What to Look for

During triage, you are keeping an eye out for “the killers”:

• Airway obstruction
• Excessive bleeding
• Signs of shock

• Starting at the top of the body and working your way down, here are other items to look for:

• Deformities
• Contusions (bruising)
• Abrasions
• Punctures
• Burns
• Tenderness
• Lacerations
• Swelling

Closed Head Injuries

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 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
• Nausea or vomiting
• Victim found under collapsed building material or heavy debris

If you suspect a closed head injury, stabilize the head with whatever you can find in the are.

Remember:  Moving victims with suspected head, neck, or spinal injury requires sufficient victim stabilization.  If the rescuer or victim is in immediate danger, however, safety is more important than any potential spinal injury and the rescuer should move the victim from the area as quickly as possible.

Water Purification

• 8 drops of bleach per gallon of water

• 16 drops per gallon of water, if the water is cloudy or dirty

Let the bleach and water solution stand for 30 minutes.  Note that if the solution does not smell or taste of bleach, add another six drops of bleach, and let the solution stand for 15 minutes before using

Preventing the Spread of Disease

CERT members must use non-latex exam gloves, goggles, and an N95 mask during all medical operations. Cover all open wounds as a way of preventing the spread of infection.

Burn Classification

• Superficial – Epidermis – Reddened & Dry Skin, Pain, Swelling possible
• Partial Thickness – Partial destruction of Dermis – Reddened Blistered Skin, Wet Appearance, Pain, Swelling Possible
• Full Thickness – Complete destruction of Epidermis and Dermis, Possible subcutaneous damage – Whitened, leathery or charred, painful or relatively painless

Treating Burns

•  Remove the victim from the burning source.  Put out any flames and remove smoldering clothing unless it is stuck to the skin.
• Cool skin or clothing, if they are still hot, by immersing them in cool water for not more than 1 minute or covering with clean compresses that have been soaked in cool water and wrung out.  Cooling sources include water from the bathroom or kitchen; garden hose; and soaked towels, sheets, or other cloths.  Treat all victims of full thickness burns for shock.

•    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% of the body surface area (the size of one arm) at once, to reduce the chances of hypothermia.

• Cover loosely with dry, sterile dressings to keep air out, reduce pain, and prevent infection.
• Wrap fingers and toes loosely and individually when treating severe burns to the hands and feet.
• Loosen clothing near the affected area.  Remove jewelry if necessary, taking care to document what was removed, when, and to whom it was given.
• Elevate burned extremities higher than the heart.
• Do not use ice.  Ice causes vessel constriction.
• Do not apply antiseptics, ointments, or other remedies.
• Do not remove shreds of tissue, break blisters, or remove adhered particles of clothing.  (Cut burned-in clothing around the burn.)

https://www.youtube.com/watch?v=Dsvtzwp4nG8

Chemical Burns

Chemical burns are not always obvious. You should consider chemical burns as a possibility if the victim’s skin is burning and there is no sign of a fire. If chemical burns are suspected:

1.   Protect yourself from contact with the substance. Use your protective gear — especially goggles, mask, and gloves.
2.   Ensure that any affected clothing or jewelry is removed. 
3.   If the irritant is dry, gently brush away as much as possible.  Always brush away from the eyes and away from the victim and you.
4.   Use lots of cool running water to flush the chemical from the skin for 15 minutes.  The running water will dilute the chemical fast enough to prevent the injury from getting worse.
5.   Apply cool, wet compress to relieve pain.
6.   Cover the wound very loosely with a dry, sterile or clean cloth so that the cloth will not stick to the wound.

