OUTPUT

IN
EMERGENCY
DISASTER NURSING

Submitted by:

Racquel V. Canono

BSN 4

Submitted to:

Jerry Able, RN, MAN

Sandra Gruy, RN, MAN

 “My Learning Experience during Our Emergency Medical Service Training”

Our EMS or Emergency Medical Service Training only lasted for about four days. The
first two days were composed of the orientation, lectures, and return-demonstrations; the third
day was also composed of lectures and return-demonstrations, but the highlight during that day
was the simulation; and the last or the fourth day of our training was the Water Safety Training.
The first three days of the training was held in our school, St. Anthony's College, while the last
day of the training was held in Binirayan Sports Complex Swimming Pool.

On the first day of our training, I must admit that I had mixed feelings of excitement and
nervousness. It was because I am unsure of myself if I am capable of doing the tasks and
responsibilities in EMS, pass the training, and become a competent and reliable EMS
Respondent. When our trainers arrived with their EMS materials and equipment, I was a bit
amazed because I've never seen one up-close due to the reason that I've never been in an
ambulance before. I was now feeling a little determined to learn how these things were handled
and used, so I prepared my notebook and pen to take note of everything, and to watch and listen
carefully to understand everything better. First, we had our prayer and orientation. The EMS
trainers, who are really a licensed EMS respondent, introduced themselves one by one and told
us the purpose and objectives of their presence in front of us. They were friendly and
approachable which made the atmosphere comfortable and less tensed. It made us able to
cooperate and participate actively. Sir Joseph, one of our trainers, had a lecture first about soft
tissues and the musculoskeletal system, since the most common emergencies are related with the
integumentary and musculoskeletal system of the human body. It was just a review for us since
we already had studied these during our Anatomy and Physiology class back when we were first
year college students. During the lecture about soft tissues, what I have learned are how to
assess, treat, dress, and bandage different kinds of closed wounds, open wounds, and burns. The
reasons why we assess the wounds are to know what type of wound, procedure, and care will be
used to treat it. We treat the wounds to prevent infection and complications to the victim or
patient, and it's also important that we note that the wound healing process is complex and
fragile. Bandages and dressings are both used in managing wound. A bandage is a piece of cloth
or other material used to bind or wrap a diseased or injured part of the body. It is either placed
directly against the wound or used to bind a dressing to the wound. Dressing on the other hand, is
a sterile pad or compress applied to a wound to promote healing and protect the wound from
further harm like infection. A dressing is designed to be in direct contact with the wound, while a
bandage is most often used to hold a dressing in place. I have also known the different types of
closed wounds, and they are: "contusion" or a bruise, "hematoma" or swelling of blood, and
"closed crush injury" or rupturing of the internal organs due to excessive force. The different
types of open wounds on the other hand are "abrasions" or scrapes, "laceration" or a blunt
wound, "puncture" or a wound by a sharp object, impaled object, "avulsion" or the separation or
loss of a body part, "amputation" or the loss of a limb, crush injury, and blast injury. Tne burns
are either caused or created from thermal, chemical, and electric. The burns are assessed through
depth and severity. Stages of burns are superficial or the first degree burns that only involves the
epidermis, partial thickness or the second degree burn, and the full thickness or third degree.

During the lecture about musculoskeletal system, I have learned how to assess, treat, cast
and splint different kinds of fractures. The kinds of fractures are "comminuted" or broken in
several places, "greenstick" or incomplete break, "angulated" or bent at angle, "dislocation" or
coming apart a joint, "sprain" caused by stretching and tearing of ligaments, and "strain" which is
caused by stretching of muscle. In assessing an injury, we will use the six P’s or the pain, pallor,
paresthesia, pulselessness, paralysis, and pressure. Casts and splints are hard wraps used to
support and protect injured bones, ligaments, tendons, and other tissues. They help broken bones
heal by keeping the broken ends together and as straight as possible. Also, casts and splints helps
in reducing the pain and swelling and protect the injured area from more harm and injury, so they
are very essential.

