Shock is a condition that occurs when the body is not getting enough blood flow.

When blood doesn’t circulate, oxygen and other nutrients are not carried to tissues and organs.

Blood vessels begin to close and organs are damaged and, if left untreated, will shut down completely.

Shock can worsen very rapidly.

Remaining in shock will lead to the death of:

Cells

Tissues

Entire organs

Immediate (I): The victim has life-threatening injuries (airway, bleeding, or shock) that demand immediate attention to save his or her life; rapid, lifesaving treatment is urgent.These victims are marked with a red tag or labeled “I”

The main signs of shock that CERT members should look for are:

Rapid and shallow breathing

Capillary refill of greater than 2 seconds

Failure to follow simple commands, such as “Squeeze my hand”

Although victims who are suffering from shock may be thirsty, they should not eat or drink anything initially because they may also be nauseated.

Capillary Refill:

How long it takes for the color to return to the skin. Also called the “blanch test.”

A good place to do the blanch test is the palm of one hand. Sometimes, a nail bed is used.

You should see the color return to the tested area within 2 seconds.

Elevate the wound above the level of the heart

Put pressure on the nearest pressure point to slow the flow of blood to the wound. Use the:

brachial point (bend of the elbow) for bleeding in the arm

femoral point (inner thigh) for bleeding in the leg

popliteal point (back of the knee) for bleeding in the lower leg.

The correct pressure point is between the wound and the heart.

1 – Maintain an open airway.2 – Control obvious bleeding.3 – Maintain body temperature (e.g., cover the ground and the victim with a blanket if necessary).Notes – Avoid rough or excessive handling.Do not provide food or drink.

Voice Triage:

Begin by calling out, “Community Emergency Response Team. If you can walk, come to the sound of my voice.” Speak loudly and firmly.

If there are survivors who are ambulatory, tag them M (Minor) and direct them to a designated location.

Minor (M) : Walking wounded and generally ambulatory. These victims are marked with a green tag or labeled “M”

Dead (DEAD) : No respiration after two attempts to open the airway.Because CPR is one-on-one care and is labor intensive, CPR is not performed when there are many more victims than rescuers.These victims are marked with a black tag or labeled “DEAD”

Simple Triage And Rapid Treatment

Capillaries carry blood under low pressure.

Blood coming from capillaries will ooze.

Delayed (D): Injuries do not jeopardize the victim’s life. The victim may require professional care, but treatment can be delayed.These victims are marked with a yellow tag or labeled “D”

Tag them as “Black” and move to the next victim.

In an unconscious or semiconscious victim, especially one positioned on his or her back, the most common airway obstruction is the tongue. The tongue — which is a muscle — may relax and block the airway.A victim with a suspected airway obstruction must be checked immediately for breathing and, if necessary, the airway must be opened.The head-tilt chin-lift is the most reliable method of opening the airway.

A pressure bandage should be tied with a bow, so that it can be loosened — rather than cut — to examine the wound, and then retied.

This procedure helps to conserve supplies and saves time. The bandage maintains the direct pressure needed to stop the bleeding.

CERT members: continue to assess the victim’s status.

If the victim’s limb is turning blue or becoming numb below the bandage, then it should be loosened.

Veins transport blood under low pressure.

Blood coming from a vein will flow.

In mass casualty events, medical personnel:

Identify the dead and those who are too severely injured to be saved

Send those with relatively minor injuries and wounds to a holding area to await treatment

Identify those who would die from life-threatening injuries and treat them immediately

The term for this is Triage.

If the victim’s breathing is rapid and shallow, i.e., more than 30 breaths per minute

In emergency medicine, airway obstruction, bleeding, and shock are “killers” because without treatment they will lead to death.The first priority of medical operations is to attend to those potential killers by:

Opening the airway

Controlling excessive bleeding

Treating for shock

The three methods of controlling bleeding are:

Direct Pressure

Elevation

Pressure Points

Direct pressure and elevation will control bleeding in 95% of cases.

Arteries transport blood under high pressure.

Blood coming from an artery will spurt.

The phases of death from trauma are:

Phase 1: Death within minutes as a result of overwhelming and irreversible damage to vital organs

Phase 2: Death within several hours as a result of excessive bleeding

Phase 3: Death in several days or weeks as a result of infection or multiple organ failure (i.e., complications from an injury)

Rescuer safety is crucial during triage.

Rescuers must wear all safety equipment, including non-latex exam gloves, goggles, a helmet, and an N95 mask when examining victims and should try to change gloves between victims.

Because of limited supplies, it may not be possible to use a new pair of gloves for every victim. If this is the case, gloves may be sterilized between treating victims using 1 part bleach to 10 parts water.

To Sort

Triage must be practiced to avoid triage pitfalls.

Triage pitfalls include:

No team plan, organization, or goal

Indecisive leadership

Too much focus on one injury

Treatment (rather than triage) performed

There are several ways to evaluate mental status.Ask, “Are you okay?”Give a simple command such as “Squeeze my hand.”If you are concerned that there might be a language barrier or hearing impairment, reach out with both hands and squeeze one of the victim’s hands. The person will squeeze back if they can.

Treatment for life-threatening conditions – airway obstruction, bleeding, and shock – and for other, less urgent conditions – the greatest good for the greatest number of people by conducting Simple Triage And Rapid Treatment (START)