                                   |
| islocations, Sprains, and Strains |                                   |
+-----------------------------------+-----------------------------------+
| The objective when treating a     |                                   |
| suspected fracture, sprain, or    |                                   |
| strain is to immobilize the       |                                   |
| injury and the joints immediately |                                   |
| above and below the injury site.  |                                   |
|                                   |                                   |
| Because it is difficult to        |                                   |
| distinguish among fractures,      |                                   |
| sprains, or strains, if uncertain |                                   |
| of the type of injury, CERT       |                                   |
| members should treat the injury   |                                   |
| as a fracture.                    |                                   |
+-----------------------------------+-----------------------------------+
| ## Fractures                      |                                   |
+-----------------------------------+-----------------------------------+
| A fracture is a complete break, a |                                   |
| chip, or a crack in a bone. There |                                   |
| are several types of fractures:   |                                   |
+-----------------------------------+-----------------------------------+
| -   A [closed                     |                                   |
|     fracture]{.underline} is a    |                                   |
|     broken bone with no           |                                   |
|     associated wound. First aid   |                                   |
|     treatment for closed          |                                   |
|     fractures may require only    |                                   |
|     splinting.                    |                                   |
|                                   |                                   |
| -   An [open                      |                                   |
|     fracture]{.underline} is a    |                                   |
|     broken bone with some kind of |                                   |
|     wound that allows             |                                   |
|     contaminants to enter into or |                                   |
|     around the fracture site.     |                                   |
+-----------------------------------+-----------------------------------+
| ![](media/image5.                 |                                   |
| wmf){width="0.7756944444444445in" |                                   |
| height="1.5381944444444444in"}    |                                   |
+-----------------------------------+-----------------------------------+
| **Closed Fracture**               | **Open Fracture**                 |
|                                   |                                   |
| **Closed Fracture in which the    | **Open Fracture in which the bone |
| fracture does not puncture the    | protrudes through the skin.**     |
| skin.**                           |                                   |
+-----------------------------------+-----------------------------------+
| Open fractures are more dangerous |                                   |
| because of the risk of severe     |                                   |
| bleeding and infection.           |                                   |
| Therefore, they are a higher      |                                   |
| priority and need to be checked   |                                   |
| more frequently.                  |                                   |
|                                   |                                   |
| When treating an open fracture:   |                                   |
|                                   |                                   |
| -   Do [not]{.underline} draw the |                                   |
|     exposed bone ends back into   |                                   |
|     the tissue.                   |                                   |
|                                   |                                   |
| ```{=html}                        |                                   |
| <!-- -->                          |                                   |
| ```                               |                                   |
| -   Do [not]{.underline} irrigate |                                   |
|     the wound.                    |                                   |
+-----------------------------------+-----------------------------------+

+-----------------------------------+-----------------------------------+
| #                                 |                                   |
| Treating Fractures, Dislocations, |                                   |
|  Sprains, and Strains (Continued) |                                   |
+-----------------------------------+-----------------------------------+
| You [should]{.underline}:         |                                   |
|                                   |                                   |
| -   Cover the wound with a        |                                   |
|     sterile dressing.             |                                   |
|                                   |                                   |
| -   Splint the fracture without   |                                   |
|     disturbing the wound.         |                                   |
|                                   |                                   |
| -   Place a moist 4\" x 4\"       |                                   |
|     dressing over the bone end to |                                   |
|     keep it from drying out.      |                                   |
+-----------------------------------+-----------------------------------+
| Displaced fractures may be        |                                   |
| described by the degree of        |                                   |
| displacement of the bone          |                                   |
| fragments. If the limb is angled, |                                   |
| then there is a [displaced        |                                   |
| fracture]{.underline}.            |                                   |
|                                   |                                   |
| [Nondisplaced                     |                                   |
| fractures]{.underline} are        |                                   |
| difficult to identify, with the   |                                   |
| main signs being pain and         |                                   |