After the lecture, our trainers showed us the materials and equipment used during
emergencies. They showed each one and told us the name of each one and its purpose. I've
learned that the most commonly used materials here in our province Antique are the triangular
bandage, gauze, elastic bandage, splint, spine board, spider strap, head and neck stabilizer. Then
after that, we were given each with a triangular bandage. We were now getting excited. This was
now the first return-demonstration part of the training. So, we had learned the different kinds of
wounds, right? Now we will learn how to cover the wounds using a triangular bandage. We were
asked to pair up with our classmates, and my partner was my seatmate Helen. First, we studied
the parts of the triangular bandage. It is composed of the face, two sides, a base, and two ends.
We also learned the four types of folding the triangular bandage. It was the open phase, the broad
phase, the semi-broad phase, and the cravat or narrowed phase. Then, we learned how to tie a
knot using the square knot method. The reason why we use square knot method in tying is to
make two ends in a single line secured and not easily moved; the other reason is because a square
knot is easy and fast to remove once we already need to remove it. So, we will use the square
knot in tying in every procedure.

Our trainers demonstrated in front of us the different types of bandaging using the open
phase and cravat phase of the triangular bandage. After our trainers demonstrated each type one
by one in front, we had returned-demo it with our partner. Then they will check our work and
make sure everyone did the procedure right before proceeding to another type of bandaging. In
the open phase, I have learned six types of bandaging: the “head topside bandaging” which is for
the wounds in the head, the “face or back of the head bandaging” which is for the wounds found
in the face or back, the “chest or back bandaging” which is for the wounds in the chest or back of
the body, the “arm sling” which is for fractures in the arm, the “underarm sling” which is also for
fractures in the arm but with wounds or fractures on the shoulders, and the “hand or foot
bandage” which is for the wounds found in the hand or foot. In the cravat phase type of
bandaging, where we fold the triangular bandage into 3 folds to make it narrowed, I have learned
seven types of bandaging. The first one is the "forehead bandage", and it is for wounds found in
the forehead. Then the "ear, cheek, and jaw bandage", for wounds or injury found in the ear,
neck, and jaw of the victim. We also performed the "eye bandage," which is for one or both eyes
injury. The "hand bandage" has two types: the "close palm bandage" for wounds that are
horizontal in the palm, and the "open palm bandage" for wounds that are vertical in the palm of
the hand. And the last type of cravat phase bandaging that we performed is the "sprain-ankle
bandage", and it also has two types: the "shoe on" or the victim is still wearing his or her shoes
and is unable to remove it, and the "shoe off" where the victim's shoes can be removed.

After learning different kinds of bandaging, I had realized that even with just using a
simple cloth, we could save someone who suffered from an injury by giving them this kind of
first aid procedure to lessen the risk for other complications like infection, another injury, and
even death. We could save someone just by managing their wounds and injury, and also by
stopping the bleeding to prevent blood loss. I am now feeling a bit determined that I could help
others with this new skills that I had just acquired from the training. Then after that, we are now
able to proceed to the next part of the training which is now using of splints to immobilize the
victim's injury. The splints are used for fractures, and we could also use a plank or a flat wood as
a splint if there is none. I have learned four types of splinting and these are the wrist splint,
elbow splint, leg splint, and foreleg splint. The wrist splint is for fractures found below the
elbow, while the elbow splint is for fractures found in the elbow and above to the shoulders. The
foreleg splint is used for injury below the knee, while the leg splint is used for injuries on the
knee and above it. We also performed how to transfer the victim to the spine board. So, first we
finished immobilizing the victim's wounds and injuries, then we will log roll, unroll, and
reposition the patient. In doing this, there must be at least two respondents in both sides. The
other one will log roll the patient towards him, while the other one will hold the spine board
closer to the patient's body, then unroll the victim by putting his back onto the spine board then
reposition the victim. I also learned that when unrolling the victim to the spine board, we should
make at least 1 feet space above the victim's head, so when we reposition the patient, it will be
easier. We will reposition the victim using down-up method, because it could minimize the risk
of adding more injury to the victim especially in the victim's spine. I had also take-note that
communication of the respondents and even to the victim is very important, because
communication is key to cooperation and teamwork, thus leads to a good outcome.

