Overview

As you have seen in all your training, you never know when the ‘big one’ is going to hit.  That is why you should review the contents of your backpack regularly and ensure that it all stays together in a state of readiness.

Backpack Checklist

Personal items

DWS card
Cell Phone

Personal Protection

CERT backpack
Saratoga CERT Baseball cap
Yellow reflective safety vest
CERT Hardhat
Work Gloves
Safety goggles
Particulate masks
Knee pads

Sustenance / clothing

Plastic Water bottle
Energy Food bars
Jacket
Eyeglasses (if needed)

Search and Rescue / Damage Assessment Supplies

Pad of paper and/or CERT standard forms assortment
Pencil or pens
Clipboard
LED headlamp
All-in-one shutoff tool
Mylar blanket
Whistle

Medical Supplies

Gauze pads  (20)
Gauze rolls  (4)
Non-latex exam gloves  ( a few pairs)

Note:  Items shown in italics are not provided by the Saratoga CERT program and must be obtained yourself.

A few things to note with your backpack.  The Nitrile (non-latex) gloves do degrade over time.  If you keep these in your backpack in the trunk of your car, you should check and/or replace them annually.

For you homework, print off a copy of this one page checklist and take a look at your backpack.  You can refresh any missing items at our next skills-building exercise on October 28th.

Whenever we might be called upon to provide triage in an environment, what do we need to do first?  Get a plan of action.  Is the environment safe to enter?  Do we have the necessary personal protective equipment?  Who is going in?  Will the search be clock-wise or counter-clockwise?

After we have a sufficient plan, we need to quickly evaluate any victim’s injuries and provide the best judgement of severity of injury.  During the evaluation phase of each survivor, we follow the RPM acronym.  This is in both our training manual as well as the Field Operations Guide (FOG).  It is a good idea to re-familiarize ourselves with this acronym.

R – Respirations
P – Profusion
M – Mental state

Remember, also the triage categories:

Red – Immediate
Yellow – Delayed
Green – Minor (walking wounded)
Black – Deceased

Now, getting back to the RPM triage evaluation, we start with a callout to see if any can walk to the sound of your voice.  You might actually get a few survivors to come to you and be considered ‘walking wounded’ and marked as Minor.

Then, you systematically go through the RPM on each person we encounter.  Any failure of a step results in them being identified as ‘Immediate’.

Respirations

Are they breathing?
Yes, over 30/min? — Immediate
No, reposition and recheck.

Now breathing?  — Immediate
No — Deceased

Profusion

Blanch test or radial pulse

Capillary refill in less than 2 seconds?
No — Immediate

Mental State

Can follow simple commands?

No — Immediate
Yes — Delayed

You see that we can quickly determine if a survivor is in need of immediate attention, or can be delayed.  We should be able to determine this in around 30 seconds to one minute each.

When performing this RPM triage evaluation of a survivor, speak calmly.  Don’t promise anything like ‘You’re going to be alright’.  Try to calm them down.  Just by talking to them, you will be getting a good judgement of their mental state.  Also, it’s a good idea to identify yourself and that you need to check on their condition.  Ask for permission if you can.  Convey to them that you need to check on the other survivors and we will be back shortly to assist in getting everyone out.

Some of the other tasks we can perform while doing this quick triage of survivors is to control any excessive bleeding.  For that reason, it is a good idea to keep a quantity of gauze pads in your vest when performing the triage.

Finally, ensure that you always stay in pairs of rescuers and one is evaluating the survivor and the other is scribing some notes.

Questions to consider:

1. If you have what looks like 10 or 12 survivors and one is not breathing/no pulse, do you start CPR?
2. Once you have covered the perimeter of the room, have you looked in the center of the room, alcoves, closets, under beds, and other ‘safe’ places where children might be?
3. Do you triage all, then start transfer?  Or triage and then transport the first immediate you encounter?

Initial organization

With a significant event occurring at random, we don’t know who will be available to assist or who might be available at any rally point.  Some of the ‘old-timers’, leaders, or more experienced folks may not be able to assist.  That being said, any assembly of CERT personnel needs to have the initial few people who show up start to form a working group.