| swelling. Treat a suspected       |                                   |
| fracture as a fracture until      |                                   |
| professional treatment is         |                                   |
| available.                        |                                   |
+-----------------------------------+-----------------------------------+
| ![](media/image7.                 |                                   |
| wmf){width="1.0576388888888888in" |                                   |
| height="1.9166666666666667in"}    |                                   |
+-----------------------------------+-----------------------------------+
| **Displaced Fracture**            | **Nondisplaced Fracture**         |
|                                   |                                   |
| **Displaced fracture in which the | **Nondisplaced fracture, in which |
| fractured bone is no longer       | the fractured bone remains        |
| aligned.**                        | aligned.**                        |
+-----------------------------------+-----------------------------------+
| ## Dislocations                   |                                   |
+-----------------------------------+-----------------------------------+
| Dislocations are another common   |                                   |
| injury in emergencies.            |                                   |
|                                   |                                   |
| A dislocation is an injury to the |                                   |
| ligaments around a joint that is  |                                   |
| so severe that it permits a       |                                   |
| separation of the bone from its   |                                   |
| normal position in a joint.       |                                   |
|                                   |                                   |
| The signs of a dislocation are    |                                   |
| similar to those of a fracture,   |                                   |
| and a suspected dislocation       |                                   |
| should be treated like a          |                                   |
| fracture.                         |                                   |
|                                   |                                   |
| You should [not]{.underline} try  |                                   |
| to relocate a suspected           |                                   |
| dislocation. Immobilize the joint |                                   |
| until professional medical help   |                                   |
| is available.                     |                                   |
+-----------------------------------+-----------------------------------+

+-----------------------------------------------------------------------+
| # Treating Fractures, Dislocations, Sprains, and Strains (Continued)  |
+-----------------------------------------------------------------------+
| ## Sprains and Strains                                                |
+-----------------------------------------------------------------------+
| A sprain involves a stretching or tearing of ligaments at a joint and |
| is usually caused by stretching or extending the joint beyond its     |
| normal limits.                                                        |
|                                                                       |
| A sprain is considered a partial dislocation, although the bone       |
| either remains in place or is able to fall back into place after the  |
| injury.                                                               |
+-----------------------------------------------------------------------+
| The most common signs of a sprain are:                                |
|                                                                       |
| -   Tenderness at the site of the injury.                             |
|                                                                       |
| -   Swelling and/or bruising.                                         |
|                                                                       |
| -   Restricted use, or loss of use.                                   |
+-----------------------------------------------------------------------+
| The signs of a sprain are similar to those of a nondisplaced          |
| fracture. Therefore, do [not]{.underline} try to treat the injury     |
| other than by immobilization and elevation.                           |
|                                                                       |
| A strain involves a stretching and/or tearing of muscles or tendons.  |
| Strains most often involve the muscles in the neck, back, thigh, or   |
| calf.                                                                 |
|                                                                       |
| In some cases, strains may be difficult to distinguish from sprains   |
| or fractures. When uncertain whether an injury is a strain, sprain,   |
| or fracture, treat the injury as if it is a fracture.                 |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Splinting                                                           |
+-----------------------------------------------------------------------+
| Splinting is the most common procedure for immobilizing an injury.    |
|                                                                       |
| Cardboard is the material typically used for "makeshift" splints but  |
| a variety of materials can be used, including:                        |
|                                                                       |
| -   [Soft materials]{.underline}. Towels, blankets, or pillows, tied  |
|     with bandaging materials or soft cloths.                          |
|                                                                       |
| -   [Rigid materials]{.underline}. A board, metal strip, folded       |
|     magazine or newspaper, or other rigid item.                       |
|                                                                       |
| [Anatomical splints]{.underline} may also be created by securing a    |
| fractured bone to an adjacent unfractured bone. Anatomical splints    |
| are usually reserved for fingers and toes but, in an emergency, legs  |
| may also be splinted together.                                        |
+-----------------------------------------------------------------------+
| ![](media/image9.wmf){width="2.1486111111111112in"                    |
| height="2.247916666666667in"}                                         |
|                                                                       |
| **Cardboard** **Splint**                                              |
|                                                                       |
