Wednesday, April 16, 2014

Tourniquets: The Class Every CERT Wants to Take (But No CERT Wants to Use)

Based on the near-instant sellout for Fairfax County CERT's first-ever "tourniquet class," (officially known as "First Aid for Hostile Mass Casualty Incidents and Improved Splinting Skills") you might get the mistaken impression that huge numbers of people in the US are dying due to the lack of tourniquet training.

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A selection of commercially available tourniquets demonstrated during the class. Image by Flickr user joelogon. All images used under Creative Commons.
Fortunately, the truth is not quite so dire, and the need for tourniquets in the US is still pretty rare. (For example, a 5.5-year-study of Houston trauma centers found that, out of over 75,000 eligible cases, only 8 might have benefited from the use of a tourniquet.)

However, CERTs thrive on being prepared for low-probability, high-impact events of all kinds. And, with active shooter incidents and the one-year anniversary of the Boston Marathon bombing fresh in our minds, Fairfax County CERT instructors Rich Hall and Brian Talbot taught CERT students about the use of tourniquets, pressure dressings, occlusive dressings, and improved splinting techniques for both hostile and non-hostile environments.
 
A Hostile Environment Forces a Change in Treatment
A critical thing for CERTs to remember is that a hostile mass casualty incident (MCI) requires a very different response than non-hostile ones.

If there's a present threat, like an active shooter on the move or a bombing scene where secondary devices may be suspected, the goal of CERTs should be to keep themselves safe, while using the resources on hand to do two things for themselves and others:
  1. Stop major blood loss
  2. Treat open chest wounds
That's it. Unlike other scenarios CERTs train for, there is no triage, tagging, or treatment.

Applying Tourniquets
In a hostile environment (think "pinned down by an active shooter"), when faced with an obvious, actively spurting arterial wound to a limb, instructors Rich and Brian recommended immediately applying a tourniquet, instead of trying to first use a pressure dressing.

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Instructors Rich Hall and Brian Talbot demonstrate the use of a MAT tourniquet. Image by Flickr user joelogon.
They demonstrated the use of commercially available tourniquets, as well as improvised tourniquets made from materials likely to be on hand: belts, t-shirts, long sleeves torn off of shirts, etc.

When improvising a tourniquet, they advised that using wider materials is better, though if the alternative is letting someone bleed out to death, a shoelace is better than nothing.

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CERTs check for pulse after an improvised duct tape tourniquet is applied. Note that current EMT protocols usually call for tourniquets placed close to the wound site, while military practice is to apply tourniquets as high on the limb as possible. Image by Flickr user joelogon.
Students learned how to apply a tourniquet, and how to check that the pulse was stopped in the affected limb (to ensure that the tourniquet has stopped both arterial and venous blood flows, preventing a complication known as compartment syndrome).

CERTs were also taught how to apply a second tourniquet if blood flow wasn't completely halted, to mark a patient with the time the tourniquet was applied, and to never take off a tourniquet once applied.

Pressure Dressings
Instructors also demonstrated the use of pressure dressings to control less serious bleeding, using both a trauma bandage (popularly known as an "Israeli bandage"), as well as one improvised using gauze pads and rolls.

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Chris Thiel, Fairfax County CERT Class 74, acts as victim while Randy Weidman, Class 80, applies an Israeli-style trauma bandage, under the guidance of Instructor Brian Talbot. Image by Flickr user joelogon.

Occlusive Dressings
Penetrating chest injuries (like from gunshots, shrapnel, or stab wounds) can allow air into the cavity that surrounds the lungs, causing life-threatening breathing impairment.

To prevent this, Rich demonstrated how to cover a chest wound with a piece of plastic wrap (or similar impermeable material), sealing with tape on three sides to create a one-way valve. (He also reminded CERTs to check the back for an exit wound, which should be sealed on all four sides.)

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Rich demonstrates an occlusive dressing on a CPR dummy. Image by Flickr user joelogon.

