Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX D n Disaster Preparedness and Response
urgent care. The higher the incidence of over-triaged
patients, the more the medical system is overwhelmed.
Under-triage occurs when critically injured patients
requiring immediate medical care are assigned to
a delayed category. Under-triage leads to delays in
medical treatment as well as increased mortality
and morbidity.
Pitfall
Medical providers
over-triage children
and pregnant women.
Blast injury victims
are over-triaged
due to mechanism
of injury.
prevention
Base triage on severity of injury
and likelihood of survival, not
emotional considerations of
age and gender.
Although the mortality of
blasts is significant, base the
triage of surviving victims on
ATLS principles and severity
of injury, not etiology of
the disaster.
Definitive Medical Care
Definitive medical care refers to care that will improve
rather than simply stabilize a casualty’s condition.
Maximally acceptable care for all disaster victims is
not possible in the early stages of the disaster given the
large number of patients in a mass-casualty event. In
the initial stages of the disaster, minimally acceptable
trauma care (i.e., crisis management care) to provide
lifesaving interventions is necessary to provide the
greatest good for the greatest number of individuals.
Damage control surgery is an important component of
crisis management care. In many disasters, hospitals
are destroyed and transportation to medical facilities
may not be feasible, or the environment may be
contaminated. To ensure surge capacity, many hospitals
use mobile facilities that can provide a graded, flexible
response for trauma care.
Evacuation
Evacuation is often necessary in disasters, both at the
disaster scene and to facilitate transfer of patients to
other hospitals. Acute care providers, in addition to their
medical knowledge, must be aware of physiological
changes due to the hypobaric environment and
decreased partial pressure of oxygen that can occur
during air evacuation.
DecontamiNAtion
Decontamination is the removal of hazardous materials
from contaminated persons or equipment without
further contaminating the patient and the environment,
including hospitals and rescuers. Decontamination
may be necessary following both natural
and human-made disasters.
Prehospital and hospital personnel must rapidly
determine the likelihood of contaminated victims in
a disaster and proceed accordingly. Decontamination
must be performed before patients enter the
emergency department. Failure to do so can result
in contamination and subsequent quarantine of
the entire facility. Hospital security and local police
may be required to lockdown a facility to prevent
contaminated patients from entering the hospital.
Events such as the terrorist attack using the nerve agent
sarin in Tokyo in 1995 have shown that up to 85% of
the patients arrive at the healthcare facility without
prehospital decontamination.
The basic principles in response to any hazardous
material incident are the same regardless of the agents
involved. Removal of clothing and jewelry may reduce
contamination by up to 85%, especially with biological
and radioactive agents. To protect themselves during
decontamination, medical providers must wear the
appropriate level of personal protective equipment.
The site for decontamination is arranged in three
zones: the hot zone, the warm zone, and the cold zone.
••
The hot zone is the area of contamination. The
area should be isolated immediately to avoid
further contamination and casualties.
••
The warm zone is the area where decontamination
takes place. The warm zone should
be “upwind” and “uphill” from the hot zone.
Intramuscular (IM) antidotes and simple lifesaving
medical procedures, such as controlling
hemorrhage, can be administered to patients
before decontamination by medical personnel
wearing appropriate protective gear.
••
The cold zone is the area where the
decontaminated patient is taken for definitive
care, if needed, and disposition (transfer to
other facilities or discharge).
The choice of decontamination technique (gross
decontamination versus full decontamination) depends
on the number of casualties, severity of contamination,
severity of injuries, and available resources. There are
two types of decontamination:
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