| **Cardboard Splint in which the edges of the cardboard are turned up  |
| to form a "mold" in which the injured limb can rest.**                |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Splinting (Continued)                                               |
+-----------------------------------------------------------------------+
| ![](media/image10.wmf){width="5.259027777777778in"                    |
| height="3.1333333333333333in"}                                        |
+-----------------------------------------------------------------------+
| ![](media/image11.png){width="4.44375in"                              |
| height="1.6736111111111112in"}                                        |
|                                                                       |
| **Splinting Using A Blanket**                                         |
|                                                                       |
| **Splinting using a blanket in which the victim's legs are            |
| immobilized by tying blankets at intervals from mid-thigh to feet.**  |
+-----------------------------------------------------------------------+
| The guidelines for splinting include:                                 |
|                                                                       |
| 1.  Support the injured area above and below the site of the injury,  |
|     including the joints.                                             |
|                                                                       |
| 2.  If possible, splint the injury in the position that you find it.  |
|                                                                       |
| 3.  Don't try to realign bones or joints.                             |
|                                                                       |
| 4.  After splinting, check for proper circulation (warmth, feeling,   |
|     and color).                                                       |
|                                                                       |
| 5.  Immobilize above and below the injury.                            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Splinting (Continued)                                               |
+-----------------------------------------------------------------------+
| With this type of injury, there will be swelling. You should remove   |
| restrictive clothing, shoes, and jewelry when necessary to prevent    |
| these items from acting as tourniquets.                               |
+-----------------------------------------------------------------------+
| ## Exercise: Splinting                                                |
+-----------------------------------------------------------------------+
| **[Purpose]{.underline}:** This exercise allows you to practice the   |
| procedures for splinting.                                             |
|                                                                       |
| **[Instructions]{.underline}:** Follow the steps below to complete    |
| this exercise:                                                        |
+-----------------------------------------------------------------------+
| 1.  Working in two-person teams, one person will be the victim and    |
|     one person will be the rescuer.                                   |
|                                                                       |
| 2.  Victims should lie on the floor on their backs or sit in a chair. |
|                                                                       |
| 3.  The rescuer should apply a splint on the victim's upper arm using |
|     the procedure demonstrated earlier. Then, the rescuer should      |
|     apply a splint to the victim's lower leg.                         |
|                                                                       |
| 4.  The victim and the rescuer should change roles.                   |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Nasal Injuries                                                      |
+-----------------------------------------------------------------------+
| Bleeding from the nose can be caused by:                              |
|                                                                       |
| -   Blunt force to the nose.                                          |
|                                                                       |
| -   Skull fracture.                                                   |
|                                                                       |
| -   Nontrauma-related conditions such as sinus infections, high blood |
|     pressure, and bleeding disorders.                                 |
|                                                                       |
| A large blood loss from a nosebleed can lead to shock. Actual blood   |
| loss may not be evident because the victim will swallow some amount   |
| of blood.                                                             |
|                                                                       |
| Victims who have swallowed large amounts of blood may become          |
| nauseated and vomit.                                                  |
|                                                                       |
| The methods for controlling nasal bleeding include:                   |
|                                                                       |
| -   Pinching the nostrils together.                                   |
|                                                                       |
| -   Putting pressure on the upper lip just under the nose.            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Nasal Injuries (Continued)                                          |
+-----------------------------------------------------------------------+
| While treating for nosebleeds, you should:                            |
|                                                                       |
| -   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.                                            |
|                                                                       |
| -   Ensure that the victim's airway remains open.                     |
|                                                                       |
| -   Keep the victim quiet. Anxiety will increase blood flow.          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Treating Hypothermia                                                |
+-----------------------------------------------------------------------+
| [Hypothermia]{.underline} is a condition that occurs when the body's  |
| temperature drops below normal.                                       |
|                                                                       |
| Hypothermia may be caused by exposure to cold air or water or by      |