Improving Your Splinting Technique
CERTs also learned improved techniques for a skill they'll be far more likely to use: Applying splints. CERTs learned how to use a second rescuer to stabilize the limb while applying the splint, and were reminded on best practices including:
  • Securing the splint by wrapping the limb above and below the point of injury
  • Immobilizing the joints above and below the injury using slings and swathes
  • Checking the limb before and after the splint is applied for PMS: Pulse, Movement, Sensation
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Instructor Rich Hall checks the secureness of the splint and sling on CERT James Weikert, as CERT Volunteer Lead Missy Tuttle-Ferrio assists. Image by Flickr user joelogon.

Summary
Hopefully, CERTs will never be in a position where they'll need to apply a tourniquet, though should the need arise, they'll be much more prepared.
The class is very hands-on and covers much more information not included in this blog post -- I highly recommend taking it.

Also, remember that tourniquets are not recommended for general civilian use, and please don't attempt to apply a tourniquet without proper training.

The next sessions for First Aid for Hostile Mass Casualty Incidents and Improved Splinting Skills (CERT-MCI-1) are scheduled for May 5 (class full) and June 9 (register now at FairfaxCERT.com).

Keep reading the weekly Fairfax County CERT emails for announcements for upcoming classes, for this class and other great offerings.



Did you attend the class and have any impressions to share? Or are you planning on taking this course in the future? Please leave a comment below.

Thursday, March 27, 2014

Being Prepared Is Practically Cheating: Fairfax County CERT Spring 2014 Final Exercise

On Saturday, March 22, 52 students from Fairfax County's Community Emergency Response Team (CERT) classes 78, 79, and 80 faced a final exercise specifically designed to test the disaster response skills they'd learned over the previous seven weeks, in a realistic training environment filled with wrecked buildings and live human victim actors.

The CERT students tore through the scenario, rescuing 64 victims and completing a lifting and cribbing skills challenge in near-record time.

How'd they do so well, so fast? They cheated.

Or, more accurately, they prepared so thoroughly in advance, when CERT command staff and rescuers executed their plan, they started so quickly and were so efficient and effective it practically looked like they were cheating.

Command Staff Pre-Planning
CERTs don't operate in the complete unknown; instead, when called to respond in their communities, they rely on their knowledge of local vulnerabilities, resources, and hazards, and combine it with their CERT training. Given the rough outlines of the scenario (a hurricane striking a local retirement community) in advance, the command staff began to plan.

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CERT IC Rob Pratten, Accountability lead Suzanne Anglewicz, and Assistant IC Jamie DeMonaco confer at the Command Post. Photo: Joe Loong
 Rob Pratten, tapped to be Incident Commander three days before the exercise, and Accountability lead Suzanne Anglewicz developed a plan of attack using the organizational framework they'd learned in their classes.

In addition to designating Medical and Logistics leads, they divided rescuers into 2-person teams, initially assigning four teams to each of their four buildings. More importantly, they designated one team each to act as the area commander for the rescue efforts in and around their building, in some measure decentralizing command functions to let them focus on the bigger picture.

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CERTs prepare in the staging area. Photo: Joe Loong
 Saturday morning, the command team tapped CERT Jamie DeMonaco to fill the Assistant IC role, then used the critical time before the start of the exercise to communicate the strategy and organize the CERTs into each of the required functions for the rescue effort.


CERTs Deploy
Once in action, CERTs rapidly went to work, deploying their organization and executing their tasks. CERT rescuers had to use the skills they learned to survey the scene, conduct a safe building search, rapidly triage and treat victims in the field, transport injured survivors to the Medical area, and provide care until additional resources arrived.

CERTs enter the grounds at the start of the exercise and start to deploy. Photo: © 2014 Daniel Liebman, All Rights Reserved

Several CERTs commented on how the state of the wrecked buildings at the former Lorton Juvenile Detention Center truly added to the realism and the stress of the exercise. Rescuer John Hanchulak noted that CERTs had to be mindful at all times of the potential hazards in the buildings, and exercise controllers reinforced that point by keeping an eye out for rescuers not properly using their Personal Protective Equipment.

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CERTs transport a victim actor from a wrecked building. Photo: Joe Loong

Adding to stress levels were the victim actors, made up with moulage (realistic wound makeup), and who added stress and confusion to the exercise by acting out their injuries and responding realistically -- and sometimes uncooperatively -- to commands.