Treat for shock if appropriate.

https://www.safetyandhealthmagazine.com/articles/15312-treating-chemical-burns

Inhalation Burns

Remember that 60 to 80% of fire fatalities are the result of smoke inhalation.  Whenever fire and/or smoke is present, CERT members should assess victims for signs and symptoms of smoke inhalation.  These are indicators that an inhalation burn is present:

• Sudden loss of consciousness
• Evidence of respiratory distress or upper airway obstruction
• Soot around the mouth or nose
• Singed facial hair
• Burns around the face or neck

https://www.jems.com/articles/print/volume-39/issue-10/features/treating-smoke-inhalation-and-airway-bur.html

More Burn Related Content

https://www.profirstaid.com/training_video/burns

Types of Burns

Wound Care

The main treatment for wounds includes:

• Control bleeding
• Clean the wound
• Apply dressing and bandage

Cleaning and Bandaging Wounds

• Wounds should be cleaned by irrigating with clean, room temperature water.
• NEVER use hydrogen peroxide to irrigate the wound.
• You should not scrub the wound.  A bulb syringe is useful for irrigating wounds.  In a disaster, a turkey baster may also be useful.
• When the wound is thoroughly cleaned, you will need to apply a dressing and bandage to help keep it clean and control bleeding.

Rules of Dressing

You should follow these rules:

1.    If there is active bleeding (i.e., if the dressing is soaked with blood), redress over the existing dressing and maintain pressure and elevation to control bleeding.

2.    In the absence of active bleeding, remove the dressings, flush the wound, and then check 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

If necessary and based on reassessment and signs of infection, change the treatment priority (e.g., from Delayed to Immediate).

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. Label them with the date, time, and victim’s name.
• Keep the tissue parts cool, but NOT in direct contact with ice
• Keep the severed part with the victim

Impaled Objects

Sometimes, 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 attempt to move or remove the object, unless it is obstructing the airway
• Try to control bleeding at the entrance wound without placing undue pressure on the foreign object
• Clean and dress the wound making sure to stabilize the impaled object. Wrap bulky dressings around the object to keep it from moving.

Types of Fractures

A fracture is a complete break, a chip, or a crack in a bone. There are several types of fractures.

• A closed fracture is a broken bone with no associated wound. First aid treatment for closed fractures may require only splinting.
• An open fracture is a broken bone with some kind of wound that allows contaminants to enter into or around the fracture site.

Treating an Open Fracture

Open fractures are more dangerous than closed fractures because they pose a significant 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 draw the exposed bone ends back into the tissue.
• Do not irrigate the wound.

You should:

• Cover the wound with a sterile dressing
• Splint the fracture without disturbing the wound
• Place a moist 4 by 4-inch dressing over the bone end to keep it from drying out

If the limb is angled, then there is a displaced fracture. Displaced fractures may be described by the degree of displacement of the bone fragments.

Non-displaced fractures are difficult to identify, with the main signs being pain and swelling. You should treat a suspected fracture as a fracture until professional treatment is available.

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. Towels, blankets, or pillows, tied with bandaging materials or soft cloths
• Rigid materials. A board, metal strip, folded magazine or newspaper, or other rigid item

Anatomical splints 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.

Soft materials should be used to fill the gap between the splinting material and the body part.

With this type of injury, there will be swelling. Remove restrictive clothing, shoes, and jewelry when necessary to prevent these items from acting as unintended tourniquets.

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.

If dislocation is suspected, be sure to assess PMS (Pulse, Movement, Sensation) in the affected limb before and after splinting/immobilization. If PMS is compromised, the patient’s treatment priority is elevated to “I.”

You should not try to relocate a suspected dislocation. You should immobilize the joint until professional medical help is available.

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, you should not 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. 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. Towels, blankets, or pillows, tied with bandaging materials or soft cloths
• Rigid materials. A board, metal strip, folded magazine or newspaper, or other rigid item

Anatomical splints 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.

Soft materials should be used to fill the gap between the splinting material and the body part.

With this type of injury, there will be swelling. Remove restrictive clothing, shoes, and jewelry when necessary to prevent these items from acting as unintended tourniquets.

See Videos in the Fractures section on splinting techniques

Nasal Injuries

Bleeding from the nose can have several causes.  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.  Those who have swallowed large amounts of blood may become nauseated and vomit.

These are methods for controlling nasal bleeding:

• Pinch the nostrils together
• Put pressure on the upper lip just under the nose

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. 

