The Sunnyvale SNAP class last night was a real eye-opener. First of 2 sessions on disaster medical response. Forget what they teach you in Red Cross lifesaving class, because it’s “do the greatest good for the greatest number”. This is the same triage training that firefighters and police get– in fact, we saw a firefighter training video.
It’s fast, efficient, and brutally realistic.
START WHERE YOU STAND. When you enter the scene and become a first responder, whether it’s the doorway of a room, or (as in the film) going through the windshield of an overturned bus.
MINOR: Anyone who can stand up and walk past you, out to where you tell them to go, which is the first thing you do. Retain a couple of the ones that look the least bad and ask if they can stay here a minute, you may need them to help. Get one to call 911, if you aren’t responding to a 911.
Then, from nearest to you outward, you go and do a check on everyone else. It will take less than a minute per person; it may take less than 30 seconds per person. Yes, you or someone else will come back to them later, but you must check everyone.
Are they breathing? Yes, next test. No, clear airway and re-check. No, tag as DECEASED. That was the shocker for most of us. Why? Because when you begin CPR, you can’t stop until the professionals arrive. Which means that someone further on who you might be able to save may die. So you tag and move on. If they’re breathing but unconscious, ask one of your MINOR (walking wounded) to hold them in the cleared-airway position, or use the Recovery Roll to put them on their side so they won’t aspirate if they start to vomit.
Is their circulatory system ok? Pinch the finger of a hand, the earlobe, or the web between fingers hard. If the area doesn’t recover normal skin color in 2 seconds, tag as IMMEDIATE and stop any active bleeding. Get a MINOR to hold and press a cloth or dressing while you move on, or tie one on if you are alone. Not a tourniquet– a tight dressing. Tourniquets are ‘goodbye limb, we must save the person’. Don’t use. Ever. Unless you are EMT or similarly trained. If ok, move to next test.
Mental awareness? Ask questions you know the answer to (what day is it? do you know what happened? what city are we in?). If the person can’t answer, or is mumbling to themselves over and over, etc, tag as IMMEDIATE. Otherwise, tag as DELAYED.
That’s it. Period.
Not office first aid. Give the most people the best chance, because the assumption is that either temporarily or long-term, there just aren’t enough caregivers to deal with all the victims.
Sucking chest wound, but passes those 3 tests? DELAYED
Huge piece of metal sticking out of torso or eye? DELAYED
No breathing, but it’s a child or baby? DECEASED
I have no problem with this. From what some other folks in the class were saying, I wonder if I should have a problem with it. But I don’t. Not sure what that makes me, except, I hope, a survivor.
Relentless Inquiry 