• Community Emergency Response Team (CERT) Refresher Course

   

  The CERT refresher course took place on Sunday, August 16, 2009 in Sherman Oaks and was taught by the LA Fire Dept. 

   

  Here are the highlights on personal preparedness and responding to emergencies that were reviewed at the course: from my personal notes and experience.  There were no official notes for the course.

   

  Equipment: Helmet, gloves, medical gloves, closed toed shoes, notebook, pen, goggles.

   

  INCIDENT COMMAND (IC) SYSTEM

  During an emergency situation, it is important for the CERT group to organize itself so that everyone participates in the rescue operation so that the team is organized and efficient in their actions.

   

  Roles for team members:

  Incident commander: you are the decision maker.

  • Identify safe locations for the IC post and staging area(s).
  • Organize your command post: id who will be the scribe, runner, logistics person and assistants.
  • Assess the situation
  • Plan which incidents your group will handle and prioritize.
  • Act on your plan
  • Your effective scope of control is 3-7 people.
  • Team functions can be combined.
  • A map can assist you in visualizing the problem location and your resources.

   

  Logistics person- you provide facilities, services, and materials in support of the incident, and assist the Incident Commander as necessary.

   

  • Choose a runner and scribe (if needed)
  • Choose a staging leader after IC establishes a staging area.
  • Keep the IC updated on the amount of resources.
  • Determine need for more resources based upon # of incidents that the IC has identified as manageable.
  • If you have inadequate resources, notify the IC and try to gather additional resources with IC approval.
  • Schedule transportation of supplies (not transportation of injured people).

   

  Staging leader – you continuously maintain a current list of all available resources (facilities, services, and materials). 

  • Gather the material s needed for keeping lists.
  • Your primary job is to add and subtract.
  • Keep the Logistics leader updated at all times.

   

  Division Supervisor – you assign resources and monitor divisional progress and resources.

  • You will be supervising either multiple team types or multiple group supervisors.
  • Stop any unsafe operations.
  • Oversee and manage your resources.
  • Monitor work progress.
  • Keep the IC updated on progress and needs.

   

  Fire Team Leader- you ensure that all small fires are overhauled and that all utilities problems are handled.

  • Stop any unsafe operations.
  • Oversee and manage your resources.
  • Monitor work progress.
  • Keep the IC updated on progress and needs.

   

  Search and Rescue Team Leader- you  assess the safety of light search and rescue operation, and coordinate safe search and rescue operations.

   

  Medical Team Leader- you manage triage and treatment of the injured, coordinate procurement of supplies, monitor health of working team members, and oversee the morgue.

  • Select a medical operations area that: is large enough for anticipated # of victims, is free of hazards, has good access points for transportation, provides for separation of: delayed treatment area, immediate treatment area, and the morgue.
  • Create your triage teams: perform head to toe assessments and document findings.
  • Create your treatment teams: open airway, control breathing, and treat for shock.
  • Give your team assignments.
  • Notify other teams/groups of the location of the medical operations area.
  • Maintain a log.
  • Remember that PATIENTS MUST BE RE-TRIAGED PERIODICALLY.
  • Consider identifying resources for grief counseling.

   

  FIRE SUPPRESSION

• Review of types of fires:

   

  Class A: fires involving combustibles (i.e., things that leave ASH such as wood, plastics, clothing, etc.)

  Class B: fires due to flammable liquids such as gasoline.

  Class C: electrical fires.

  Class D: fires due to combustible metals (i.e., things that end in I U or M such as magnesium, titanium, aluminum).

  • Most common fires in the home setting are Class A, B and C fires.
  • Reminder to check that your fire alarm is working and has new batteries in the home/work setting.
  • For cooking fires, such as fire in a frying pan at home, a good technique to suppress this fire is to SLIDE THE LID across the pan instead of putting lid directly on top as this may burn your hand if fire escapes from under the lid on your side.  Baking soda is also excellent for fire suppression.
  • Fire dept does NOT recommend using water (as this is most likely a grease fire), no wet towel or cloth and no sugar or salt and no baking powder (too small particulates that can burn with the fire)…baking soda is fine.

   

  B. Fire Extinguishers (FE)

  • Buy FE that is for Class A-C fires.
  • Buy FE that you can lift (not a very heavy one as you may not be able to lift it during a fire!).
  • FE do have a 10% failure rate so keep more than one in the home.
  • Ideal locations include near the kitchen, in the garage and in the bedroom.  FE can also be kept in your car/truck.
  • FE should not be older than 3 years.
  • Every 6 yrs, FE have to be hydrostatically tested (a pressure test) to ensure that the FE can hold pressure). 
  • Invert the FE every 6 months.
  • Know how to operate the FE before a fire!
  • Remember PASS:
  • P- Pull the pin
  • A- Aim at the BASE of the fire, not the top!
  • S- Squeeze on top handle of FE (the trigger).
  • S- Sweep along the base of the fire slowly back and forth until fire is suppressed.
  • Maintain a safe distance from the fire of 8-12 feet (this is also the range of most FE).
  • Be aware of scene safety including awareness of wind direction and how this can affect the fire.  Ideal to have the wind at our back instead of against us.
  • Proper disposal of FE – can’t throw them away.  Take them to a recycling facility or a fire extinguisher company or the HAZMAT round up locations in the city. 
  • Remember if you need info on FE disposal locations or other city info, dial 311, a free service.

