DISASTER  RESPONSE – AN  OVER  VIEW

(Chapter – 4)

 

 

It is necessary to take firm and quick decision to save lives and property.  To achieve these objective Rly. have a well defined action plan that is successfully executed by the co-ordinated efforts of different disciplines, all of whom function as a team.  The three groups which are active during Disaster response, may be classified as follows –

A.     Instant Action Team (IAT)

B.      First Responders (FR)

C.      Disaster Management Team (DMT)

D.      Coordination centres.

 
4.1        FIRST AID IN  EMERGENCY
4.1.1         Order of priority for dealing with and helping injured passengers should be as follows –

F     Unconscious

 

F     In a state of shock

F      Bleeding excessively

 

F      Having fractures

F      Having breathing problems

 

F      Simply injured

F      Grievously injured

 

 

 

 

4.1.2         For assessing and handling injuries, acronym  DR  ABC is to be followed -

i.    D- Danger

Look for danger.  Make sure that no further danger exists either for the patient or for the First Aider

ii.   R – Response

Check for consciousness.  Call by his/her name, slap, pinch and shake gently.  If there is no response, then it means that the patient is unconscious.

iii.   A – Air Way

Clear the airway(Trachea).  If patient is unconscious, then the airway may be narrowed or blocked making breathing impossible.  This occurs due to several reasons.  Mass food particles or foreign body in the air passage; or the tongue may have sagged back and blocked the air passage.

To open the airway lift the chin forward with the fingers of one hand while pressing the forehead backwards with the other hand, now the tongue comes forward and the airway is cleared.  To clear the other objects in the mouth press the Jaw, open the mouth put your fingers or a clean cloth in the mouth and clear the things.  Now the air passage is clear.

iv.   B - Breathing

Check for Breathing.  Keep the back of your fingers near the nose of the patient.  You can feel the warm air (or) keep your ear near the nose and look for the movement of chest, listen to the sound from the throat and feel the warm air from the nose.

v.   C - Circulation

Check the pulse.  Normally we check the pulse at the wrist, however, sometimes it is not felt because of severe bleeding.  So, it is better to check the pulse at neck. (Carotid Pulse)

 

4.1.3         After checking DR ABC, there may be two possibilities –

                                      i.      If patient is breathing, has circulation but is unconsciousness, immediately turn him to Recovery position and transport to hospital.

                                     ii.      If the patient has failure of breathing and circulation, then immediately start CPR (CARDIO PULMONARY RESUSCITATION) the important life saving technique in First Aid.

4.1.4        Recovery position -

                                      i.      Recovery position is the safest position for unconscious patients.  Normally we keep the patient in a supine position.  However, in case of unconscious patients, it is a very dangerous position because the tongue can fall back and close the airway or saliva and other secretions may get into windpipe.  To avoid that, turn the casualty into recovery position and transport to hospital.

                                     ii.      Sometimes, you may not be in a position to do First Aid due to tense situation.  In such circumstances at least turn the casualty to Recovery position, which would help to save many precious lives.

 

4.2        GOLDEN  HOUR  RULE

4.2.1         The basic principle of Trauma Management is speed and expediency – “Most Trauma patients die of shock, which comes from sluggish or non existent circulation and the resulting chemical changes in the body. “ ( Dr. R. Adams Cowley,  Maryland Institute for Emergency Medical Services). Thus the first Hour after accident is termed as “ GOLDEN HOURS”  as -

i.       Most Trauma patients can be saved if bleeding is effectively stopped and blood pleasure restored within an hour.

ii.     It is likely that patients, who have experienced shock and remain in that state of shock for long duration will die.  Surgical intervention within that first one hour is, therefore, crucial for increasing the patients’ chances of survival.

iii.   This hour, called “The Golden Hour,” begins the moment the injury occurs.

4.2.2        The basic steps for quick and effective rescue and relief operations are following :

                                       i.      Rapid access to the site of accident.

                                      ii.      Quick extrication of victims and effective on-site medical management.

                                    iii.      Expeditious extraction and shifting to rescue vehicle(s).

                                   iv.      Speedy transportation to hospital.

 

 

 

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