The way I see it, when the first person arrives, he or she should begin and assume a role of Incident Commander.  They should grab a piece of paper (or, more effectively, an ICS-211 form) and log themselves in.  As subsequent personnel show up, they can also sign in.  The Incident Commander can transfer duties to any more qualified individual if they like as members arrive.  The Incident Commander can also ask for someone to be a scribe and to manage the sign-in sheet.

Next, a backpack checklist can be reviewed to ensure that all members have the necessary supplies and Personal Protective Equipment.  Any member that is missing something can be assigned roles that do not require that equipment.  For instance, someone missing work gloves or hard hat might be ineligible to perform Search and Rescue, however, they might be equipped enough to perform a role within medical operations.

Critical Mass

While members are being signed-in, one question should be to enquire if anyone has their amateur radio license and has communications with the EOC.  If so, that person can be our communications person until such time that an embedded Amateur Radio Operator is sent to our rally point.

When the number of members present is sufficient, it might be a nice time to ask someone to take on the following roles:

Planning Section Chief

This role should review the sign-in sheet and see if members have identified any special skills, desires, or even restrictions.  Then, they can sit tight until the IOC identifies an incident that needs attention.

Logistics Section Chief

This role should see if an amateur radio operator is available.  If so, a query should go out to the EOC asking if the city’s caches have been activated and are staffed.  Knowing where possible equipment and supplies are and lead times would be important to assist when teams are dispatched.

This role should immediately call to the EOC for a number of FRS radios, an ICS bag, and a few Triage ‘Go’ boxes.

Summary

In summary, you cannot count on any Incident Command skilled personnel being present at the start of an event.  It is incumbent on each of you to have a few blank forms or, at minimum a pad of paper and some pens or pencils.  Having a standard backpack checklist and reviewing it to ensure you are always prepared is also a very good practice.

We want our members to feel they have the skills necessary to assume any role that comes up.  With our current Saratoga CERT organization, we may not have the necessary Division Leaders or starter supplies available at the start of any real event.  That is the reason for this article.  It is necessary to self-assemble and to build out an effective Incident Command Post starting with the first member arriving at any rally point.

I also hope the following simple scenarios might help stimulate your thinking.  Ensuring that all allocation of resources comes from the EOC is important.  Ensuring that effective two-way communications with the EOC is just as important.  Finally, being responsible for the members present at a rally point is paramount.  Knowing who they are, what skills they bring, to what activity they have been deployed to, and their safety and welfare are important.  To that end, some level of paperwork is necessary to know who is present, where they are, and what activity they have been deployed to.

Think through the following scenarios to see what you might do in any of the following situations.  The questions on each scenario are not exhaustive.  They are just there to stimulate some thinking.

Scenario 1

You have assumed the Incident Command role at a rally point.  Someone comes in and lets you know of a neighboring house that might be structurally unstable and there might, possibly be someone inside.

• Do you head over?
• Do you collect details and ask the EOC for guidance?
• Do you log it on a neighborhood survey?

Scenario 2

You have assumed the Incident Command role at a rally point.  You have 6 people ready for assignment.  The EOC asks that once you have 4 members available, send them to pick a dumpster off a crash test dummy (sound familiar?).  Then, the EOC needs another 4 members to setup a triage site in front of the neighboring elementary school.

• Do you send 4 to save the crash test dummy?
• Do you just say no to the triage site?
• Do you ask the EOC for clarity on assignment priority as you do not have enough resources?
• Do you ever send just one member on an assignment?

Scenario 3

You are readying your members as they are assembling.  You ask the EOC if you can get starter supplies.  Either there is no reply from the EOC or there is no logistic team available to assist.

• Do you operate without any supplies?
• Do you send two members over to a cache and try to break-in?
• Do you ask if anyone on the Amateur Radio net has access to the storage caches or has the combinations?
• Once you find you can gain access, do you send one or two members over to get the necessary supplies?

For further reading, please checkout:

ICS Overview (FEMA)  https://training.fema.gov/emiweb/is/is100b/visuals/pdf/02ics100b_visuals_october2013.pdf

ICS Training (FEMA)

https://training.fema.gov/emiweb/is/icsresource/assets/reviewmaterials.pdf

CERT Organization

https://www.fema.gov/media-library-data/1446233752698-58226b49f172793dbffb3bf9d08e1ac8/section_06_unit_6_ppt_102715_508.pdf