Frequently Asked Questions & **What Defines a Mass Casualty Incident:** & **START Triage System (Simple Triage and Rapid Treatment):** & **Triage Tagging Systems:** & 6. Coordinate search areas & **Tornado Injuries:** & **Active Shooter/Bombing:** & **Bystander Assignments:** & **Treatment Area Setup:** & **Supply Prioritization:** & **Shelter Considerations:** & **Elderly and Disabled:** & Personal and Family Preparedness & **Community Integration:** & **Recovery Phase Injuries:**

Common Problems:

- Talking over child's head - Ignoring child's input - Dismissing fears - Using scary terms - Not preparing for procedures

Q: When should I call 911 vs. driving to the hospital with a child?

A: Call 911 for breathing problems, unconsciousness, severe bleeding, seizures, or major trauma. Drive only if the child is stable and you can do so safely. When in doubt, call 911.

Q: How do I know if my baby is breathing normally?

A: Newborns breathe irregularly, 30-60 times/minute. Worry signs: sustained rate >60, grunting, flaring nostrils, skin pulling in between ribs, or blue color.

Q: Should I give medicine before getting help?

A: Only give prescribed medications or those directed by Poison Control/911. Never give adult medications to children. Aspirin is particularly dangerous for children.

Q: What's different about checking a pulse in babies?

A: Check brachial pulse (inner upper arm) in infants, not neck. Normal infant heart rate is much faster (100-160 bpm). Check for full 10 seconds.

Q: Can I practice CPR on my child?

A: Never practice compressions on a living child. Use infant/child mannequins or stuffed animals. You can practice finding landmarks and hand positions gently.

Q: When is a fever an emergency in children?

A: Any fever in infants under 3 months, fever >104°F in any child, fever with stiff neck, difficulty breathing, rash, or lethargy. Trust your instincts.

Q: How do I splint a child who won't cooperate?

A: Use distraction, let them help, splint quickly, use comfort positioning, have parent help hold, make it a game. Sometimes good-enough is better than perfect.

Q: What if a child won't let me help them?

A: Build trust quickly, let parent help, use distraction, work fast when necessary, explain simply. In true emergencies, you may need to provide care despite protests.

Q: Should children learn first aid?

A: Yes! Age-appropriate first aid builds confidence. Preschoolers can learn to call 911, school-age children can learn basic first aid, teens can learn CPR.

Q: How do I explain medical emergencies to siblings?

A: Use simple, honest language. "Sister got hurt and doctors are helping." Address fears, maintain routines, watch for behavior changes, consider counseling if needed.

> Final Quick Reference Box: > Pediatric First Aid Priorities - Remember CHILD: > - Check thoroughly (toe to head for young) > - Handle gently (emotional and physical) > - Involve parents when possible > - Less is often more (gentle techniques) > - Developmental stage matters > > When to Call 911 - The PARENT Rule: > - Persistent symptoms > - Altered consciousness > - Respiratory distress > - Excessive bleeding > - Not acting normally > - Temperature extremes

Final Critical Message:

Children require special consideration in first aid situations—they're not just small adults. Their unique anatomy, physiology, and psychology demand modified approaches to assessment and treatment. Remember that children compensate well until they don't, making vigilant monitoring essential. Parents know their children best; never dismiss parental concern. When treating children, address both physical and emotional needs, using age-appropriate communication and comfort techniques. Most importantly, when in doubt about a child's condition, always err on the side of caution and seek professional medical help. Your knowledge of pediatric first aid could make the difference in a child's outcome, turning a potential tragedy into a story of successful intervention.# Chapter 16: Natural Disasters and Mass Casualty First Aid: Triage and Emergency Response

The earthquake struck without warning at 2:47 PM, turning the downtown office district into chaos in 37 seconds. Maria, a nurse on her lunch break, found herself surrounded by injured people—some bleeding, others trapped under debris, many in shock. Her everyday first aid knowledge suddenly needed to expand exponentially. She couldn't help everyone at once. Making rapid life-and-death decisions, she marked a barely breathing man with crushing injuries as her first priority, directed walking wounded to help each other, and organized bystanders into teams. Using lipstick from her purse to mark foreheads with triage categories, she managed to coordinate care for 47 people before professional responders arrived 40 minutes later. Her understanding of mass casualty principles saved at least a dozen lives that day. Natural disasters and mass casualty incidents require a fundamental shift from traditional first aid thinking. Instead of focusing all resources on one patient, you must do the greatest good for the greatest number. Whether facing earthquakes, hurricanes, terrorist attacks, or multi-vehicle accidents, understanding triage principles, resource management, and disaster-specific injuries can help you save lives when professional help is overwhelmed or delayed. In our increasingly unstable world, these skills have become essential knowledge for every citizen.

