Advanced Trauma Life Support ATLS Student Course Manual 2018
Pitfall Inadequate security Failed communication Over-triage prevention • Include security provisions in disaster plans. • Be prepared to reroute/limit flow into the hospital. • Be mindful of surroundings (situational awareness). • Don’t assume landlines and cell phones will function. • Have backup such as runners and walkie-talkie radios available for use. • Take available resources into account. • Use minimally acceptable care (crisis management care). MCE response in their training, given the complexity of today’s disasters. The goal of the disaster medical response, both prehospital and hospital, is to reduce the critical mortality associated with a disaster. Critical mortality rate is defined as the percentage of critically injured survivors who subsequently die. Numerous factors influence the critical mortality rate, including: •• Triage accuracy, particularly the incidence of over-triage of victims •• Rapid movement of patients to definitive care •• Implementation of damage control procedures •• Coordinated regional and local disaster preparedness. Bibliography Under-triage Inadequate capacity to manage influx of patients errors, and surge capabilities. The lessons learned from previous disasters are invaluable in teaching us how to better prepare for them. SummARy • Use personnel trained in rapid triage to perform this task. • Apply the ABCDs within the framework of doing the greatest good for the greatest number of patients. • Remember that capacity does not equal capabilities. • Make provisions for the obtaining the personnel and equipment necessary to align capability and capacity. A consistent approach to disasters by all organizations, including hospitals, based on an understanding of their common features and the response they require, is becoming the accepted practice throughout the world. The primary objective in a mass casualty event is to reduce the mortality and morbidity caused by the disaster. The ATLS course is an important asset in accomplishing these goals. ATLS guidelines for managing traumatic injuries are applicable to all disaster situations. All medical providers need to incorporate the key principles of the 1. Ahmed H, Ahmed M, et al. Syrian revolution: a field hospital under attack. Am J Disaster Med 2013;8(4); 259–265. 2. American Academy of Pediatrics (Foltin GL, Schonfeld DJ, Shannon MW, eds.). Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians. AHRQ Publication No. 06- 0056-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2006. http://www.ahrq. org/research/pedprep/resource.htm. Accessed February 26, 2008. 3. Bartal C, Zeller L, Miskin I, et al. Crush syndrome: saving more lives in disasters, lessons learned from the early-response phase in Haiti. Arch Intern Med 2011;171(7):694–696. 4. Born C, Briggs SM, Ciraulo DL, et al. Disasters and mass casualties: II. Explosive, biologic, chemical, and nuclear agents. J Am Acad of Orthop Surg 2007;15:8:461–473. 5. Briggs, SM. Advanced Disaster Medical Response, Manual for Providers. 2nd ed. Woodbury, CT: Cine- Med; 2014. 6. Committee on Trauma, American College of Surgeons. Disaster Management and Emergency Preparedness Course. Chicago, IL: American College of Surgeons; 2009. 7. Gutierrez de Ceballos JP, Turegano-Fuentes F, Perez-Diaz D, et al. 11 March 2004: the terrorist bomb explosions in Madrid, Spain— an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Crit Care 2005;9: 104–111. n BACK TO TABLE OF CONTENTS
300 APPENDIX D n Disaster Preparedness and Response 8. Holden, PJ. Perspective: the London attacks—a chronicle. N Engl J Med 2005;353:541–550. 9. Kales SN, Christiani DC. Acute chemical emergencies. N Engl J Med 2004;350(8):800–808. 10. Kearns, R, Skarote, MB, Peterson, J, et al. Deployable, portable and temporary hospitals; one state’s experiences through the years, Am J Disaster Med 2014;9(3):195–207. 11. Latifi, R, Tilley, E. Telemedicine for disaster management: can it transform chaos into an organized, structured care from the distance? Am J Dis Medicine 2014;9(1):25–37. 12. Lin G, Lavon H, Gelfond R, et al. Hard times call for creative solutions: medical improvisations at the Israel Defense Forces Field Hospital in Haiti. Am J Disaster Med 2010 May–June;5(3):188–192. 13. Mettler FA, Voelz GL. Major radiation exposure— what to expect and how to respond. N Engl J Med 2002;346(20):1554–1561. 14. Musolino SV, Harper FT. Emergency response guidance for the first 48 hours after the outdoor detonation of an explosive radiological dispersal device. Health Phys 2006;90(4):377–385. 15. Pediatric Task Force, Centers for Bioterrorism Preparedness Planning, New York City Department of Health and Mental Hygiene (Arquilla B, Foltin G, Uraneck K, eds.). Children in Disasters: Hospital Guidelines for Pediatric Preparedness. 3rd ed. New York: New York City Department of Health and Mental Hygiene; 2008. https://www1.nyc.gov/ assets/doh/downloads/pdf/bhpp/hepp-pedschildrenindisasters-010709.pdf. Accessed January 4, 2017. 16. Sechriest, VF, Wing V, et al. Healthcare delivery aboard US Navy hospital ships following earthquake disasters: implications for future disaster relief missions. Am J of Disaster Med 2012;7(4):281–294. 17. Sever MS, Vanholder R, Lameire N. Management of crush-related injuries after disasters. N Engl J Med 2006;354(10):1052–1063. 18. Weiner DL, Manzi SF, Briggs SM, et al. Response to challenges and lessons learned from hurricanes Katrina and Rita: a national perspective. Pediatrics 2011;128:S31. n BACK TO TABLE OF CONTENTS