We also had a review again with how to perform Cardio-pulmonary Resuscitation and
Artificial Rescue Breaths to both infant and adult. We were now a bit expert with this because
we had already performed it during our NCM 106 skills lab, but during our EMS training, we
were able to perform using a real AED or Automated External Defibrillator. We reviewed again
the emergency action principles which were wearing first our PPE on, surveying if the scene is
safe for the respondents, the bystanders, and the victim, introducing self to the victim or the folks
then ask for consent to help, then check for responsiveness, pulse and breathing of the victim,
activate EMS by telling someone to do it, then perform CPR. In performing CPR, the
compression rate is 100-120 per minute, the depth is 2 to 2.4 inches for an adult while for infants
and children, the depth is 1 to 1.5 inches, and we will perform five cycles, and each cycle is
composed of 30 compressions and two rescue breaths. I had also take down note that 30
compressions should only last for 15-18 seconds for a much effective CPR. We should also wait
for the chest to fully recoil when compressing, and always assess the victim's pulse and breathing
after 5 cycles. The AED is just simple and easy to use because there is a voice that gives
instructions and tells you want to do. I also learned that once you're just a bystander,
automatically we will only perform the CPR with hand compressions only. 200 compressions for
2 minutes. We will only stop CPR when the victim is stabilized, taken over by another
respondent, over-exhausted, and when the physician has arrived. And in giving artificial breaths,
24 blows are for the adults and 40 blows are for the infants, and there should be 3 seconds of
interval for each rescue breath. We can open the victim's airway using three methods: the head
tilt and chin lift method, the jaw thrust maneuver, and the finger-crossed method to open the
mouth. Also, when the victim has now recovered, we will put him in a recover position and in
assess for blood and DCAPBTLS or deformity, contusion, abrasion, puncture, burns, tenderness,
lacerations, and swelling.

We also learned how to perform FBAO or Foreign Body Airway Obstruction or simple
called "choking". If the victim is able to cough and make sounds, let them resolve it on their
own, but don't leave their side. If the victim who is choking is holding their neck, can't cough, or
make any sound, we will perform Heimlich maneuver or Abdominal Thrust. We will put our left
feet between the victim's legs for support, open the airway and use the J-stroke method when
compressing. Give 5 thrust then assess if any object came out of the mouth. The for infants, we
will give 5 back slaps and 5 chest thrusts, then assess if any object came out of the baby's mouth.

I've also learned and acquired new skills in lifting and moving the victims. In one-man
rescue or one respondent rescuing a victim, there are six types: the "assist to stand" and "assist to
walk" for patients who are conscious, the "piggy back" and "pack strap" carry where the victim
is carried in the back of the respondent, the "fire arms" carry or putting the patient in the
shoulders and holding the legs with the hand while the other hand is used to open doors, and the
"cradle arms or sweetheart" carry. In two man rescue, there are also six types: he assist to walk
with assistant, where two respondents assist the victim and is both in the patient's side, the four
hand seat, the hand as a litter, the chair is a litter where we use a triangular bandage to secure the
patient in the chair, the carry by extremities, and the fireman's carry with assistance. We also
learned how to put the victim on the spine board and using the spider strap to secure the victim.
We also performed the 3 man carry of the spine board, where we form like a triangle, the 4 man
carry where we form like a diamond or side by side, and the five and six man carry. I also took
down note that communication is important during moving and lifting the patient because if
could prevent further damage to the victim and also prevent danger to the respondents. We also
performed the Kendrick’s Extrication Device or KED's. This is performed when moving the
patient out of a car during a vehicular accident. In putting the patient in the KED's, all we have to
remember is "My Baby Looks Hot Tonight" - or middle, bottom, lower extremities, head, and
torso. We can also perform fast extrication when the victim is not in a safe scene like for
example, the car is about to blow up.

