San Francisco Neighborhood Emergency Response Team - Drill Guidelines

DISASTER MEDICINE EXERCISE

MATERIALS NEEDED: Moulage kit and 4 to 5 volunteers

SET UP:

Prompt victims according to injuries
Place victims in an area that is make to look damaged
ASSUMPTIONS:

Information was received at the NERT command center that people have been reported injured in this building. NERT command has directed this team to search for victim.
All NERT team members are equipped with the proper safety equipment.
The team has already done an exterior search of the building and it was determined to have suffered Light Damage.
A communications system with the command center has been established through the use of HAM radios or runners.
In a real situation the team would be divided into an inside and outside team, but for the purpose of this exercise, all members will do the interior search.
BEFORE DISASTER MEDICINE:

Team must select a leader.
For the benefit of the group the team should verbalize all their actions.
Ask the team "What is your primary concern as a team?" 85.. Team safety.
This is a multi- causality incident so they will have to assess each victims condition using START triage. With each patient the team should remember to use A. B. C. D. (see student manual) to determine whether they are immediate, delayed, or dead.
The team should gather as much information as possible from the victims.
All medical actions should be taken.... opening airways, shock position, bandaging, position of comfort, tagging, etc.
DISASTER MEDICINE:

Team to treat and tag all victims.
Make sure they feel the door for heat before entering the building.
Allow team to operate until victims have been satisfactorily cared for.
CRITIQUE:
Be positive in all critiques. The team has very little experience with multi- causality incidents and they need to be positively reinforced. They are unsure of their abilities. We want the to succeed so that they can build confidence in their abilities and skills.

The following points should be reviewed in the critique:

How were these people injured? Did they ask the victims? Did they establish a rapport with each victim?
Was someone positioned to be the safety person to check for hazards that might affect the team?
Did they try to sort out the minor injuries when they first entered the room? "Everyone who can, move to this area"... potential helpers.
Address each victim separately. Ask the team member who treated the person to go through the steps they used to come a final decision on how the victim should be categorized and what other actions they took.
Keep the feed back simple and try to reinforce with the team members that if they follow the simple steps A. B. C. D. in a systematic way with everyone who is injured, they will be much more effective.
Once all victims are tagged, immediates should be transported to a medical facility. Remember trained NERTs should not be messengers or mules. Use untrained volunteers to carry messages or to lift and transport victims.
After the victims have been transported to a medical facility, the team would document their finding and actions, then return to the command center for rest and reassignment.

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LIFTING EXERCISE

MATERIALS NEEDED: Lever85 .5 long, 2x4
Heavy timber
Cribbing
Assorted lengths of wood
Dummy

SET UP:

ASSUMPTIONS:

BEFORE LIFT:

LIFT:

CRITIQUE: Be positive in all critiques.

The following points should be reviewed in the critique:

  1. All potential hazards should be identified before the lift can begin.
  2. If the victim is conscious, a rapport must be established to find out how he/ she was trapped and the extent of the injuries.
  3. Have all lifting and cribbing materials ready before starting.
  4. Make sure the team and the victim are aware of the lifting plan before starting.
  5. Crib to the object being lifted before lift begins so that it will be stable and not fall and cause further injure to the victim.
  6. Lift timber the height of one piece of cribbing, crib, then lower to stabilize.
  7. Cribbing team should keep hand from under the timber being lifted.
  8. Repeat procedure until timber is high enough so that victim can be removed.
  9. The lifting procedure should be slow and systematic.
  10. Teams should know and not exceed their physical and mental limits... Don't become a victim.
  11. Teams should be creative with resources and use field expedience; use what is available to get the job done.
  12. Teams should rest as they go and drink fluids often to insure their well- being and ability to continue rescue efforts.
After the victim has been taken to a medical facility, the team would document their actions and findings, then return to the command center for rest and reassignment.