Heat Related Injuries

There are several types of heat-related injuries that you may encounter in a disaster scenario:

• Heat cramps are muscle spasms brought on by over-exertion in extreme heat.
• Heat exhaustion occurs when an individual exercises or works in extreme heat, resulting in loss of body fluids through heavy sweating.  Blood flow to the skin increases, causing blood flow to decrease to the vital organs.  This results in a mild form of shock.
• Heat stroke is life-threatening.  The victim’s temperature control system shuts down, and body temperature can rise so high that brain damage and death may result.

Heat Exhaustion

The symptoms of heat exhaustion are:

• Cool, moist, pale, or flushed skin
• Heavy sweating
• Headache
• Nausea or vomiting
• Dizziness
• Exhaustion

A patient suffering heat exhaustion will have a near normal body temperature.  If left untreated, heat exhaustion will develop into heat stroke.

Heat Stroke

Heat stroke is characterized by some or all of the following symptoms:

• Hot, red skin
• Lack of perspiration
• Changes in consciousness
• Rapid, weak pulse and rapid, shallow breathing

In a heat stroke victim, body temperature can be very high — as high as 105º F.  If an individual suffering from heat stroke is not treated, death can result

Treatment

Treatment is similar for both heat exhaustion and heat stroke. 

1.    Take the victim out of the heat and place in a cool environment.

2.    Cool the body slowly with cool, wet towels or sheets.  If possible, put the victim in a cool bath.

3.    Have the victim drink water, SLOWLY, at the rate of approximately half a glass of water every 15 minutes.  Consuming too much water too quickly will cause nausea and vomiting in a victim of heat sickness.

4.    If the victim is experiencing vomiting, cramping, or is losing consciousness, DO NOT administer food or drink.  Alert a medical professional as soon as possible, and keep a close watch on the individual until professional help is available.

Hypothermia

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° F (37° C) or lower
• Redness or blueness of the skin
• Numbness accompanied by shivering

In later stages, hypothermia will be accompanied by:

• Slurred speech
• Unpredictable behavior
• Listlessness

Treatment

Because hypothermia can set in within only a few minutes, you should treat victims who have been rescued from cold air or water environments.

• Remove wet clothing.
• Wrap the victim in a blanket or sleeping bag and cover the head and neck.
• Protect the victim against the weather.
• Provide warm, sweet drinks and food to conscious victims.  Do not offer alcohol.
• Do not attempt to use massage to warm affected body parts.

Place an unconscious victim in the recovery position:

1. Place the victim’s arm that is nearest to you at a right angle against the ground, with the palm facing up.
2. Move the victim’s other arm across his or her chest and neck, with the back of the victim’s hand resting against his or her cheek.
3. Grab a hold of the knee furthest from you and pull it up until the knee is bent and the foot is flat on the floor.
4. Pull the knee toward you and over the victim’s body while holding the victim’s hand in place against his or her cheek.
5. Position the victim’s leg at a right angle against the floor so that the victim is lying on his or her side.

If the victim is conscious, place him or her in a warm bath.

Frostbite

A person’s blood vessels constrict in cold weather in an effort to preserve body heat.  In extreme cold, the body will further constrict blood vessels in the extremities in an effort to shunt blood toward the core organs (heart, lungs, intestines, etc.).  The combination of inadequate circulation and extreme temperatures will cause tissue in these extremities to freeze, and in some cases, tissue death will result.  Frostbite is most common in the hands, nose, ears, and feet.

There are several key signs and symptoms of frostbite:

• Skin discoloration (red, white, purple, black)
• Burning or tingling sensation, at times not localized to the injury site
• Partial or complete numbness

Treatment

A patient suffering from frostbite must be warmed slowly!  Thawing the frozen extremity too rapidly can cause chilled blood to flow to the heart, shocking and potentially stopping it.  

• Immerse injured area in warm (NOT hot) water, approximately 107.6° F. 
• Do NOT allow the body part to re-freeze as this will exacerbate the injury.
• Do NOT attempt to use massage to warm body parts.

