EMT Ch. 40- Incident Management

major NIMS components

1. communications/information management

2. resource management

3. command & coordination

ICS origanizational levels

larger incident=more divisions

• sections- finance/administration, logistics, planning, operations

• branches- functional/geographical, larger incidents

• divisions & groups- align resources under one supervisor

incident commander

• person in charge of overall incident

• assess incident, establish strategic objectives/priorities, develop plan to manage incident

• command duties may be delegated or retained

single command system

• one person is in charge even in presence of multiple agencies

• generally used w/ incidents in which one agency has most responsibility for management

common strobe color used to identify command post

green

open incident

• incident is not yet contained

• pts may need to be located

• situation may be ongoing

closed incident

• incident is contained

• all pts/casualties are accounted

scene size-up questions

• what do I have? (hazards, pts, casualties)

• what resources do I need? (more responders, transportation, fire response)

• what do I need to do? (safety, incident stablization, preservation of life/property/environment)

true/false: treatment of pts must not begin until all pts have been triaged

true

triage personnel/supervisor tasks

• triage/tag all pts

• work closely w/ treatment/extrication supervisor

• ensure movement of all pts to treatment area

• ensure adequate personnel to accomplish tasks

• ensure safety of all members

• communicate w/ EMS branch on progress of operations

• establish initial morgue if necessary

• document activities of triage areas

treatment personnel/supervisor tasks

• separate pts by priority category

• assign crews to treat pts

• communicate w/ transportation supervisor

• ensure safety of all members working in area

• ensure sufficient supplies & personnel

• maintain security of treatment area

• initiate decontamination procedures if necessary

• document activities of treatment area

• provide updates to EMS branch director

transportation personnel/supervisor tasks

• direct movement of all pts

• ensure safety of all members

• establish loading zone

• work w/ treatment supervisor on pt movement to hospitals

• establish/determine destination for pts

• communicate w/ hospitals

• request additional transport units from EMS branch/staging supervisor

• provide updates to EMS branch director

• establish landing zone if necessary

• track all pt movement

• document activities of transportation area

signs of stress

• fatigue

• altered thinking patterns

• complete collapse

primary triage

• initial triage done in field

• allows quick/accurate categorization of pt’s condition & transport needs

• given a triage tag/tape for identification

secondary triage

• performed as pts are brought to treatment area

true/false: in lightning strike incident, treat cardiac/respiratory arrest pts first

true

red tag triage category

• first priority (immediate)

• pts who need immediate care/transport

yellow tag triage category

• second priority (delayed)

• pts whose treatment/transport can be temporarily delayed

green tag triage category

• third priority (minimal) (walking wounded)

• pts who require minimal/no treatment

• transport can be delayed until last

black tag triage category

• fourth priority (expectant)

• pts who are already dead/have minimal chance for survival

typical red tag injuries

• airway/breathing compromise

• uncontrolled/severe bleeding

• severe medical problems

• signs of shock

• severe burns

• open chest/abdominal injuries

typical yellow tag injuries

• burns w/o airway compromise

• major/multiple bone/joint injuries

• back injuries w/ or w/o spinal cord damage

typical green tag injuries

• minor fractures

• minor soft-tissue injuries

typical black tag injuries

• obvious death

• obviously nonsurvivable injury (open brain trauma)

• respiratory arrest (if limited resources)

• cardiac arrest

START triage

simple triage & rapid treatment

1. call out to pts during disaster scene & have ambulatory pts move

2. assess respiratory status of nonambulatory pts, perform simple open airway maneuver if needed, & tag

3. assess hemodynamic status by checking for bilateral radial pulses

4. assess neurologic status by checking for ability to follow/understand commands

triage category for pt w/ RR >30 or <10 breaths/min

red

triage category for pt w/ absent radial pulses

red

triage category for pt who is unconscious/unable to follow simple commands

red

triage category for pt who is able to follow simple commands

yellow

JumpSTART triage

• triage method used for children <8 yrs or <100 lbs or pts w/ special needs

• if pt is not breathing, reposition airway & reassess, apneic=red

  • check pulse, pulseless=black

  • if pulse present, provide five rescue breaths, reassess

    • remains apneic=black

    • resumes breathing=red

• assess RR

  • <15 breaths/min or >45 breaths/min=red

• assess hemodynamic status (distal pulses)

  • absent=red

• assess neurologic status (modified AVPU)

  • unresponsive, responds to pain by posturing/incomprehensible sounds, unable to localize pain=red

