Review of Key Concepts-Response Stages

-Response Tasks

Response Stages

• Recognition Stage

• Response Stage

• Intervention Stage

• Recovery Stage

Key Response Tasks

• Assessment• Personal Protection• Control of Situation• Casualty Management• Communication• Call for Additional Resources

Assessment

• Recognize was the expectation at the Basic Level

• Analyze and intervention is the expectation at the Intermediate Level

Personal Protection

• At the Basic Level we avoided rushing in, remained uphill and upwind and avoided contact with contaminated victims

• At the Intermediate Level we will make carefully considered entry, and decontaminate and treat contaminated victims

Personal Protection

Level A – Fully Encapsulating Air Tight – SCBA insideLevel B – Splash Protection with SCBALevel C – Splash Protection with APRActive Carbon Garment with APR

Control of Situation

• At the Basic Level, you establish inner and outer perimeters, safe gathering points, use bullhorn techniques, and conduct emergency wash down

• At the Intermediate Level, you establish full control zones, control access/egress corridors, forward treatment areas, handle patients, and perform technical decontamination

Cold Zone

Warm Zone

WindOuter (Security)

Perimeter

Inner (Safety) Perimeter

Protective Action Zone

Hot (Initial

Isolation) Zone

Wind

Protective Action ZoneProtective Action Zone

Hot (Initial

Isolation) ZoneWarm Zone

Cold Zone

Outer (Security) Perimeter

Inner (Safety) Perimeter

Principles of Decontamination

• Minimize Contamination• Minimize Spread of Contamination• Reduce Contamination to Safe Level• Use PPE Until Safe to Remove• Arrange Disposal of Contaminated Items

Principles of Decontamination

Minimize Contamination

• Avoid/minimize direct contact with contaminant

• Establish decontamination line uphill, upwind

• Avoid cross contamination

Principles of Decontamination

Minimize Spread of Contamination

• Use controlled access/egress corridors• Perform gross decon as early as possible• Control runoff, secure contaminated

equipment/PPE• Delineate and control movement in decon

Principles of Decontamination

Reduce Contamination to Safe Level

ALARA

• Use appropriate decon measures… (absorbents, adsorbents, vacuuming, evaporation, chemical degradation, clothing removal)

• Measures with vary according to contaminant

Principles of Decontamination

Use PPE until safe to remove

• No PPE should be doffed until it is assured safe to do so• Use an appropriate decon process prior to doffing PPE• Doff PPE in a safe, systematic manner • Secure removed PPE appropriately

Principles of Decontamination

Arrange Disposal of Contaminated Items

• Appropriate arrangements must be made of site remediation/clean-up

• Ongoing site security must be arranged• Site security must be maintained until transition to

appropriate agency/agencies

Casualty Management

• At the Basic Level we were unable to handle contaminated casualties or enter the area of gross contamination, thus decon and treatment of non-ambulatory patients might not be possible

• At the Intermediate Level we will be able to effect rescue, decon and treatment of the non-ambulatory patients

Triage

• Definition: A dynamic, on-going process of sorting casualties throughout an event

• Goal: Establishes medical priorities, organizes chaos and plans treatment

• ****Do the greatest good for the greatest number****

S.T.A.R.T. - Triage Classification Protocol

• Simple Triage And Rapid Treatment

Able to Walk NoYes

Delayed AssessVentilation

Step 1

VentilationPresent Yes

< 30/min> 30/min

Immediate Assess CapRefill

No

PositionAirway

Ventilation Present?

No Yes

ImmediateExpectantor Dead

Step 2

CapillaryRefill

< 2 sec> 2 sec

Immediate

ControlBleeding Assess

MentalStatus

Mental Status

Follows SimpleCommands

Fails to FollowSimple Commands

Immediate Delayed

Step 3

Step 4

Treatment Area

• Definition: A casualty collecting point • Goal:

– organize casualties by acuity– initiate treatment/mitigate life threat until

the casualty can be decontaminated (if needed) and transported

Communications

• Basic Level involves relaying scene information, estimating numbers affected, alerting hospitals and calling for additional resources (specialists)

• At the Intermediate Level we confirm numbers affected and expand the communications network

Call for Additional Resources

• You are the additional resources

• If you are not enough (Canadian Examples)• :

– CANUTEC Phone: 1-613-996-666– DRDC Suffield Phone: 1-403-544-4000– Joint National CBRNT Team via RCMP National

Operations Center Phone: 1-613-993-4460

Summary

• There will continue to be assessments to make, a scene to control, patients to care for, and communications to maintain

• The methods, mechanisms and tools will change