- Page 301 and 302: 248 CHAPTER 13 n Transfer to Defini
- Page 303 and 304: 250 CHAPTER 13 n Transfer to Defini
- Page 305: 252 CHAPTER 13 n Transfer to Defini
- Page 310 and 311: Appendix A OCULAR TRAUMA OBJECTIVES
- Page 312 and 313: 259 APPENDIX A n Ocular Trauma In c
- Page 314 and 315: 261 APPENDIX A n Ocular Trauma to t
- Page 318 and 319: Appendix B HYPOTHERMIA AND HEAT INJ
- Page 320 and 321: 267 APPENDIX B n Hypothermia and He
- Page 322 and 323: 269 APPENDIX B n Hypothermia and He
- Page 324 and 325: 271 APPENDIX B n Hypothermia and He
- Page 328 and 329: Appendix C TRAUMA CARE IN MASS-CASU
- Page 330 and 331: 277 APPENDIX C n Trauma Care in Mas
- Page 332 and 333: 279 APPENDIX C n Trauma Care in Mas
- Page 334 and 335: 281 APPENDIX C n Trauma Care in Mas
- Page 336 and 337: 283 APPENDIX C n Trauma Care in Mas
- Page 338 and 339: 285 APPENDIX C n Trauma Care in Mas
- Page 342 and 343: Appendix D DISASTER PREPAREDNESS AN
- Page 344 and 345: 291 APPENDIX D n Disaster Preparedn
- Page 346 and 347: 293 APPENDIX D n Disaster Preparedn
- Page 348 and 349: 295 APPENDIX D n Disaster Preparedn
- Page 350 and 351: 297 APPENDIX D n Disaster Preparedn
- Page 356 and 357: Appendix E ATLS AND TRAUMA TEAM RES
- Page 358 and 359: 305 APPENDIX E n ATLS and Trauma Te
- Page 360 and 361: 307 APPENDIX E n ATLS and Trauma Te
- Page 362 and 363: 309 APPENDIX E n ATLS and Trauma Te
- Page 364 and 365: 311 APPENDIX E n ATLS and Trauma Te
- Page 366 and 367: 313 APPENDIX E n ATLS and Trauma Te
- Page 370 and 371: Appendix F TRIAGE SCENARIOS OBJECTI
- Page 372 and 373: 319 APPENDIX F n Triage Scenarios T
- Page 374 and 375: 321 APPENDIX F n Triage Scenarios T
- Page 376 and 377: 323 APPENDIX F n Triage Scenarios T
- Page 378 and 379: 325 APPENDIX F n Triage Scenarios T
- Page 380 and 381: 327 APPENDIX F n Triage Scenarios T
- Page 382 and 383: 329 APPENDIX F n Triage Scenarios T
- Page 384 and 385: 331 APPENDIX F n Triage Scenarios T
- Page 386: 333 APPENDIX F n Triage Scenarios 4
- Page 390 and 391: Skill Station A AIRWAY Part 1: Basi
- Page 392 and 393: 339 APPENDIX G n Skills One-Person
- Page 394 and 395: 341 APPENDIX G n Skills STEP 5. Con
- Page 396: 343 APPENDIX G n Skills STEP 13. Co
- Page 399 and 400: 346 APPENDIX G n Skills STEP 1. D
300<br />
APPENDIX D n Disaster Preparedness and Response<br />
8. Holden, PJ. Perspective: the London attacks—a<br />
chronicle. N Engl J Med 2005;353:541–550.<br />
9. Kales SN, Christiani DC. Acute chemical<br />
emergencies. N Engl J Med 2004;350(8):800–808.<br />
10. Kearns, R, Skarote, MB, Peterson, J, et al.<br />
Deployable, portable and temporary hospitals;<br />
one state’s experiences through the years, Am J<br />
Disaster Med 2014;9(3):195–207.<br />
11. Latifi, R, Tilley, E. Telemedicine for disaster<br />
management: can it transform chaos into an<br />
organized, structured care from the distance?<br />
Am J Dis Medicine 2014;9(1):25–37.<br />
12. Lin G, Lavon H, Gelfond R, et al. Hard times call<br />
for creative solutions: medical improvisations at<br />
the Israel Defense Forces Field Hospital in Haiti.<br />
Am J Disaster Med 2010 May–June;5(3):188–192.<br />
13. Mettler FA, Voelz GL. Major radiation exposure—<br />
what to expect and how to respond. N Engl J Med<br />
2002;346(20):1554–1561.<br />
14. Musolino SV, Harper FT. Emergency response<br />
guidance for the first 48 hours after the outdoor<br />
detonation of an explosive radiological dispersal<br />
device. Health Phys 2006;90(4):377–385.<br />
15. Pediatric Task Force, Centers for Bioterrorism<br />
Preparedness Planning, New York City Department<br />
of Health and Mental Hygiene (Arquilla B, Foltin<br />
G, Uraneck K, eds.). Children in Disasters: Hospital<br />
Guidelines for Pediatric Preparedness. 3rd ed. New<br />
York: New York City Department of Health and<br />
Mental Hygiene; 2008. https://www1.nyc.gov/<br />
assets/doh/downloads/pdf/bhpp/hepp-pedschildrenindisasters-010709.pdf.<br />
Accessed<br />
January 4, 2017.<br />
16. Sechriest, VF, Wing V, et al. Healthcare delivery<br />
aboard US Navy hospital ships following<br />
earthquake disasters: implications for future<br />
disaster relief missions. Am J of Disaster Med<br />
2012;7(4):281–294.<br />
17. Sever MS, Vanholder R, Lameire N. Management<br />
of crush-related injuries after disasters. N Engl J<br />
Med 2006;354(10):1052–1063.<br />
18. Weiner DL, Manzi SF, Briggs SM, et al. Response<br />
to challenges and lessons learned from hurricanes<br />
Katrina and Rita: a national perspective. Pediatrics<br />
2011;128:S31.<br />
n BACK TO TABLE OF CONTENTS
Change language