Wrap affected body parts in dry, sterile dressing.  Again, it is vital this task be completed carefully.  Frostbite results in the formation of ice crystals in the tissue; rubbing could potentially cause a great deal of damage!

Bites & Stings

When conducting a head-to-toe assessment, you should look for signs of insect bites and stings.  The specific symptoms vary depending on the type of creature, but, generally, bites and stings will be accompanied by redness and itching, tingling or burning at the site of the injury, and often a welt on the skin at the site.

Treatment for insect bites and stings follows these steps:

1.    Remove the stinger if still present by scraping the edge of a credit card or other stiff, straight-edged object across the stinger.  Do not use tweezers; these may squeeze the venom sac and increase the amount of venom released.

2.    Wash the site thoroughly with soap and water.

3.    Place ice (wrapped in a washcloth) on the site of the sting for 10 minutes and then off for 10 minutes.  Repeat this process.

You may help the victim take his or her own allergy medicine (Benadryl, etc.), but you may NOT dispense medications.

Bites and Stings and Allergic Reactions

The greatest concern with any insect bite or sting is a severe allergic reaction, or anaphylaxis.  Anaphylaxis occurs when an allergic reaction becomes so severe that the airway is compromised.  If you suspect anaphylaxis:

1.    Check airway and breathing.

2.    Calm the individual.

3.    Remove constrictive clothing and jewelry as the body often swells in response to the allergen.

4.    If possible, find and help administer a victim’s Epi-pen.  Many severe allergy sufferers carry one at all times. 

a.    DO NOT administer medicine aside from the Epi-pen.  This includes pain relievers, allergy medicine, etc. 

5.    Watch for signs of shock and treat appropriately. 

https://www.youtube.com/watch?v=HTvNND0S9IQ

Simple
Triage
And
Rapid
Treatment

This PDF is a great resource

https://www.cert-la.com/downloads/education/english/start.pdf

Opening Airway

Head-Tilt/Chin-Lift Method for Opening an Airway

Step 1 – At an arm’s distance, make contact with the victim by touching the shoulder and asking, “Can you hear me?” Speak loudly, but do not yell.

Step 2 – If the victim does not or cannot respond, place the palm of one hand on the forehead.

Step 3 – Place two fingers of the other hand under the chin and tilt the jaw upward while tilting the head back slightly.

Step 4 – Place your ear close to the victim’s mouth, looking toward the victim’s feet, and place a hand on the victim’s abdomen.

Step 5 – Look for chest rise.

Step 6 – Listen for air exchange.

• Document abnormal lung sounds (wheezing, gasping, gurgling, etc.).

Step 7 – Feel for abdominal movement.

Step 8 – If breathing has been restored, the clear airway must be maintained by keeping the head tilted back. If breathing has not been restored, repeat steps 2-7.

Maintaining The Airway

If breathing has been restored, the clear airway still must be maintained by keeping the head tilted back. One option is to ask another person to hold the head in place; even another victim with minor injuries could do this. The airway also can be maintained by placing soft objects under the victim’s shoulders to elevate the shoulders slightly and keep the airway open.

Remember that part of your mission is to do the greatest good for the greatest number of people. For that reason, if breathing is not restored on the first try using the Head-Tilt/Chin-Lift method, CERT members should try again using the same method. If breathing cannot be restored on the second try, CERT members must move on to the next victim.

There are three types of bleeding and the type can usually be identified by how fast the blood flows:

• Arterial bleeding. Arteries transport blood under high pressure. Blood coming from an artery will spurt.
• Venous bleeding. Veins transport blood under low pressure. Blood coming from a vein will flow.
• Capillary bleeding. Capillaries also carry blood under low pressure. Blood coming from capillaries will ooze.

There are three main methods for controlling bleeding:

• Direct pressure (95% success)
• Elevation
• Pressure points

Methods to Stop Bleeding

Direct Pressure

Place direct pressure over the wound by putting a clean dressing over the wound and pressing firmly.

Maintain pressure on the dressing over the wound by wrapping the wound firmly with a pressure bandage and tying with a bow.