OTHER ISSUES THAT SHOULD BE ADDRESSED:

  1. Using fulcrums in soft ground by using supports.
  2. Stabilizing round objects.
  3. Protective cribbing.
  4. The use of straps when there is not enough room to get lever under load.

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BLIND FOLD SEARCH CLASS

TIME: 15 Minutes

MATERIALS NEEDED: 2 inch gauze bandage for each participant

SET UP:

ASSUMPTIONS:

BEFORE SEARCH:

SEARCH:

CRITIQUE:
Be positive in all critiques. The following points should be reviewed in the critique:

  1. While searching, team members should always know the closest way out.
  2. The hand on the wall is their life line. To get out, all they have to do is reverse direction.
  3. Team members should always stay in physical contact with their partner.
  4. In poor visibility, the team should slide feet along floor while they search and maintain physical contact with their partner.
  5. When leaving the wall to search the interior of a room, put a flashlight at the spot on the wall for a point of reference.
  6. In a smoky situation (if they awaken and find their home on fire), this is all that they will see.
  7. It is important to have escape routes planned from every room of their home or in hotels while on vacation.
  8. Teams should know and not exceed their physical and mental limits. Don't become a victim.
After the search is completed, the team would document their finding and actions, then return to the command center for rest and reassignment.

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DAMAGE ASSESSMENT AND PERIMETER SEARCH

MATERIALS NEEDED: Gas shutoff and wrench, Exterior of a building

ASSUMPTIONS:

BEFORE DAMAGE ASSESSMENT SEARCH:
Utility review. When do you shut off the gas?

How do you tell there is a gas leak?

Where do you shut the gas off?

Gas meter demonstration

Where is the shutoff and is it on or off?

When do you shut off the water? When it is leaking.

When do you shut off the electricity?

DAMAGE ASSESSMENT:

What are the signs of structural damage?

How would you classify this building?

CRITIQUE:
Be positive in all critiques.

The following points should be reviewed in the critique if not mentioned by team members. Damage assessment:

  1. When approaching the building, start from the top down when doing a damage assessment.
  2. Water can be a hazard. It can be energized by electricity, cover hazards such as sharp objects or holes, or contain hazardous liquids.
  3. If accessible, examine all four sides of the building for signs of structural damage. Also examine the adjacent buildings.
  4. Look for cracking around doors and the foundation of the building (mud sill).
  5. The perimeter of heavily damaged buildings should be checked for victims if safe to do so. Otherwise, secure the perimeter and stay away. Shut off the utilities only if safe.
  6. In looking at horizontal and vertical lines, start at the top of the building and work down. Look at doors and windows and compare the building to the one next door.
  7. Was the separation between the buildings there before and is it consistent all the way up?
  8. When looking at paint lines, determine which building has moved.
Building characteristics:

After the building has been classified as light or moderate the team will divided itself into an outside control team and an inside search team and begin to search for the missing person.

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INTERIOR SEARCH CLASS

TIME: 15 Minutes

MATERIALS NEEDED: Dummy
Electrical wire for hazard
Paper, tape and pens for marking building

SET UP:

ASSUMPTIONS:

BEFORE SEARCH:

SEARCH:

CRITIQUE:
Be positive in all critiques.

The following points should be reviewed in the critique:

  1. Search in teams of at least two people. Stay together and along the walls to minimize potential injuries from falling debris in an aftershock.
  2. Always know where at least two exits are (stairs, fire escape, windows, roof, through interior wall).
  3. Each room should be marked with an "/" when entering and an "X" when exiting.
  4. In a multi- story building, conduct the search from the top down. At each stair landing stop, look, smell for hazards; call out and listen.
  5. Team should search under tables and beds, in closets, cabinets, showers etc.; anywhere a person can hide.
  6. Once victim is found, the team must evaluate medical and physical condition before doing anything else.
  7. If the victim is conscious, a rapport must be established to find out how the person was injured and the extent of the injuries.
  8. If victim is not breathing and attempts to open airway are unsuccessful, make a note of location and continue search.
  9. Teams should continually review "size- up" as they are searching to minimize risk to themselves.
  10. The team should be aware ofthe electrical hazards in the room and assume that all wires are energized.
  11. In poor visibility, team should slide feet along floor as they search and stay in physical contact with their partner.
  12. Teams should know and not exceed their physical and mental limits... Don't become a victim.
  13. Teams should be creative with resources and use field expedience; use what is available to get the job done.
  14. Teams should rest as they go and drink fluids often to insure their well- being and ability to continue rescue efforts.
  15. All quadrants of the "X" should be completed and all relevant information should be written in the correct quadrant.