Left: Victim actor getting moulage (wound makeup) applied. Right: Victim actor in the field with a simulated cheek laceration. Photo: © 2014 Daniel Liebman, All Rights Reserved

Reactions to "Injections"
During any exercise, challenges will appear: Communications problems  arise, bottlenecks form, resources get constrained, and more. Building Commander Chris Kocsis noted that one of his greatest challenges was keeping track of victims. IC Pratten was sometimes frustrated by resource limitations and communications gaps with Building Commanders. Assistant IC Jamie DeMonaco noted a few teams were "lost," out of communication for a while. Rescue teams occasionally mis-tagged victims.

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CERT rescuers treat "bulldozer driver" Jeffrey Katz for a medical emergency.
However CERTs continued to adapt and overcome problems, doing so well that Exercise Controller Mike Forgy had to inject several additional challenges into the exercise: An unexpected building to survey, a simulated fire breaking out, and a medical emergency suffered by a distant bulldozer driver (played by Fairfax County Fire & Rescue Department Volunteer Coordinator Jeffrey Katz).

Transfer of Command
Towards the end of the exercise, members of the Fairfax County Fire & Rescue Department arrived to take command. CERT command staff provided an accurate accounting of actions taken and status of patients rescued, then handed off command to the professional first responders.

The CERT IC transfers command scene to arriving Fairfax County Fire & Rescue Department personnel. Photo: Carlos Santiso
Teen CERTs
Of particular note were the Teen CERTs from Class 78, from the Falls Church High School Academy. The students take CERT training as part of their studies in the Fire and Emergency Medical Sciences to prepare them for careers in the emergency services.

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Some of the Teen CERTs from the Falls Church High School Academy. L-R: Alexa Chavera, Alex Bottlick, Joey Barbaris, Matt Whalen, Tommy Veatch. Photo: Joe Loong
Since the Academy students also get firefighting and EMT training, the CERT program complements their skills. Several noted they especially enjoyed the search and rescue training, which they got to use when they were were integrated into rescue teams, working alongside CERTs with whom they hadn't previously met.

No matter what their age or physical ability, the skill demonstrated by the graduating CERTs showed that trained CERTs with a plan are able to "cheat" and beat disasters.



For more photos from the exercise, visit the Fairfax County CERT Facebook page. For information about upcoming activities and training opportunities with Fairfax County CERT, visit http://www.fairfaxcountycert.org.

Wednesday, March 26, 2014

Children's Disaster Services Workshop, March 28-29, 2014

The Virginia chapter of VOAD (Volunteer Organizations Active in Disaster) passes along this unique training opportunity starting this Friday, March 28:

Children's Disaster Services is an organization that screens and trains volunteers who set up child care centers in shelters and disaster assistance centers across the country.

A Children's Disaster Services volunteer works with a child after the 2011 Joplin, Missouri tornado. Photo: CDS on Facebook
By caring for children, CDS volunteers ease the burden of parents, and use toys, art, play, and other techniques to help children start to recover after a disaster.

CDS volunteers helps a child paint after Tropical Storm Issac in 2012. Photo: CDS on Facebook

The Arlington, Virginia workshop starts Friday, March 28, running overnight through Saturday, March 29, at Marymount University in Arlington:

Marymount University
1000 N. Glebe Rd.
Arlington, VA 22207

The registration fee is $55, and participants (over the age of 18) should bring a sleeping bag and personal items, because the 27-hour workshop includes an overnight stay in a simulated shelter.

In addition, workshop participants will get hands-on training on how to set up a Children's Disaster Service Center, and how to provide a calm, safe, and reassuring environment after a disaster. (See more details about the workshops.)

To register and to get additional contact information, visit:


Thursday, March 13, 2014

When Was the Last Time You Were in a CERT Exercise? Join Us March 22nd!

Calling all Fairfax County CERTs! On Saturday, March 22nd, our current crop of CERT students will have their final graduation exercise at the training grounds of the lovely former Lorton Juvenile Detention Facility.