  • responds to pain by localizing, withdrawing, becoming alert=yellow

disaster

widespread event disrupting functions/resources of community & threatens life/property

hazardous material

any material posing an unreasonable risk of damage/injury to people, property, environment if not properly controlled

examples of bulk storage containers

• fixed tanks

• highway cargo tanks

• rail tank cars

• totes

• intermodal tanks

examples of nonbulk storage vessels

• drums

• bags

• compressed gas cylinders

• cryogenic containers

pesticide label contents

• name of product

• active ingredients

• hazard statement

• total amount of product in container

• manufacturer’s name/address

• EPA registration number

• EPA establishment number

• signal words indicating relative toxicity of material

  • danger- poison: highly toxic by all routes of entry

  • danger: severe eye damage/skin irritation

  • warning: moderately toxic

  • caution: minor toxicity/minor eye damage/skin irritation

• practical first-aid treatment description

• directions for use

• agricultural use requirements

• precautionary statements (mixing directions, environmental hazards)

• storage/disposal info

• classification statement on who may use product

placards

• diamond-shaped indicators placed on all four sides of highway transport vehicles, railroad tank cars, other modes of transportation carrying hazardous materials weighing >1000 lbs

• identify broad hazard class

materials stored in cardboard drums

solids

materials stored in stainless steel containers

particularly dangerous materials

materials stored in intermodal tanks

gaseous substances chilled until liquefied

materials stored in steel utility drums

noncorrosives

materials stored in polyethylene drums

corrosives

materials stored in bags

solids, powders

materials stored in carboys

corrosives

materials stored in cylinders

liquids, compressed gases

hazmat placard- red diamond w/ white stripes

dangerous; flammable solid

hazmat placard- white w/ vertical black stripes

miscellaneous dangerous chemicals

hazmat placard- half white/black

corrosive

hazmat placard- half white/red

spontaneous combustion

hazmat placard- half red/white

organic peroxide

hazmat placard- red

flammable, combustible

hazmat placard- orange

explosive

hazmat placard- yellow

oxygen/oxidizer

hazmat placard- green

nonflammable/nontoxic gas

hazmat placard- blue

dangerous when wet

hazmat placard- white

toxic gas/inhalation hazard

class 1 hazardous materials

explosives

class 2 hazardous materials

gases

class 3 hazardous materials

flammable liquids

class 4 hazardous materials

flammable solids, spontaneous combustible, dangerous when wet

class 5 hazardous materials

oxidizer, organic peroxide

class 6 hazardous materials

poison (toxic), poison inhalation hazard, infectious substances

class 7 hazardous materials

radioactive

class 8 hazardous materials

corrosive

class 9 hazardous materials

miscellaneous hazardous materials

NFPA fire diamond- blue

health hazard

NFPA fire diamond- red

fire hazard

NFPA fire diamond- yellow

instability hazard

NFPA fire diamond- white

specific hazard

health hazard- 4

deadly

health hazard- 3

extreme danger

health hazard- 2

hazardous

health hazard- 1

slightly hazardous

health hazard- 0

normal material

fire hazard- 4

<73°F

fire hazard- 3

<100°F

fire hazard- 2

<200°F

fire hazard- 1

>200°F

fire hazard- 0

will not burn

instability hazard- 4

may detonate

instability hazard- 3

shock/heat may detonate

instability hazard- 2

violent chemical change

instability hazard- 1

unstable if heated

instability hazard- 0

stable

specific hazard- ACID

acid

specific hazard- ALK

alkali

specific hazard- COR

corrosive

specific hazard- OX

oxidizer

specific hazard- radiation symbol

radiation hazard

specific hazard- strikethrough w

use no water

indicators of hazmat situation

• visible cloud/strange-looking smoke resulting from escaping substance

• leak/spill from tank, container, truck, railroad car w/ or w/o hazmat placards/labels

• unusual, strong, noxious, harsh odor in area

hot (exclusionary) zone

immediate area around hazard, most contaminated

warm (contamination reduction) zone

control points, transition point for personnel

decontamination zone

remove contaminants

cold (outer perimeter) zone

safe area, no special protection needed

toxicity level

measures of health risk a substance poses to someone coming in contact

toxicity level 0

materials causing no/minimal health hazard

toxicity level 1

materials causing irritation on contact but only mild residual injury even w/o treatment

toxicity level 2

materials potentially causing temporary damage/residual damage unless prompt medical treatment is provided

toxicity level 3

materials extremely hazardous to health

toxicity level 4

materials causing death on minimal contact