[Plane Crash]

at the scene of the disaster teamwork of Key Community Services goes into action the first objective is to put out the fire and prevent further destruction and danger no single group can operate alone when major disaster strikes scoup comes its own share of the respon to each its own share of the burden and the Heart of the operation is a plan a disaster plan implemented and ready for Action Now under medical Direction the first the first aid part of the training of any Boy Scout there is to devote their skills to the more seriously injured work that could mean the difference between life and death work that takes its own toll of concentration work that teaches the all important lessons of survival at a time of critical importance work that will leave an unforgettable memory yes on all sides Guided by the skills the doctors and assistants have given Red Cross Boy Scout veterans are united in a common effort to help and assist when disaster strikes after administering all the first aid and emergency treatment that can be given the move to the hospital begins carried out by willing skilled and Cooperative hands vehicles too are carefully planned for with attendants as well as drivers assigned to each regular ambulances station wagons manned by the Red Cross mail trucks flat bodies are ideal for emergency service meanwhile the hospital evacuation team swings into action the purpose here is to make room for the reported number of casualties by moving ambulatory and other patients to the nurse's home across the street in a major disaster up to 450 emergency cases could be handled by using the facilities of this hospital and its nurses home in this case however only enough patients are removed to make room required for casualties medical records and personal belongings accompany each patient help comes from many quarters including official and volunteer community groups all working under the Community disaster plan for the less seriously injured an out patient department is established in the nurse's home thus the hospital's maximum facilities will be available for emergency cases other teams break out supplies and set up stored CS converting the cafeteria into an emergency shock and burn Ward the accident room is converted into a fracture room and other shifts are made in preparation until the entire hospital is in a state of readiness the somber rolling parade reaches the hospital Gates post office trucks ambulances private station wagons and other vehicles all part of the community disaster plan all handled by teams drilled and practiced in their roles the hospital yard has been cleared to make room for the arrivals the casualties are handled carefully but swiftly out area it is important that the Sorting area be located near an entrance available to ambulances to provide quick and efficient transfer of casualties from here the hopelessly injured are removed to a temporary Ward where their pain can be eased until Medical Care More urgently needed elsewhere can come their way the seriously injured are moved directly to the shock and burn room for intensive immediate treatment from here they can be moved to the fracture room or operating room if necessary ambulatory patients go to the outpatient area in the nurse's home and finally those Dead on Arrival to the temporary M of extreme importance in the sorting and transfer of casualties is the identification and history tag attached to the patient on arrival it will be filled out where first treatment is given or if Dead on Arrival it will serve to identify the victim when such information is sought by relatives and friends in the cafeteria now converted to an emergency shock and burn Ward immediate treatment is given a number of things prepared for and outlined in the overall disaster plan happen almost simultaneously the casualties are re-evaluated for treatment fluids and plasma expanded ERS are given for those who have inhaled burning fumes emergency tracheotomies may be needed to permit air passage to the lungs for burn treatment the emergency procedures agreed upon by the medical staff in advance are put into effect patients in shock will usually have feet elevated on block to promote blood flow to the head and for those who must have it a blood transfusion after blood types have been crossmatched at the laboratory in another part of the community new blood is donated place that used in the emergency at every step of the way records are kept for the time when they will be needed clothing is removed and arrangements made for safekeeping of valuables here in the emergency shock and burn Ward we see the value of planning for disaster essential minimum treatment is provided so that all casualties can receive medical attention extensive treatment will be administered as soon as possible under extreme emergency conditions only procedures to preserve life are done on re-evaluation this case was diagnosed as ruptured spleen with internal bleeding for shock and is now ready for surgery to preserve life an exploration is made keeping the operating room clear for this kind of work while work not so essential weights is one of the basic and primary goals of the entire plan to surgery would come for example severe Hemorrhage cases crushing injuries of the head or chest and severe penetrating injuries now thanks to the planning already done a serious case has been cared for and the operating room is cleaned and made ready for another in the accident room now established as a fracture room preparations are made for splinting or traction this patient has been evaluated as to his basic state and now more adequate splinting is applied again the emphasis is on keeping the facilities clear making room for a steady flow of necessary work and avoiding bottlenecks under disaster conditions cases which would normally be handled immediately will have to wait except under unusual circumstances no x-ray evaluation will be made of a case like this plaster immobilization too will come later for the present splints will do the orthopedic team is responsible for the repeated observation of all casualties as well as traction frames and special appliances designed to preserve function through proper position by preventing pressure complications from the shock and burn Ward from surgery from the fracture room all patients move into the expanded Wards temporary areas set up with cots and beds in this Hospital there is room for six Wards organized on this pattern patient care in the immediate post- disaster period is instituted along supportive lines bed rests parental therapy oxygen therapy antibiotics and other medically indicated therapy and observation an immunization team consisting of a physician and a nurse is responsible for prompt Administration and tetanus prophylaxis to all patients with Burns compound fractures puncture wounds and multiple lacerations in making the patient comfortable able this nurse's aid under supervision of the head nurse provides valuable and helpful service at this point the disaster victims have become patients of the hospital and are cared for as such these activities provide another example of the kind of planning training and teamwork that could mean the difference between life and death under other and deadlier conditions other means of communication trained alert Messengers are an integral part of the disaster team as are the members of the information and Records team to them are brought the individual cards the identifications the other Clues to the identity of the casualties upon them Falls the responsibility for making sure that information correct information is available on demand they are also responsible for making sure that families friends and relatives receive accurate knowledge of those dear to them as prompt ly as possible it now becomes increasingly clear why the outpatient emergency area is set up across the street first to provide immediate care for ambulatory patients second to keep the critical areas of the main hospital clear for smooth handling of the seriously injured the hospital must arrange to care for those who were evacuated earlier to make room for the disaster casualties re-evaluation of their needs May make it possible in some cases to have them move to their homes or other nearby facilities this will provide room for casualties who cannot be moved again the records and belongings of these patients are carefully checked and arrangements made for transfer of those who can be moved as soon as practicable the hospital administrator calls a meeting of the departmental heads to plan for the best possible medical and hospital care for casualties yes when disaster strikes it is too late to make plans a way must be devised before disaster strikes to handle casualties swiftly efficiently and capably a disaster plan prepared in advance and coordinated with existing services and Facilities is essential to a sound Hospital program personnel must be trained to provide immediate care for each patient in accordance with his needs in addition the plan must anticipate the needs of the hospital itself should Public Utilities be disrupted this may call for standby sources of power water fuel and other Essentials necessary to hospital function in time of emergency