   

  • Pearls of fire suppression:
  • When approaching a fire scene, before putting out fire, turn gas valve off.  There may be more than one gas valve (i.e., upper and lower valve) but turn the valve off that is CLOSEST TO THE GROUND as this is the gas main line whereas the upper valve may be for another unit or commercial line.
  • Good to have a buddy to go with – can be your back up with a FE following you. Need to coordinate activity so you are both moving together and doing the same thing – approach fire with buddy behind you as back up.
  • Five second rule - If a fire is not out within 5 sec of using FE, it is not going out and fire dept recommends that we step away and evacuate.
  • When evacuating, head for the exit and close door or window behind you to try to contain fire.  Use stairs instead of elevators if not on the first floor.
  • Call 911.  It is generally better to call 911 from a land line as this goes directly to the 911 dispatcher and your exact location address is automatically is sent to the dispatcher.
  • If calling from a cell phone, be aware that the calls to 911 go to the Highway Patrol and then they connect to the 911 dispatcher so this can cause a delay in response. Also, your address DOES NOT APPEAR to the dispatcher when calling from your cell phone so know at least the major intersection of where you are or actual address to give to 911 dispatcher if using a cell phone.

   

  MEDICAL EVALATION / SEARCH AND RESCUE

  • Good Samaritan Protection Act (Senate Bill 39) was signed into law by the Calif. Gov. Schwarzenegger in early Aug. 2009.
  • see link: http://www.californiachronicle.com/articles/view/113429
  • Assembly Bill 83 also passed which immunizes Good Samaritans from liability when they assist others at the scene of an emergency – regardless of whether the care provided is of a medical or non-medical nature – unless the person providing assistance acts in a reckless or grossly negligent manner”.

   

  • These laws “provide legal immunity to emergency service volunteer workers who perform disaster services during a state of emergency”.
  • Have personal protective equipment (PPE) ready: disposable gloves, mask, and goggles. 
  • When approaching a victim, be aware there may be spinal injury so don’ go moving them right away.
  • Approach by identifying yourself as part of CERT, “Hi, I’m xxx, here to help you…are you ok?...does anything hurt?”
  • When they id a problem area, “my knee really hurts”, don’t go feeling and touching there right away, tell them what you are going to do. “I’m going to feel around your knee, ok?”.
  • Despite knowing what areas the person is complaining of, do a good head to toe assessment and again tell them first what you are doing.  Explain that “I am looking for any other injuries”. 
  • Look for body symmetry and check each side the same way.
  • Again, a buddy system is useful…have your partner document what you are doing with the victims and what your findings are.  Decide between you who wants to do the hands on assessment and who wants to be the scribe.
  • For fractures or areas needing bandaging or splinting, some pearls are:
  • 1. Keep fingertips and toes exposed when applying bandage or splint so can easily assess capillary refill (how blood is flowing to the limb).
  • 2. When splinting the upper extremity/arm, use “pledge of allegiance” posture with arm across chest as this makes it less painful and there is reabsorb ion of fluid into the body.  Keeping an injured arm dangling down tends to cause throbbing pain and increases swelling.
  • 3. Remember to pad the splint (soft cloth or pad between body area and hard splint) for victim comfort.
  • Before transporting the victim, try to stabilize/splint injured areas is possible and feasible.  Also, if heavy bleeding, have to stop by placing pressure firmly over bleeding area(s) and have to secure airway if breathing problem.

   

  • Transporting victims: do not do by yourself.  Almost always better to have help.
  • Types of transport: Chair lift – lifting a victim in a chair with one person holding chair legs and one person holding the back support and moving the victim.  This is better than side to side lift in a chair.
  • Blanket lift – If a stretcher or gurney not available, can move victim in a blanket.  May need to roll the victim towards your side with help and then place blanket under victim and place victim face up on the blanket.  One person should hold the head, the rest the body and one person the feet.  The person holding the head can be the leader.  Make sure you communicate among your team before lifting so the victim is moved in coordination and their head, body, legs all remain stable.  Better to move victim feet first so they can see where they are going.  Always explain what you are doing if victim is conscious).
  • Stretcher – same as blanket lift but may be easier to lift.

   

  HEAVY LIFT – this section reviewed how to perform a group heavy lift to remove victims from under heavy items such as a large concrete block weighing several thousand pounds.

   

  • Review of Absolute rules to follow for heavy lift:
  • 1. NEVER put any of your body area(s) under the object you are lifting to avoid a crush injury during rescue operations.  We want to be rescuers not become injured victims ourselves!
  • 2. Do not sit or kneel while at the site, stay on the balls of your feet if squatting or stand/bend.

   

  • If victim is alive, attempt to remove victim by performing heavy lift. If dead, leave body.  If victim expires during the lift, complete task and remove the body.
  • Assemble a team of volunteers to coordinate the rescue effort:
  • Teams: leader (1), cribbing team (2), lifting with pry bar (2), safety officer (1), wood supplier to cribber (2).
  • During cribbing (use plywood or flat surface, then place 2x2, 2x4 and wedge pieces of wood as lift is being performed by pry bar operators so that eventually a space of about 2 inches is achieved between the end of the heavy object and victim’s body area so safe removal can be performed of the victim.
  • Be aware that when injured limbs (e.g., legs) are freed from the heavy object, blood will rush back into the body and the victim may become unstable and die.  Ideal if medical rescue team/paramedics are present but often this is not the case so do the best that you can.
  • Be aware that if object is top heavy, may not want to move as it may fall on you.
  • If on a hillside or slope, want an even surface prior to lift so may have to even out object to make it flat prior to lift.

• If you have any questions, please contact Bhavesh Pandya, MD at bhavesh@ammateam.org.

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