On the third day of our training, we had a lecture first about Disaster Triage with Sir
Joseph again. MPI means multi-patient incident which means the patients are up to 25. MCI
means mass casualty incident which means the patients are 50 to 100. Then, Disaster is already
over 100 patients. After that we studied about Triage. Triage is the screening or classification of
sick, wounded, or injured persons during war or disaster, to determine the priority needs for
efficient use of manpower, equipment, and facilities. Triage is important because it separates
those who need rapid treatment. We also have to take note of the word START or Simple,
Triage, and Rapid Treatment. In doing triage, we use a standardized triage tag or color coding.
Red is for immediate or altered respiratory, pulse, and mental status. Yellow is for delayed or
RPM is normal. Green is for the walking wounded. And black is for the dead patients- mortal
wounds. The basic principles of triage is that triage should take less than 30 seconds per patient.
The four factors of triage or what to assess are the ability to walk away from the scene,
respiration, pulse, and mental status. In doing triage, I will first call out everyone who can stand
to stand and come to me and tell them to follow the nurse who is assigned to the green medic.
And now, to remember the normal readings in assessing, we will remember "30-2-can do",
which means respiratory rate of 30 and below, pulse present and capillary refill time which is
two seconds and below, and can do or follow simple commands. This way we can determine
whether the remaining victims will be tagged yellow or red or black.

After the lecture, we now had our simulation in the afternoon. Here, we applied all our
learnings, acquired skills, and common sense. We really practiced before the simulation. I was
feeling both nervous and excited for the simulation that I was feeling an adrenaline rush, but our
trainers told us to stay calm and relax. When we already started our simulation, we admit that we
had a lot of mistakes done due to the reason that it was our first time. In our team, I was assigned
as an extricating respondent. I was one of the respondents who carried the spine board and help
carry the patient out of the scene and into safety for treatment. It was a very nice experience
because even though it was just a simulation, it was like an actual disaster scene. We were able
to build teamwork, communicate well, and trust our skills. The simulation was a memorable
experience for me.
 “My Learning Experience during Our Water Safety Training”

Our Water Safety Training was held in Binirayan Sports Complex Swimming Pool. We
also wore our proper swimming attire with swimming cap and goggles for protection. We were
all very excited for this part of the training because we will get to swim in a pool- a very large
and deep pool here in our municipality San Jose. We know it was not a vacation, holiday or an
outing, but we were still excited even though it was a training.

First, after we properly fixed our swimming attire, we were all assembled in one area to
have our stretching before proceeding with the swimming lessons. The importance of stretching
before swimming is to mainly prevent our body muscles to cramp or sprain. At first, I thought
that the stretching was simple, but at the end part of our stretching, it was very difficult that all of
us screamed out of laughter or out of pain. This was the stretching of the feet and legs. The way
the body is to be positioned made the procedure of the stretching very difficult because we have
to keep our body lying on the ground, raise our two legs with an angle of 45 degrees, and
practice the flatter kick, scissor kick, and the frog kick. It was tiring and painful for my legs but
we all know it is for the best. No pain, no gain.
Then our trainers oriented us about the water safety, and asked us who is unable to swim
so they will be watched carefully by our trainers to prevent drowning. They even joked that we
should not be afraid because all of us know how to perform CPR in case something occurred.
After that, we all took a shower and were all excited to go swimming. We first performed how to
do bubbling. It was just a simple procedure but very essential. We will take a deep breath first
then breathe it out under the water using the nose only. The reason why we do this is to promote
oxygen in our body while in the water, and to help us relax and prevent exhaustion. We also
learned the different kinds of floating. I even quoted them saying that "once you know how to
float in water, automatically you know how to swim." The different types of floating were the
jelly fish float, the turtle float, the dead man’s float, and the back float. I was a bit happy because
I am good at floating. Well, my body is consists of fat, maybe that's why. Just kidding. The jelly
fish float is performed by holding the ankles with the hands, while the turtle gloat is performed
by raising the knees to the chest and encircled by the arms. The dead man’s float is a prone
floating position with the arms extended forward, while the back float is a floating position on
one's back with arms extended out to the sides and face upward.