As a trained CERT, there are three ways you can participate. To get more details and to claim your spot, please email Kevin at actors@fairfaxcountycert.org:

1. Be a Player! Did you know CERTs from previous classes can be rescuers in the graduation exercises? (I didn't, until this week.) If it's been a while since you last strapped on your CERT gear, take this chance to fulfill your training requirement and practice your triage, search and rescue, disaster medical skills, and more in a realistic, simulated disaster environment.

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CERT students from class 73 transport a patient during their graduation exercise.
Not only do you get to work on your skills, but your participation also gives the student CERTs practice working with unfamiliar people.

To be a rescuer, you'll need your CERT gear, plus long pants and closed-toe shoes. Also, bringing a victim actor is appreciated.

2. Help Run the Exercise: A smooth-running exercise needs a lot of help behind the scenes.

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CERT controllers and support staff get briefed before a final exercise.
Roles for CERTs include:
  • Moulage: If you've had moulage training, you can help give the victim actors the wound makeup that adds to the realism of the drill. Moulage personnel arrive need to arrive early, and can either check out after the makeup is done, or help in other ways (as player, helper, or even as a victim.)
  • Division Controllers: During the exercise, division controllers help mark off "no-go" areas, place victim actors, keep headcounts, and watch CERT students and actors during the exercise to make sure that they maintain safety all times.
  • Logistics: Logistics personnel support the exercise controller to do everything else: deliver supplies, help set up, and more. (There may be other roles, too, like helping with evaluations.)
3. Be a Victim Actor: As always, CERTs, family members, friends, minors with parental permission, those looking for community service credits, and all others are welcome to participate as victims.

Victim actors will need to arrive at the Lorton site around 7AM; wear clothes you don't mind messing up, and make sure you have long pants and closed-toe shoes. You'll get made up with moulage (wound makeup), and given symptoms to act out:

Examples of different types of moulage used by victim actors in an exercise.
Afterwards, lunch will be served, and victim actors will be released by about 1:30pm.

Whether you participate as rescuer, helper, or actor, being part of a CERT exercise is a lot of fun. For more info and to reserve your spot as a rescuer, helper, or victim actor, email Kevin at actors@fairfaxcountycert.org.

Thursday, January 23, 2014

Preparedness Tips Via Text Message? FEMA Has It Covered...

You may know that FEMA uses text messages to help people find open shelters and open disaster recovery centers during an incident. However, did you know you can also sign up to receive regular safety tips for specific disaster topics ranging from hurricanes, home fires, and more?  For example, you can text WINTER to 43362 to receive winter storm and extreme cold safety tips directly to your cell phone (standard message and data rates apply).

cell phonesFEMA sends you bi-monthly safety tips on a variety of disaster related topics:  
  • Hurricanes: text HURRICANE to 43362 (4FEMA)
  • Home fires: text FIRE to 43362 (4FEMA)
  • Wildfires: text WILDFIRE to 43362 (4FEMA)
  • Tornadoes: text TORNADO to 43362 (4FEMA)
  • Earthquakes: text EARTHQUAKE to 43362 (4FEMA)
  • Winter storms and extreme cold: text WINTER to 43362 (4FEMA)
  • Power outages: text BLACKOUT to 43362 (4FEMA)
  • Floods: text FLOOD to 43362 (4FEMA)
  • General monthly safety tips: text PREPARE to 43362 (4FEMA)
A couple of details to note about the program:
  • If subscribing to more than one list, please send a separate text for each topic. 
  • There is no limit to the number of lists you can subscribe to.
  • Sending STOP will automatically unsubscribe you from all lists. 
All FEMA text messages are sent from a dedicated number, which is 43362 (4FEMA).  Also, the FEMA text message program is not a substitute for 9-1-1. During an emergency, call your local fire/EMS/police or 9-1-1.

Learn more about the FEMA Text Message Program.

Friday, January 17, 2014

FEMA Seeking Applicants for its Youth Preparedness Council

[Editor's Note: As CERTs, we know how important it is to look at citizens not as potential victims, but as assets to help increase preparedness and respond to disasters. This also holds true for youths, teens, and young adults: Getting their involvement is vital to increasing community resilience and preparedness. Not only are kids great at convincing their parents to do stuff, but if you can get a child into the habit of preparedness early on, they'll be more likely to keep that mindset for life.