After the search is completed, the team would document their finding and actions, then return to the command center for rest and reassignment.

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TABLETOP DRILL

PURPOSE OF THE TABLETOP DRILL
The purpose of this drill is to give NERTs an opportunity to experience how their skills can be used in response to a disaster. It emphasizes working as an individual with untrained volunteers, or together as a team, assessing an appropriate leadership structure and making choices that do the most good for the most people. It also serves to demonstrate how a staging area is used and can assist in a subsequent exercise to choose a staging area.

Remember, disasters are not democracies, they are disastrous. It is important to use this drill as an exercise on how to think as a NERT and how to make decisions by arriving at a consensus of opinion with your team. NERTs don't vote; they discuss all of their options and make choices based on what resources are available to them at any given time.

Not everyone may agree with the final choices made, but they should be able to see how the decisions were reached. Allowing the team to vote on priorities only fragments the group and encourages dissension. As NERTs, our objective is to work together as a team and make choices that DO THE MOST GOOD FOR THE MOST PEOPLE.

ASSUMPTIONS:
Every NERT must know and practice these three points:


This means if you are tired, you rest; hungry, you eat, and you drink before you're thirsty. If you have trouble with the sight of blood or suffering, find a job that does not deal directly with in jured victims. If you don't feel safe around a building, don't go near it. Electricity and natural gas present special hazards; if you don't have knowledge or experience with them, stay away and look for so meone who does.


NERTs never work alone. Assess your surroundings for the safety of the team and also with an eye for possible resources and volunteers to assist you in response efforts.

Facilitators: Your instructions and information will be shown in italics, in brackets. Repeat the bolded assumptions named above repeatedly throughout the drill. Follow them with "As NERTs, what else can we do?" This can also be used to answer "What if" questions.

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DISASTER SCENARIO

[Read the following out loud]

Today is Saturday. An earthquake of the magnitude 7.8 on the Richter scale struck at 9: 45 this morning. The quake was on the Hayward fault and was centered somewhere in the East Bay. It lasted for 53 seconds. The present time is 10: 30 am. Family and immediate neighbors are safe and in an open area with their 72- hour supply kit.

The City has widespread damage. Fire, police, and paramedics are overvhelmed by thousands of calls. The freeway system and both bridges have been severely damaged. All transportation routes in and out of the City are either blocked with debris or gridlock because of vehicle accidents. Help from the outside will be days in coming. Telephone communications are inoperative and there is no power in San Francisco except for those facilities that have backup generators.

NERT personnel are assembling in predesignated staging areas with appropriate safety gear, tools, and supplies. The objective is to set up a command structure for the team and to prioritize incidents. Team members will be dispatched to handle various incidents and all actions taken will be documented.

Your goal is to do the most good for the most people. You are now on your way to your NERT staging area with your NERT kit. You are writing down incidents that you observe with as much detail as possible: the scope of the incident, number of possible victims, addresses, a brief physical description, possible hazards and the time of observation. This is the basic information shown on the sample NERT form in the student manual.

[Refer to Building Damage Assessment form in the NERT Manual.]
As you arrive at the staging area, what's the first thing you're going to look for?

[Incident Triage]
What happens if you arrive at the staging area and there is no Incident Triage?

[You become Incident Triage]
What does Incident Triage do with these reports?