Our trainers also taught us the types of swimming used in Red Cross. The freestyle
swimming is performed by looking straight at the victim to know where he or she is, and this
swimming is done using flatter kick style. I find this swimming easy and faster than the other
swimming styles. The second one was the breast stroke swimming, where we use the frog kick.
Then the side stroke where we use the side kick. The back stroke where we do a back float first
the swim just like in the breast stroke. The one that I remembered in all the types of swimming is
that our head is above the water and looking straight at the victim, so that when the victim is
moved by the water or drowned under the water, we know where to find them. Also, if we do not
know how to swim or the scene is very unsafe, we should not go directly and save the victim
because instead of having only one victim, we now have to. Then after that, we were taught three
types of diving. To be honest, I wasn't really good at it because I never dived before, I just swim
and float. I was really having a difficult time, but I got that hang of it. First was the shallow dive,
it was like diving like a dolphin. Then the giant stride, which is like kicking and giving the water
a big hug in order to create a force to pull you up in the water. The last one was the dive usually
used when we want to jump down from a boat, and it is performed by keeping the feet down,
pinching the nose, and protecting the chest to prevent impact. After that, we were now taught
how to carry a victim who doesn't know how to swim or got drowned using armpit carry, chest
carry, and chin carry. Then we were also thought how to throw a throw bag properly. A throw
bag or throw line is a rescue device with a length of rope stuffed loosely into a bag so it can pay
out through the top when the bag is thrown to a swimmer. A throw bag is standard rescue
equipment for kayaking and other outdoor river recreational activities. I also learned how to save
a victim by swimming with a rescue buoy. A rescue buoy or rescue tube or torpedo buoy is a
piece of lifesaving equipment used in water rescue. This flotation device can help support the
victim's and rescuer's weight to make a rescue easier.

Then we also performed how extrication in water is done by group. We all wore life vests
and helmets first then the two first rescuers went directly to the victim to save her. I was one of
the four rescuers who carried the spine board. When we got the signal by the two rescuers, all of
us dived using a giant stride and swim to the victim's left side carrying the spine board. Then we
submerged the spine board under the water to the victim's back. After that, one rescuer will go
out of the water and signal the rescuers to go to him. The purpose of this, is to have one person to
assist in carrying the spine board with the patient up or out of the water. Then, we assessed the
pulse and the breathing of the patient. This is important to know whether we will give CPR or
rescue breaths to the victim. And the last part of our training was the self-defense under water.
We performed seven types of self-defense. Two self-defense for wrist, or how to remove the
victim's hand when they are holding our wrists, thus preventing us to swim and float properly.
Two self-defense when the victim is holding our neck, front or back, thus lowering us under the
water. Two self-defense when the victim is hugging us in the chest or back. And the last self-
defense was when a victim is holding our legs or ankles. The main reason why we must learn
how to defend our self is to prevent the victim from drowning us as rescuers. We will swim away
from them after we defended ourselves and removing their grasps on our body, but we will ask
the victim to stay calm because we are unable to rescue them if they are panicking. Once they
calmed down, we will now save them. This is also to prevent us rescuers from drowning, and to
keep us away from danger and to safety. I am really glad that they taught us how to defend
ourselves because it is really beneficial to us especially because we are girls. The self-defense
techniques were also good to use even if it isn’t underwater, like for example, someone tries to
grab you and do harm to you. My experience during the simulation on how to defend myself was
really awesome because I felt like I am now capable of saving myself. It was a bit scary at first
because our trainers really did all the grasps done by victims, and is really holding us under
water. All in all, it was a great adventure. I really learned a lot from them,