FEMA has a Youth Preparedness Council that seeks to represent youth and find ways to increase preparedness awareness among them. The following is a press release seeking applicants for the council. If you know of a preparedness-minded child or teen between the ages of 12 and 17, let them know about this great opportunity.]

Washington, D.C. – The U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA) is seeking applicants for its Youth Preparedness Council.

The Youth Preparedness Council is a unique opportunity for youth leaders to serve on a highly distinguished national council and participate in the Youth Preparedness Council Summit. Additionally, the youth leaders have the opportunity to complete a self-selected youth preparedness project and to share their opinions, experiences, ideas, solutions and questions regarding youth disaster preparedness with the leadership of FEMA and national youth preparedness organizations. Once selected, members serve on the Council for one year, with the option to extend for an additional year, if formally requested by FEMA.

Washington, D.C., Aug. 6, 2012 -- Tim Manning, Deputy Administrator for National Preparedness listens as council members discuss their experiences with dealing with disasters. The council also met with Administrator Fugate and discussed steps to strengthen the nation's overall resiliency.
Council activities and projects center around five key areas of engagement: Programs, Partnerships, Events, Public Speaking/Outreach and Publishing. Members represent the youth perspective on emergency preparedness and share information with their communities. They also meet with FEMA on a regular basis to provide ongoing input on strategies, initiatives and projects throughout the duration of their term.

Any individual between the ages of 12 and 17 who is engaged in individual and community preparedness or who has experienced a disaster that has motivated him or her to make a positive difference in his or her community, may apply to serve on the Youth Preparedness Council. Individuals who applied last year are highly encouraged to apply again. Adults working with youth and/or community preparedness are encouraged to share the application with youth who might be interested in applying.

Youth interested in applying to the Council must submit a completed application form and two letters of recommendation. Specific information about completing and submitting the application and attachments can be found in the application instructions. All applications and supporting materials must be received no later than February 24, 2014, 11:59 p.m. EST in order to be eligible. New Youth Preparedness Council members will be announced in May 2014.

For more information about the Youth Preparedness Council and to access the application materials, please visit http://www.ready.gov/youth-preparedness-council.

Tuesday, December 31, 2013

CERTs: Are you "Ready" for 2014?

I think it's safe to say that we CERTs believe that we're better prepared for disasters than many of our friends, neighbors, and even family members. (Sometimes, we might even feel a bit smug about it.)

Then again, all too often, people find themselves falling victim to "Do as I say, not as I do" syndrome.

For 2014, resolve to do your part to use your CERT training to help your community (including your own family) be better prepared for disasters and emergencies.

Emergency Mommy: Put more meaning in your merry & give the gift of preparedness
Image by Flickr user emergencyinfobc, used under Creative Commons license.
But before you start going around asking people to "Resolve to Be Ready" in 2014 (which I hope you'll do... more on that in a moment), take a moment to look at your own preparedness:
  • Have you updated your family's communication plan in the past year? And have you reviewed it with your family?
  • Have you checked your 72-hour disaster supply kit, making sure no one's "borrowed" stuff from it over the past year, and checked to see that things like batteries, medical supplies, and prescription drugs are still good? (The same goes for additional kits, like in your car or workplace. And how about your CERT backpack?)
  • Have you stayed current in your disaster skills and knowledge? Taken refresher CERT training, or renewed your First Aid and CPR/AED certification? Downloaded the helpful smartphone apps from FEMA and American Red Cross, and bookmarked the FEMA mobile site? And liked or followed Fairfax County CERT on Facebook and Twitter?

Resolve for 2014

After you've reviewed your own family's preparedness, I hope you'll use your knowledge and leadership as a CERT to help your friends, neighbors, and community become better prepared in 2014. It can be as simple as posting a Facebook status asking people to check out Ready.gov's Prepared 2014 page, which reminds everyone that "Winging It" is not an emergency plan:
 

Together, let's make our friends, neighbors, and nation better prepared in 2014. Have a happy and safe New Year's holiday, and we look forward to seeing you in a prosperous and prepared 2014!