Disaster Medicine

Disaster Medicine Priorities

Disaster Medicine is a severe form of First Aid, in which treatment priorities need to be reassessed against those usually applied in an everyday First Aid emergency. Priorities are reassessed because significant numbers of casualties are involved, emergency services are overwhelmed, hospital facilities are compromised and damaged roads mean difficulties with transportation.

The following notes outline the basic steps to follow when dealing with casualties, depending on the type of injury suspected. Try to do the most good for the greatest number in the shortest possible time but always ensure your own safety first!

Do not attempt cardiopulmonary resuscitation (heart massage) unless you have received instruction in the technique. Do not give a casualty any food or drink if they are badly injured, suspected of having broken bones, or are likely to require surgical treatment.

Primary Survey

Ensure your own safety first.
Assess the hazards and remove or secure them where possible.
Sort mobile casualties from immobile ones.
Assess the consciousness of any silent, immobile casualties by use of voice and/or tapping collarbone.
Use your voice first - "Can you hear me?".
If casualty responds, place in a comfortable position and monitor.
If casualty does not respond, tap their collarbone to check response to pain.
If casualty responds to tap, place in recovery position and arrange transfer to hospital.
If patient does not respond, assess their breathing and circulation (see below).
If breathing and pulse detected, place in recovery position, cover and arrange urgent transfer to hospital (advanced life support facility).
Where there are many casualties, if there is no breathing or pulse, move on to others.

Breathing Assessment

An open airway is essential.
Position the victim flat on their back on a firm surface.
Tilt the head back and pull the point of the chin up.
Check they have a clear airway, look in their mouth and remove any obstructions.
Look for the chest rising and falling, feel for expired air movement, and listen for breathing.

Circulation Assessment

Establish if the casualty has a heartbeat by checking their pulse.
Place two fingers on the casualty's Adams Apple and then slide fingers into the groove at its side. This pulse is more reliable than the one in the wrists.
Monitor the pulse for around 10 seconds.

Recovery Position

For use with unconscious casualties without suspected neck or spinal injuries.

The position maintains an open airway and allows any fluid to drain from the mouth.

For a casualty lying on their back, kneel beside their waist.
Extend their arm closest to you above their head.
Place their other arm across the chest and put their palm on the opposite shoulder.
Bend the leg farthest from you upwards as far as it will bend.
Place one hand on the bent knee, support the head and neck with the other hand slipped under the neck.
Pull gently on the knee until the casualty is lying on their side against your thighs.
Move their top leg until it is at a right angle to ensure the thigh is well forward.
Their head should be resting on their extended bottom arm - stretch out the top arm.
Tilt the head towards their extended hand to ensure the airway is open.
The casualty should now be in a stable position, check they cannot roll backwards or forwards.
Cover the casualty to keep body heat in.

Shock

Shock is caused by inadequate oxygen supply to body cells. It is life threatening.

Indicated by shallow and rapid breathing, weak and rapid pulse, anxiety, nausea, thirst, decreasing level of consciousness, and pale, cool, clammy skin.

Ensure the casualty has an open and clear airway.
Control any external bleeding.
It is important to elevate the casualty's feet if possible and loosen any tight clothing.
Immobilise any fractures and keep the patient warm.
Reassurance is important, but do not give any food or drink.
Monitor airway, breathing and circulation.

External Bleeding

External bleeding can lead to a lack of oxygen, decreased blood pressure, increased heart rate, shock and ultimately death.

Keep the casualty at rest and apply direct pressure to the wound.
Elevate the affected area and bandage up.
If bleeding through the bandage, apply more bandages over the original.
Treat the casualty for shock and monitor their circulation via nailbeds and pulse.
Loosen bandages if circulation is being compromised.
Do not remove embedded objects - pack dressings around the object and bandage in place.
Monitor airway, breathing and circulation.

Internal Bleeding

Look for bleeding from body orifices, blood in urine, fractures, or signs of shock.
If the abdominal area is affected, there may be pain, distension, spasms or rigidity.
Maintain an open airway and treat for shock.
Arrange for urgent transfer to advanced life support facility.
Monitor airway, breathing and circulation until help arrives.

Fractures

Expose the affected area but do not attempt to straighten.
Control any external bleeding - if bone is showing treat as for embedded objects.
Immobilise the casualty in the position found (use pillows, newspapers, etc).
Secure support above and below fracture to prevent movement.
Treat for shock, but do not move or elevate any affected limb.
Life threatening fractures are those of the skull, spine, ribs, femur and pelvis.
Monitor airway, breathing and circulation.

Burns

Life threatening if covering a large surface area (20% of body surface or more) and/or if casualty is very young or very old.

Treat by cooling with water or other available liquid.
Cover with non-fluffy material (plastic food wrap, plastic bags, etc) and repeat cooling as required.
Treat for shock.

Crush Injury

Crush injury will cause death if not treated correctly.
Has the casualty been crushed for 60 minutes or more?
If yes, leave the crushing agent in place, control bleeding, reassure and access medical personnel to assist.
If no, remove crushing agent, control bleeding and immobilise fractures.
In both cases, treat for shock and access advanced life support personnel as soon as possible.
Record the duration of crushing and time of release.
Monitor airway, breathing and circulation.

Spinal Injury

A conscious casualty may complain of head injury, numb or tingling arms or legs, inability to move limbs or head, or suffer from pain or profuse bleeding from head, neck or back.

In an unconscious casualty, look for head injury, profuse bleeding from head, neck or back, and the cause of injury.
Do not move the casualty unless breathing is threatened.
Watch their breathing, keep the patient warm and give reassurance.
Access advanced life support personnel who can transfer casualty correctly and safely.

If spinal injury casualty is in further danger

Unstable environments, hazards such as fire or gas and breathing problems may mean the casualty must be moved to preserve life.

It is critical to keep the nose in the position found when moving the casualty.
Firmly grip casualty's clothing close to the head, elevate the head, supporting the neck, and drag slowly.
If a head first drag is impossible, grasp casualty by ankles (not feet) using clothing for assistance and carefully drag them, observing upper body and head at all times.

Electric Shock

If possible, break the contact - switch off the current, pull the plug the cable free.

If the current cannot be broken, the casualty must be removed from the point of contact.

Insulate yourself first with rubber gloves or by standing on a dry, rubber surface or thick layers of dry cloth or dry newspaper.

Grasp the casualty's dry clothing or pull them away with a dry rope or stick.
Never use anything damp or metallic.
Check airway, breathing and circulation.
Treat any burns and treat for shock.

Hypothermia

Look for shivering (early stage), slow pulse, slow breathing, pale cool and dry skin, and irrational behaviour.

Move the casualty to a warm, dry site.
Remove any wet clothing.
Apply mild heat to chest area only.
Insulate from the ground, keep the patient covered and their head and neck warm.
If conscious and with no other serious injury, give a warm, sweet drink and/or chocolate.
If unconscious, place the casualty in the recovery position.