CM13.{3,5} | CM13.{3,5} | Man-made Disasters and Simulated Response — Summary & Reflection

KEY TAKEAWAYS

This module has covered man-made disasters and the principles of medical response in a simulated environment:

Man-made disaster classification (CBRN + broader framework):
- Technological/industrial: Bhopal 1984, rail accidents, building collapses — standard trauma MCI response
- Chemical: agent-specific toxidromes — organophosphate (SLUDGE + bronchospasm → atropine + pralidoxime); cyanide (cellular asphyxia → hydroxocobalamin)
- Biological: epidemic emergence or deliberate release — isolation, prophylaxis, surveillance
- Radiological/nuclear: ARS at high doses, cancer risk long-term — KI for radioiodine, G-CSF for bone marrow suppression
- Conflict-related: trauma, displacement, mental health

Decontamination rule: always BEFORE the treatment area — hot zone (contaminated) → warm zone (decontaminate) → cold zone (treat). Non-negotiable.

START triage — four categories:
- GREEN: walking wounded (self-sort)
- BLACK: no breathing after airway repositioning, or expectant
- RED: RR > 30/min OR cap refill > 2 sec OR unable to follow commands — ANY one criterion → RED
- YELLOW: all three assessments within normal limits

ICS: Incident Commander → Operations / Planning / Logistics / Finance. SBAR for communication.

Simulation evaluation: triage accuracy (undertriage dangerous, overtriage safe); response time; ICS activation; decontamination compliance; AAR within 24–48 hours.

Physician's role in simulated MCI: scene safety → triage (START, categorise-and-move) → SBAR to IC → chain of evacuation → activate surveillance.

REFLECT

Review the following five simulated casualties from an industrial gas leak (organophosphate pesticide release). Apply START triage to each and assign a category. Then reflect: which of your assignments was most uncertain, and why? What additional information would have changed your decision?

1. A 45-year-old male, walking, repeatedly saying 'my eyes are burning.' Breathing rate 20/min, radial pulse present.
2. A 22-year-old female, lying on the ground, unresponsive. Airway repositioned; breathing resumes at 34/min. Radial pulse absent.
3. A 60-year-old male, lying still, no breathing. Airway repositioned; no breathing resumes.
4. A 30-year-old female, sitting upright, confused, unable to follow the command 'squeeze my hand.' Breathing rate 22/min, capillary refill 1.5 seconds.
5. A 17-year-old male, limping, holding his right arm, crying. Breathing rate 18/min, capillary refill 1 second, follows commands.

For each: state your category (RED/YELLOW/GREEN/BLACK) and the specific criterion that determined it. Document your answers and discuss with a facilitator.