The main treatments for an amputation (the traumatic severing of a limb or other body part) are to:

Control bleeding

Treat shock

When the severed body part can be located, CERT members should:

Save tissue parts, wrapped in clean material and placed in a plastic bag, if available. Label them with the date, time, and victim’s name.

Keep the tissue parts cool, but NOT in direct contact with ice

Keep the severed part with the victim

Because time is critical when CERTs activate, CERT medical operations personnel will need to select a site and set up a treatment area as soon as injured victims are confirmed.

Determining the best location(s) for the CERT treatment area should include the following overall considerations:

Safety for rescuers and victims

Most effective use of resources, e.g., CERT members themselves, time, medical supplies

Removing Dressing and Applying New:

In the absence of active bleeding, dressings must be removed and the wound checked for infection at least every 4 to 6 hours.

If there is active bleeding, a new dressing should be placed over the existing dressing

Patients in the treatment area should be positioned in a head-to-toe configuration, with 2 to 3 feet between victims. This system will provide:

Effective use of space

Effective use of available personnel.

As a team member finishes one head-to-toe assessment, he or she turns around and is at the head of the next patient.

Burns are classified as first-, second-, or third-degree, depending on how deep and severe they penetrate the skin’s surface.

First-degree (superficial) burns. First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually consists of an increase or decrease in the skin color.

Second-degree (partial thickness) burns. Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.

Third-degree (full thickness) burns. Third-degree burns destroy the epidermis and dermis and may go into the subcutaneous tissue. The burn site may appear white or charred.

Treatment for burns involves removing the source of the burn, cooling the burn, and covering it.For full thickness burns, always treat for shock.

A sprain involves a stretching or tearing of ligaments at a joint and is usually caused by stretching or extending the joint beyond its normal limits.

Sometimes, you may encounter some victims who have foreign objects lodged in their bodies – usually as the result of flying debris during the disaster.

When a foreign object is impaled in a patient’s body, you should:

Immobilize the affected body part

Not attempt to move or remove the object, unless it is obstructing the airway

Try to control bleeding at the entrance wound without placing undue pressure on the foreign object

Clean and dress the wound making sure to stabilize the impaled object. Wrap bulky dressings around the object to keep it from moving.

The objective when treating a suspected fracture, sprain, or strain is to immobilize the injury and the joints immediately above and below the injury site.

Head-to-toe assessments should be:

Conducted on all victims, even those who seem all right

Verbal (if the patient is able to speak)

Hands-on. Do not be afraid to remove clothing to look.

A dislocation is an injury to a joint — a place where two or more bones come together — in which the ends of your bones are forced from their normal positions. This painful injury temporarily deforms and immobilizes your joint.

Open fractures are more dangerous than closed fractures because they pose a significant risk of severe bleeding and infection. Therefore, they are a higher priority and need to be checked more frequently.

When treating an open fracture:

Do not draw the exposed bone ends back into the tissue.

Do not irrigate the wound. You should:

Cover the wound with a sterile dressing
Splint the fracture without disturbing the wound

Place a moist 4 by 4-inch dressing over the bone end to keep it from drying out

Poor sanitation is a major cause of infection.

CERT medical operations personnel can maintain sanitary conditions by:

Controlling the disposal of bacterial sources (e.g., soiled exam gloves, dressings, etc.)

Putting waste products in plastic bags, tying off the bags, and marking them as medical waste. Keep medical waste separate from other trash, and dispose of it as hazardous waste.

Burying human waste. Select a burial site away from the operations area and mark the burial site for later cleanup.

The objectives of a head-to-toe assessment are to:

Determine, as clearly as possible, the extent of injuries

Determine what type of treatment is needed

Document injuries

Remember to always wear your safety equipment when conducting head-to-toe assessments.

The most common signs of a sprain are:

Tenderness at the site of the injury

Swelling and/or bruising

Restricted use or loss of use

The main treatment for wounds includes:

Control bleeding

Clean the wound

Apply dressing and bandage

An anatomical splint is used when the person’s body is the splint. For example, you can splint an arm to the chest or an injured leg to the uninjured leg.

Anatomical splints are usually reserved for fingers and toes, but, in an emergency, legs may also be splinted together.

Soft materials should be used to fill the gap between the splinting material and the body part.

With this type of injury, there will be swelling. Remove restrictive clothing, shoes, and jewelry when necessary to prevent these items from acting as unintended tourniquets.

Major Functions of Medical Operations:

Triage – The initial assessment and sorting of victims for treatment based on the severity of their injuries

Treatment – The disaster medical services provided to victims

Transport – The movement of victims from incident location to the treatment area

Morgue – The temporary holding area for victims who have died at the treatment area. Those who are tagged as “Dead” during triage are not removed from the incident site.

Supply – The hub for crucial supply procurement and distribution

The “I” and “D” areas should be relatively close to each other to allow:

Verbal communication between workers in the treatment areas

Shared access to medical supplies (which should be cached in a central location)

Easy transfer of patients whose status has changed victims who have been identified with minor injuries may choose to stay at the treatment area or leave.

If they stay, they can assist CERT personnel. If they leave, it should be documented.

The primary public health measures include:

Maintaining proper hygiene

Maintaining proper sanitation

Purifying water (if necessary)

Preventing the spread of disease

Treatment areas should be:

In a safe area that is close to, but uphill, upwind, and, if possible, upstream from the hazard area

Accessible by transportation vehicles

Expandable

A displaced fracture is when the bone breaks and moves so the two ends are not lined up straight.

If the limb is angled, then there is a displaced fracture.

An open fracture is a broken bone with some kind of wound that allows contaminants to enter into or around the fracture site.

A closed fracture is a broken bone with no associated wound.

First aid treatment for closed fractures may require only splinting.

The medical community uses the acronym DCAP-BTLS to remember what to look for when conducting a rapid assessment.

DCAP-BTLS stands for the following:

Deformities
Contusions (bruising)
Abrasions
Punctures
Burns
Tenderness
Lacerations
Swelling

When conducting a head-to-toe assessment, CERT members should look for DCAP-BTLS in all parts of the body.

Remember to provide IMMEDIATE treatment for life-threatening injuries.

You should pay careful attention to how people have been hurt (the mechanism of injury) because it provides insight to probable injuries suffered.

A dressing is applied directly to the wound.

Whenever possible, a dressing should be sterile.

A bandage holds the dressing in place.

If a wound is still bleeding, the bandage should place enough pressure on the wound to help control bleeding without interfering with circulation.

It is very important to thoroughly document the victims in the treatment area, including:

Name, address, and phone number if victim is able to talk

Description (age, sex, body build, estimated height)

Clothing

Injuries

Treatment

Transfer location

Signs of possible infection include:

Swelling around the wound site

Discoloration

Discharge from the wound

Red striations from the wound site

Remove restrictive clothing, shoes, and jewelry when necessary to prevent these items from acting as unintended tourniquets.

Rescuers should not put anything on wounds other than purified water.

The use of other solutions (e.g., hydrogen peroxide) on wounds must be the decision of trained medical personnel.