[Collects and verifies information and passes it along to Command/ Policy)]

[Read these instructions aloud]
INSTRUCTIONS: For the purpose of this drill, we will be using the Marina street map and the list of damage assessments from the back of the NERT Training Manual. We will not be using any reference to the number of NERTs available to you, and we will not take into consideration how many of NERTs are here now.

DAMAGE ASSESSMENTS:

Any questions? You have about 10 minutes to do this.
[After a period of seven to ten minutes, call everyone back and open discussion.]

DISCUSSION Anyone should feel free to answer. Speak for your team, or speak for yourself, we want to hear from as many people as possible.

What were some of your first priorities, and why did you choose them? [Without any criticism, ask why particular choices were made. Encourage everyone to participate and be sure that all teams have reported. DO NOT REFER TO THE CORRECT ANSWER NOW.]

What were some of your second priorities, and why? [Without any criticism, ask why particular choices were made. Encourage everyone to participate and be sure that all teams have reported. DO NOT REFER TO THE CORRECT ANSWER NOW.]

[If all teams arrived at the correct answers, listed below, continue with PRIORITY #1 on the next page. If not all teams arrived at these answers, try some of the following dialogue. It is important that they come to these conclusions by themselves so that they thoroughly understand the prioritizing process.]

Let's think about these choices for a moment. As NERTs, we need to make choices that DO THE MOST GOOD FOR THE MOST PEOPLEE The whole idea behind NERT is to have trained volunteers who can react as first responders following a major disaster.

Why are these first responders so important?

[After a discussion of the basic considerations for making choices, begin discussing the first and second priorities.]

Let's go back and talk about our choices for first and second priorities. Keeping in mind what we just talked about, what will be your first priority? Does everyone understand how we arrived at this conclusion? What would your second priority be? Why?

[Use the following suggested dialogue to encourage a discussion of what NERTs can do when responding to these incidents. Encourage the team to be imaginative and to consider all options and resources.]

PRIORITY #1
Thirty- five people are reported to be injured by glass and falling debris on Chestnut Street between Steiner and Pierce Streets.

PRIORITY #2
Nine elderly people are reported trapped in their rooms by falling debris in the apartment building at the corner of Fillmore and Chestnut Streets. The building has suffered light damage.

PRIORITY #3
What were some of your Priority #3's, and why? As you can see there were lots of different answers and just as many different reasons. Once NERTs have dealt with people incidents, decisions about responding to other incidents will more than likely be based on whatever information or resources are available to you.

There can't be any absolute answers or solutions to a lot of these choices. You will just have to be alert to your surroundings and take advantage of whatever resources are available.

Let's go back and look at all the other incidents now. Remember the original assumptions:

[Facilitators: Repeat these continually. Follow with "As NERTs, what else can we do?" This can also be used to answer "What if" questions and to encourage further discussion.]

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DAMAGE ASSESSMENTS97 INDIVIDUAL REVIEW

The following is suggested dialogue to encourage discussion:

Light damage has been reported to the school at North Point and Divisader Street: broken windows and fallen plaster. As NERTs, what can we do?

A building is fully involved by fire on Scott Street between Alhambra Street and Capra Way. People have been reported missing in the building. As NERTs, what can we do? A smell of gas has been reported in an apartment building at the corner of Bay and Webster Streets. As NERTs, what can we do? Muni overhead wires are broken and down on the street at the corner of Divisadero and Jefferson Streets. As NERTs, what can we do? A small fire has been reported in the rear of 15 Cervantes Boulevard. As NERTs, what can we do? Five buildings have suffered heavy damage on Toledo Way. Three of the buildings have collapsed and two are leaning out into the street. Six people are reported missing. As NERTs, what are some of the things we already talked about that can we do here?

Light smoke can be seen coming from a sailboat in Yacht Harbor. As NERTs, what should we do?

CONCLUSION:
Let everyone know they've done a good job!

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