Mass casualty incidents (MCIs) overwhelm normal medical resources, requiring different approaches to save the most lives possible.

Key Characteristics:

- More patients than resources - Overwhelmed local response - Need for triage decisions - Extended response times - Resource scarcity - Multiple agencies involved

Types of MCIs:

- Natural disasters (earthquakes, hurricanes, floods) - Transportation accidents - Building collapses - Active shooter events - Terrorist attacks - Pandemic situations - Industrial accidents

Purpose: Sort patients in 60 seconds or less per person

Categories:

1. RED (Immediate) - Life-threatening but saveable 2. YELLOW (Delayed) - Urgent but can wait 3. GREEN (Minor) - Walking wounded 4. BLACK (Deceased/Expectant) - Dead or unsaveable

The START Algorithm:

Step 1: Can They Walk?

- If YES → GREEN (minor) - Direct to collection point - If NO → Continue assessment

Step 2: Are They Breathing?

- If NO → Open airway - If still NO → BLACK (deceased) - If YES → Check rate - Rate >30 → RED (immediate) - Rate <30 → Continue

Step 3: Check Circulation

- Radial pulse present? - Or capillary refill <2 seconds? - If NO → RED (immediate) - If YES → Continue

Step 4: Mental Status

- Can follow simple commands? - If NO → RED (immediate) - If YES → YELLOW (delayed)

> Quick Reference Box: > Triage Memorization: 30-2-Can Do > - Respirations over 30 = RED > - Capillary refill over 2 seconds = RED > - Can't follow commands = RED > - Otherwise = YELLOW or GREEN

Key Differences for Children:

- Check breathing differently - Give 5 rescue breaths if not breathing - Use AVPU scale for mental status - Different respiratory rates - Consider developmental stage

Pediatric Modifications:

- Respiratory rate >45 (infant) or >35 (child) = RED - No palpable pulse = Give 5 breaths then recheck - AVPU less than "A" (Alert) = RED

Physical Tags:

- Commercial triage tags - Tear-off sections - Color-coded - Patient information - Time stamps

Improvised Marking:

- Lipstick/marker on forehead - Colored tape/fabric - Survey tape - Anything visible - Must be consistent

Different disasters create predictable injury patterns. Understanding these helps prioritize care and resources.

Common Patterns:

- Crush injuries (most common) - Head trauma - Fractures - Lacerations - Dust inhalation - Crush syndrome

Immediate Priorities:

Crush Syndrome Prevention:

- Life-threatening complication - Occurs when crushing pressure released - Toxins flood system - Give fluids BEFORE extrication if possible - Tourniquet above crush site if trained - Immediate evacuation

Injury Types:

- Drowning/near drowning - Contaminated wounds - Electrocution - Hypothermia - Waterborne illness - Carbon monoxide poisoning

Response Priorities:

- Water safety - Wound cleaning crucial - Assume all water contaminated - Generator safety - Disease prevention - Shelter management

Characteristic Patterns:

- Complex contaminated wounds - Impalements - Head injuries - Fractures - Missing persons - Psychological trauma

Special Considerations:

- Debris in wounds - Don't remove impaled objects - High infection risk - Scene extremely hazardous - Mark searched areas - Family reunification

Primary Concerns:

- Smoke inhalation - Burns - Heat exhaustion - Dehydration - Panic injuries - Carbon monoxide

Response Modifications:

- Airway priority - Cool burns if water available - Evacuate smoke exposure - Hydration critical - Eye irrigation - Crowd control

Injury Patterns:

- Penetrating trauma - Blast injuries - Stampede injuries - Psychological trauma - Burns (bombing)

Special Protocol:

- Scene safety paramount - Hemorrhage control priority - Rapid evacuation - Limited scene time - Coordinate with law enforcement - Expect multiple scenes

In MCIs, organizing untrained helpers multiplies your effectiveness exponentially.

