Grand Rounds Recap 5.3.17

EMS Disaster Day

Triage in a Multiple Casualty Incident:

  • Highest Priority- RED (immediate or critical)
    • Critical patients with life threatening conditions
    • Have a good chance of recovery after immediate definitive care
  • Second Priority- YELLOW (Delayed or Urgent)
    • Do not have systemic signs of shock
    • Injuries may cause death if do not recieve care soon
  • Lowest Priority- GREEN (Minor or Delayed)
    • No life threatening injuries
    • Generally ambulatory
    • Constant reassessment is necessary
  • Last Priority- BLACK (Deceased or expectant)
    • Found without signs of life or with obvious mortal injuries

Where to start

  • Scene Safety
  • Walking Wounded "Anyone need help? Okay go over there." (<-- go look at people who got themselves out of the way, tag them as GREEN) 
  • Then assess the remaining patients one at a time with the pneumonic RPM
    • Respirations
      • Are they breathing? No-Black
      • Yes- how fast are they breathing? >30 then tag RED and move on
    • Perfusion- assess circulation
      • Perfusion abnormal then tag RED and move on
    • Mental Status- assess alertness
      • Unconscious, altered or cannot follow commands tag as RED and move on
      • If they can follow commands, YELLOW and move on 

Have a question about any disasters? Know where your information sits - for UCMC the yellow binder by the charge nurse desk, which contains:

  • MCI procedures and job action sheets
  • Alternative Care Center activation procedures
  • HazMat procedures and contacts
  • Radiation incident procedures and contacts
  • Severe weather procedures
  • Evacuation procedures
  • Loss of power procedures

Red binder contains highly infectious disease plans

Other codes... what do they mean to you? Look on your badge. 

  • Physicians often without specific designated tasks
  • Coordinate with the charge nurse
  • Maintain ownership of your patients, keep them informed
  • Code Grey (weather) - shoes and blankets; evacuate lobby; patients can't leave; tunnels?
  • Code Red (fire) - shelter in place facility
  • Code Adam (missing person) - observe and minimize movement of people
  • Power outage- utilize special back-up red outlets; find the flashlights in the SRU


  • Intra-hospital radios
    • ED to County-based command
  • Disaster New Radios
    • Net Control (dispatch) to ED / County command
  • MARCS Radio
    • EMS to EMS; EMS to ED
  • BRICS Radio (WCH only)
    • Butler County (MARCS)
  • Everbridge Online Warnings
    • ED / County Command to Hospital personnel

What HazMat incidents do hospitals see?

  • Low toxicity flammable hydrocarbon 70%
  • Highly toxic: Mercury, Pesticides 7%
  • Lit review of healthcare worker injury due to secondary exposure, low risk overall
    • Highest risk is organophosphate, usually related to not using appropriate or any PPE
  • Webwiser: Internet resource & app on your phone, to help identify what symptoms to look for and PPE needed for each exposure, can work backwards from symptoms as well

Definition of Disaster:

  • An event outside the normal daily experience that stresses your resources
  • Serious disruption of the functioning of society causing widespread human, material, or environmental losses
  • Unexpected number of deaths, injuries and illness that exceed available health resources
  • May destroy local health infrastructure and emergency response capabilities
  • May cause adverse effects to the environment
  • May cause large populations to move 

Types of Disasters

  • Natural
    • Tornadoes
    • Floods
    • Fires
    • Earthquakes
    • Hurricanes
    • Pandemics
  • Human Caused
    • HAZMAT, terrorism, accidents, war, riot 

What do people need in a disaster? Priorities are different for everyone

  • Medicine
  • Food
  • Water
  • Clothing
  • Safety
  • Garbage pick-up
  • Toilets
  • Transportation
  • Heat
  • Electricity
  • Shelter 
  • Communication
  • Evacuation

Factors that influence a disaster:

  • Geography
  • Weather
  • Time of Year
  • Population
  • Building Construction
  • EMS Response
  • Communication System 
  • Planning
  • Fire & Rescue
  • Public Transportation
  • Power Grid
  • Water Supply