| inadequate food combined with inadequate clothing and/or heat,        |
| especially in older people.                                           |
+-----------------------------------------------------------------------+
| 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.                                           |
|                                                                       |
| -   Listlessness.                                                     |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Treating Hypothermia                                                |
+-----------------------------------------------------------------------+
| Because hypothermia can set in within only a few minutes, you should  |
| treat victims who have been rescued from cold air or water            |
| environments by:                                                      |
|                                                                       |
| -   Removing wet clothing.                                            |
|                                                                       |
| -   Wrapping the victim in a blanket or sleeping bag and covering the |
|     head and neck.                                                    |
|                                                                       |
| -   Protecting the victim against the weather.                        |
|                                                                       |
| -   Providing warm, sweet drinks and food to conscious victims. [Do   |
|     not offer alcohol or massage]{.underline}.                        |
|                                                                       |
| -   Placing an unconscious victim in the recovery position.           |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Placing the victim in a warm bath if the victim is conscious.     |
|                                                                       |
| Do not to allow the victim to walk around even when he or she appears |
| to be fully recovered. If the victim must be moved outdoors, you      |
| should cover the victim's head and face.                              |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Unit Summary                                                        |
+-----------------------------------------------------------------------+
| To safeguard public health, take measures to maintain proper hygiene  |
| and sanitation, and purify water if necessary. All public health      |
| measures should be planned in advance and practiced during exercises. |
|                                                                       |
| Disaster medical operations includes four subfunctions:               |
|                                                                       |
| -   Triage                                                            |
|                                                                       |
| -   Treatment                                                         |
|                                                                       |
| -   Transport                                                         |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Morgue                                                            |
+-----------------------------------------------------------------------+
| Head-to-toe assessments should be verbal and hands-on. Always conduct |
| head-to-toe assessments in the same way---beginning with the head and |
| moving toward the feet. If injuries to the head, neck, or spine are   |
| suspected, the main objective is to not cause additional injury. Use  |
| in-line stabilization and a backboard if the victim must be moved.    |
|                                                                       |
| Treatment areas must be established as soon as casualties are         |
| confirmed. Treatment areas should be:                                 |
|                                                                       |
| -   In a safe area that is close to, but uphill and upwind from, the  |
|     hazard area.                                                      |
|                                                                       |
| -   Accessible by transportation vehicles.                            |
|                                                                       |
| -   Expandable.                                                       |
+-----------------------------------------------------------------------+
| Burns are classified as first, second, or third degree depending on   |
| severity and the depth of skin layers involved. Treatment for burns   |
| involves removing the source of the burn, cooling the burn, and       |
| covering it. For third-degree burns, always treat for shock.          |
|                                                                       |
| The main first aid treatment for wounds consists of:                  |
|                                                                       |
| -   Controlling bleeding.                                             |
|                                                                       |
| -   Cleaning.                                                         |
|                                                                       |
| -   Dressing and bandaging.                                           |
|                                                                       |
| > In the absence of active bleeding, dressings must be removed and    |
| > the wound checked for infection at least every 4 to 6 hours. If     |
| > there is active bleeding, a new dressing should be placed           |
| > [over]{.underline} the existing dressing.                           |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Unit Summary (Continued)                                            |
+-----------------------------------------------------------------------+
| Fractures, sprains, and strains may have similar signs, and diagnosis |
| may not be possible under disaster conditions. Treat suspected        |
| fractures, sprains, and strains by immobilizing the affected area     |
| using a splint.                                                       |
+-----------------------------------------------------------------------+
| ## Homework Assignment                                                |
+-----------------------------------------------------------------------+
| Read and familiarize yourself with Unit 5: Light Search and Rescue    |
| Operations before the next session.                                   |
|                                                                       |
| Obtain a blanket for use during Unit 5.                               |
+-----------------------------------------------------------------------+