Mass Casualty incidents are incidents in hich the number of casualties overwhelms local resources. 

CERT members can play an important role by supporting local resource in responding to the incident.

Mass Casualty incident examples

1. Commuter train derailment

2. Multi-car accident

3. Bus accident

4. Building collapse

5. Natural disasters

First responder actions during mass casualty incidents

1. Establish command and control of the incident area

2. Conduct a scene size-up and set-up

3. Send survivors with relatively minor injuries to a holding area to await treatment

4. Identify survivors who require life-saving interventions and treat them immediately

5. Identify deceased victims as well as survivors too severely injured to save

6. Manage medical transportation for survivors who require additional treatment

7. Secure the area to protect first responders, survivors, and evidence for law enforcement investigations

8. Remove debris and other safety or health threats

Role of CERT volunteers during during mass casualty incidents

As soon as injured survivors are confirmed

1. First responders will begin to set up one or more treatment areas

   1. Treatment areas will take into consideration safety for rescuers an survivors

   2. Ease of access to resources

      1. medical supplies

      2. transport areas

2. First responders may call on CERT volunteers to help establish treatment areas or supply needs.

Decentralized treatment areas

1. It is sometimes necessary to set up more than one treatment locations determined by:

   1. The severity of the damage

   2. number of injuries and casualties

   3. Safety of immediate environment

2. Determine where the initial treatment area(s) should be located.

   1. A medical treatment location

      1. Should be set-up a safe distance from each of the damage sites

   2. Each treatment location

      1. Should include physically separated treatment areas for 

         1. survivors

         2. morgue

   3. Survivors remain under treatment at the location until first responders

      1. can transport them to a location for professional medical care

   4. The location of treatment areas will take into consideration safety for 

      1. Rescuers

      2. Survivors

Centralized Treatment Areas

CERT volunteers may play a role in light search and rescue operations

During an assessment you should look for:

1. Severe Bleeding

2. Low body temperature

3. Airway obstruction

A head-to-toe assessment tries to determine the nature of a patients injury.

• perform assessment before intiating treatment

• Do not conduct an assessment if a patient requires immediate care to prevent serious injury.

  • In these cases CERT volunteers should administer the necessary treatment before they follow up with an assessment

Objectives of Head-to-Toe assessments

1. Determine the extent of injuries

2. Determine what type of treatment the patient needs

3. Document injuries

Remember to wear PPE when conducting head-to-toe assessments

Head-to-toe assessments: What to look for

use the acronym DCAP-BTLS to remember what to look for in a head-to-toe assessment

1. Deformities

2. Contusions (bruising)

3. Abrasions

4. Punctures

5. Burns

6. Tenderness

7. Lacerations

8. Swelling

When conducting a head-to-toe assessment, 

1. CERT volunteers should look for DCAP-BTLS in all parts of the body

2. Remember to provide immediate treatment for life-threatening injuries

3. Pay attention to how people have been hurt (i.e. what caused harm/ injury)

How to conduct a head-to-toe assessment

1. If the person is conscious; 

   1. CERT members should always ask permission to conduct assessment.

      1. The patient has the right to refuse treatment.

   2. CERT volunteers should ask the person about any:

      1. Injuries

      2. Pain

      3. bleeding

      4. other symptoms

   3. Be sure to talk with the patient to reduce anxiety.

Head-to-toe-assessments should be

1. Conducted on all survivors

2. Verbal (if patient is able to speak)

3. Hands on (Do not be afraid to remove clothing to look)

Make sure you conduct head-to-toe assessments the same way.

1. pay careful attention

2. look, listen, and feel for anything unsual

3. suspect a spinal injury in all survivors and treat accordingly

4. Check your own hands for patient bleeding 

   1. as you perform the assessment

5. Check BTLS body parts from head-to-toe

   1. Head

   2. Neck

   3. Shoulders

   4. Chest

   5. Arms

   6. Abdomen

   7. Pelvis

   8. Legs

6. While conducting the Head-to-toe assessment CERT volunteers should check for

   1. PMS

      1. Pulse

      2. movement

      3. sensation

   2. Medical Id emblems on

      1. Bracelet

      2. necklace

Closed- head, Neck, and Spinal Injuries

When conducting Head-to-toe assessments

1. Rescuers may find survivors who have suffered injuries to the:

   1. Head

   2. neck

   3. spine

A closed head injury

1. is a concussion-type injury

2. a laceration can indicate that the survivor suffered a closed head injury

The main objective when CERT members suspect injuries to the head or spine is to:

1. do no harm

   1. you should minimize movement of the head and spine

      1. while treating life threatening conditions

The signs of a closed-head, neck or spinal injury most often include:

1. Change in consciousness

2. inability to move one or more body parts.

3. severe pain or pressure in head, neck, or back.

4. Tingling or numbness in extremities.

5. Difficulty breathing or seeing

6. Heavy bleeding, bruising, or deformity of the head or spine.

7. blood or fluid in the ears or nose.

8. bruising behind the ear.

9. Racoon eyes (bruising around eyes)

10. "uneven" pupils

11. Seizures 

12. Nausea or vomiting

If survivors are exhibiting:

1.  any of these signs or 

2. if survivors is found under collapsed 

   1. building material

   2.  heavy debris

You should treat them as having a closed-head, neck, or spinal injury.

Stabilizing the Head

The primary public health measures include:

1. Maintaining Proper hygiene

2. Maintaining Proper Sanitation

3. Purifying Water

4. Preventing the spread of disease

Maintaining Hygiene

Steps to maintain Hygiene

1. wash hands frequently with soap and water

   1. 15-20 seconds with vigorous rubbing

   2. alcohol sanitizers at least 60% alcohol

2. Wear non-latex gloves at all times

3. Keep dressings sterile

4. Wash any areas that come into contact with bodily fluids with

   1. soap and water

   2. diluted bleach

Maintaining Sanitation

Steps to maintaining sanitary conditions

1. Controlling the disposal of bacterial sources

2. Putting waste products in plastic bags

3. tying off the bags

4. marking them as medical waste

   1. Keep medical waste separate from other trash

      1. dispose of it as hazardous waste

   2. Burying human waste

      1. select a burial site away from the operations area and mark the burial site for later clean-up

Water Purification