1. Establish Command:

- Take charge calmly - Identify yourself - Designate sectors - Assign team leaders - Create communication system

2. Safety Assessment:

- Ongoing hazards - Safe treatment areas - Evacuation routes - Danger zones - Secondary threats

3. Resource Inventory:

- Medical supplies - Trained personnel - Transportation - Communication devices - Shelter options

Medical Teams:

- Pair trained with untrained - Simple tasks for untrained - Direct pressure for bleeding - Holding pressure dressings - Comfort and reassurance

Search Teams:

- Systematic sectors - Marking system - Call out method - Safety buddies - Report findings

Supply Teams:

- Gather first aid supplies - Improvise as needed - Create treatment area - Distribute resources - Track supplies

Transportation Teams:

- Identify vehicles - Create loading areas - Map hospitals - Driver assignments - Patient tracking

> Practice This Now: > - Practice 60-second triage decisions > - Create triage tags from paper > - Identify command voice > - List available resources in your area > - Plan family reunion site

Without Cell Service:

- Runners between areas - Visual signals - Sound signals (whistles) - Written messages - Central information point

Documentation Priorities:

- Patient identification - Injuries noted - Treatment given - Destination if transported - Time stamps

Zone Organization:

- RED zone (immediate care) - YELLOW zone (delayed care) - GREEN zone (minor injuries) - BLACK zone (deceased) - Keep separated but visible

Supply Distribution:

- Critical supplies to RED zone - Basic supplies to all zones - Improvised materials - Rationing system - Resupply plan

In disasters, standard medical supplies run out quickly. Creativity saves lives.

Critical Supplies (Guard These):

- Tourniquets/pressure dressings - Airway adjuncts - Gloves (infection control) - Flashlights - Markers for triage - Clean water

Improvised Medical Supplies:

Bleeding Control:

- Clothing for pressure - Belts as tourniquets - Duct tape for pressure - Feminine products - Diapers as dressings

Splinting:

- Magazines - Cardboard - Branches - Duct tape - Pillows

Bandaging:

- Sheets torn into strips - Clothing - Duct tape - Plastic wrap - Safety pins

Safe Water Sources:

- Sealed bottles - Water heaters - Toilet tanks (not bowls) - Ice cubes - Canned goods liquid

Water Purification:

- Boiling (1 minute) - Bleach (8 drops/gallon) - Water purification tablets - UV light - Filtration

Sanitation Priorities:

- Separate latrine area - Hand hygiene stations - Waste disposal - Body fluid precautions - Vector control

Immediate Shelter:

- Safe from hazards - Weather protection - Organized by triage category - Family grouping - Special needs area

Climate Control:

- Hypothermia prevention - Heat injury prevention - Ventilation - Moisture control - Crowding limits

Certain groups require modified approaches and priority consideration during MCIs.

Special Vulnerabilities:

- Separation from parents - Limited communication - Dehydration risk - Hypothermia risk - Psychological trauma

Management Strategies:

- Keep families together - Identification system - Comfort items - Safe area designation - Adult supervision ratios

Unique Needs:

- Medication interruption - Mobility limitations - Cognitive impairment - Medical equipment needs - Social isolation

Priority Actions:

- Medication inventory - Assistive device tracking - Caregiver identification - Evacuation assistance - Comfort measures

Disaster Risks:

- Premature labor - Placental abruption - Dehydration - Stress complications - Limited positioning

Care Modifications:

- Left lateral position - Hydration priority - Rapid evacuation - Fetal monitoring if possible - Psychological support

Acute Stress Reactions:

- Dissociation - Panic - Freezing - Aggression - Withdrawal

Management Approaches:

- Calm presence - Simple instructions - Assign tasks - Buddy system - Reunification priority

Your ability to help others depends on your own preparedness.

Essential Items:

- Heavy gloves - N95 masks - Flashlight/headlamp - Permanent markers - Whistle - First aid supplies - Water purification - Multi-tool - Emergency blanket - Triage tags

Key Components:

- Meeting locations - Out-of-state contact - Important documents - Evacuation routes - Special needs planning - Pet arrangements - Communication plan - Practice schedule

Get Involved:

- CERT training - Amateur radio - Neighborhood groups - Local planning - Vulnerability mapping - Resource sharing - Drill participation

The emergency doesn't end when immediate threats pass.

Common Post-Disaster Illnesses:

- Waterborne diseases - Respiratory infections - Wound infections - Vector-borne illness - Food poisoning

Prevention Measures:

- Water treatment - Hand hygiene - Wound care - Vector control - Food safety

Common Patterns:

- Chainsaw injuries - Falls from heights - Electrocution - Carbon monoxide - Overexertion

Safety Messages:

- Proper equipment - Rest periods - Team lifting - Electrical safety - Generator placement