Elevation

Elevate the wound above the level of the heart.

Pressure Points

Put pressure on the nearest pressure point to slow the flow of blood to the wound. Use the:

• Brachial point for bleeding in the arm
• Femoral point for bleeding in the leg
• Popliteal point for bleeding in the lower leg

 Only proper medical authorities should remove a tourniquet.

CERTs will use direct pressure on pressure points and elevation to manage most bleeding. However, if bleeding cannot be stopped using these methods and professionals are delayed in responding, a tourniquet may be a viable option to save a person from bleeding to death. However, a tourniquet is absolutely a last resort (life or limb) when other preferred means have failed to control bleeding in an arm or a leg.

While the use of a tourniquet is extremely rare, it may have a use when part of an extremity is amputated or crushed and bleeding cannot be stopped by any other preferred means.

• A tourniquet is a tight bandage which, when placed around a limb and tightened, cuts off the blood supply to the part of the limb beyond it.
• A tourniquet can do harm to the limb, but it can halt severe blood loss when all other means have failed and professional help will not arrive in time to help stop the bleeding before the person dies.
• Use any long, flat, soft material (bandage, neck tie, belt, or stocking). Do not use materials like rope, wire, or string that can cut into the patient’s flesh.

To tie a tourniquet:

1. Place the tourniquet between the wound and the heart (for example, if the wound is on the wrist, you would tie the tourniquet around the forearm).
2. Tie the piece of material around the limb.
3. Place a stick, pen, ruler, or other sturdy item against the material and tie a knot around the item, so that the item is knotted against the limb.
4. Use the stick or other item as a lever to twist the knot more tightly against the limb, tightening the bandage until the bleeding stops.
5. Tie one or both ends of the lever against the limb to secure it and maintain pressure.
6. Mark the patient in an obvious way that indicates that a tourniquet was used and include the time it was applied.
7. Do not loosen a tourniquet once it has been applied.

 The main signs of shock that CERT members should look for are:

• Rapid and shallow breathing
• Capillary refill of greater than 2 seconds
• Failure to follow simple commands, such as “Squeeze my hand”

Evaluate Breathing

 Note if the victim’s breathing is rapid and shallow, i.e., more than 30 breaths per minute.

Evaluate Circulation

One way to test for circulation is the blanch test.  A good place to do the blanch test is the palm of one hand.  Sometimes, a nail bed is used.  The blanch test is used to test capillary refill.  You should see the color return to the tested area within 2 seconds.

Because the blanch test is not valid in children, mental status should be used instead as the main indicator.

Another way to check for circulation is the radial pulse test.  This is an alternative to the blanch test and can be used in the dark or where it is cold.

To perform the radial pulse test, place your middle and ring finger over the interior of the victim’s wrist where the thumb meets the arm.  A normal pulse rate is 60-100 beats per minute.

Evaluate Mental Status

There are several ways to evaluate mental status.

• Ask, “Are you okay?”
• Give a simple command such as “Squeeze my hand.”

Treating for Shock

Position the victim on his or her back and elevate the feet 6 to 10 inches above the level of the heart to assist in bringing blood to the vital organs.

1. Maintain an open airway
2. Control obvious bleeding
3. Cover with a blanket if necessary
4. Avoid rough handling.  Do NOT give food or drink.

Categorizing Victims

• Immediate (I): The victim has life-threatening injuries (airway, bleeding, or shock) that demand immediate attention to save his or her life; rapid, lifesaving treatment is urgent. These victims are marked with a red tag or labeled “I.”
• Delayed (D): Injuries do not jeopardize the victim’s life. The victim may require professional care, but treatment can be delayed. These victims are marked with a yellow tag or labeled “D.
• Minor (M): Walking wounded and generally ambulatory. These victims are marked with a green tag or labeled “M.”
• Dead (DEAD): No respiration after two attempts to open the airway. Because CPR is one-on-one care and is labor intensive, CPR is not performed when there are many more victims than rescuers. These victims are marked with a black tag or labeled “DEAD.”