FIRST AID FOR BITES AND STINGS

Prepared by: Christian Paul S. Biluan, RN, USRN, MANc

I. Snakebite
Characteristics of Poisonous snakes:
a. Large fangs
b. Vertical pupils (elliptical pupils)
c. Triangular head is larger than the neck

Types of snake bites:

a. Horseshoe-shaped bite = non-poisonous
b. Two distinct fang marks = Poisonous

Signs and symptoms:

a. Severe burning pain
b. Swelling around the fang marks
c. Purplish discoloration
d. Numbness
e. Nausea, Vomiting
f. Signs of Anaphylaxis

First Aid care fir Snake bite:

Move the victim away from the snake

Discourage walking

Clean the bite with soap and water

Splint and Immobilize

Lower the site below the level of the heart

Refer immediate medical treatment

Antivenin must be given within 4hours

NEVER:
 Cut skin - causes infection
 Use tourniquet – can result to loss of limb
 Apply ice – causes more rapid absorption
 Electric shock – causes severe injury

II. Bee Stings

Management:

If the stinger is still present, remove it by gently scraping against it with the edge of a credit card or a knife

Wash with soap solution

Never scrub

Lower the site below the level of the heart

Cold compress to relieve pain and swelling

Apply a paste of baking soda and water for bee stings

Use vinegar or lemon juice to relieve pain of a wasp stings

Limit physical activity

Refer immediately if there are signs of anaphylaxis

III. Marine Bites

Management:

Move the victim away to a dry area

Stings by Stingray, spiny fish, sea urchin = flush the site with water, immobilize, soak in hot water for 30 minutes.

Stings by Jellyfish, coral, anemone= carefully remove dried tentacles, pour vinegar on the affected area or soak to
denature the toxin, never rinse the site with ammonia or fresh water (can aggravate the stinging sensation)

MANAGEMENT FOR ANAPHYLAXIS:

1. Antihistamines
2. Epinephrine – if with evidence of Shock and bronchoconstriction
 DISASTER MANAGEMENT AND TRIAGE
Prepared by: Christian Paul S. Biluan, RN, USRN, MANc

Disaster
A disaster is any human-made or natural event that causes destruction and devastation that cannot be alleviated without
assistance.

2 Classifications
1. Natural Disasters – typhoons, flashfloods, hurricanes, wildfires, thunderstorms, earthquake, blizzards, hailstorms,
epidemics, droughts, landslide
2. Human-made Disasters
a. Biological Warfare
b. Chemical and Hazardous material (HAZMAT) Incidents
c. Radiologic Disasters
d. Terrorism Attacks
e. War
f. Transportation Accidents
g. Structural Collapse and Fires

Types of Disaster
A. Internal Disaster
An internal disaster occurs when there is an event within the hospital facility that poses a threat to disrupt the environment of
care. Internal disaster can also happen when there are numerous patients coming in at the same time in the Emergency
department than it can handle such as after a mass casualty and the victims were all rushed to the ED.

B. External Disaster
An external disaster include those that occur outside of the health care agency and becomes a problem for a facility when the
consequences of the event create a demand for services that exceed the usual available resources.

5 Phases of Disaster Management

1. Preparedness refers to the proactive planning efforts designed to structure the disaster response prior to its occurrence.
Disaster planning encompasses evaluating potential vulnerabilities (assessment of risk and the propensity for a disaster to
occur. Warning (also known as forecasting) refers to monitoring events to look for indicators that predict the location, timing,
and magnitude of future disasters.
2. Mitigation includes measures taken to reduce the harmful effects of a disaster by attempting to limit its impact on human
health, community function, and economic infrastructure. These are all steps that are taken to lessen the impact of a disaster
should one occur and can be considered as prevention measures. Prevention refers to a broad range of activities, such as
attempts to prevent a disaster from occurring, and any actions taken to prevent further disease, disability, or loss of life.
Mitigation usually requires a significant amount of forethought, planning, and implementation of measures before the incident
occurs.
3. The Response phase is the actual implementation of the disaster plan. Disaster response, or emergency management, is the
organization of activities used to address the event. Traditionally, the emergency management field has organized its activities
in sectors, such as fire, police, hazardous materials management (hazmat), and emergency medical services. The response
phase focuses primarily on emergency relief: saving lives, providing first aid, minimizing and restoring damaged systems such as
communications and transportation, and providing care and basic life requirements to victims (food, water, and shelter).
Disaster response plans are most successful if they are clear and specific, simple to understand, use an incident command
system, are routinely practiced, and updated as needed. Response activities need to be continually evaluated and adjusted to
the changing situation.
4. Recovery and Rehabilitation actions focus on stabilizing and returning the community (or an organization) to normal (its
preimpact status). This can range from rebuilding damaged buildings and repairing infrastructure, to relocating populations and
instituting mental health interventions. Rehabilitation and reconstruction involve numerous activities to counter the long-term
effects of the disaster on the community and future development.
5. Evaluation is the phase of disaster planning and response that often receives the least attention. After a disaster, it is essential
that evaluations be conducted to determine what worked, what did not work, and what specific problems, issues, and
challenges were identified. Future disaster planning needs to be based on empirical evidence derived from previous disasters.

LEVELS OF DISASTER
Disasters are often classified by the resultant anticipated necessary response:
Level I: Local emergency response personnel and organizations can contain and effectively manage the disaster and its
aftermath.
Level II: Regional efforts and aid from surrounding communities are sufficient to manage the effects of the disaster.
Level III: Local and regional assets are overwhelmed; statewide or federal assistance is required.

TRIAGE
From the French word ‘trier’ which means to sort out or to choose. Triage is a process which places the right patient in the right
place at the right time to receive the right level of care.
Principle: to do the greatest good for the greatest number of afflicted.

2 types
 1. Internal: sickest patients are given priority. The highest intensity of care is provided to the most seriously ill patients,
even if those patients have a low probability of survival.
2. External: wise allocation of limited resources. Treatment is directed towards the people who have high chances of
survival with the least use of resources.

INTERNAL TRIAGE (In-Hospital Triage)

The main purpose of in-hospital triage (usual or disaster) is to identify those patients who have the highest degree of
compromise for the purpose of providing rapid care to the sickest patients first. Therefore, in this type of triage, patients with
an airway, breathing, or circulation emergency are assigned the highest degree of urgency and receive care first. Individuals in
extremis, even if they are expected to die or require an extraordinary amount of resources for their care, are provided with
immediate treatment.
ASSESSMENT
Basic Assessment for Disaster Triage in a Hospital Setting

Airway, breathing circulation
Visual inspection for gross deformities, bruising, or

Skin vitals (color, moisture, temperature) lacerations

V/S: pulse, respiration
Level of consciousness

TIER systems
Various rating system categories are used in hospital settings. Most hospitals utilize a triage system that has between three and
five categories.
3- tier
 Emergent – requires treatment immediately or within 15 to 30 minutes
 Urgent – serious illness or injury that must be attended to within 2 hours
 Non-urgent – can wait more than 2 hours
4-Tier
 Expectant (BLACK)– victim is dead or expected to die
 Immediate (RED) – Critical; life threatening—compromised airway, shock, hemorrhage
 Delayed (YELLOW) – Major illness or injury; requires treatment within 20 minutes to 2 hours
 Minimal/Fast-Track (GREEN) – walking wounded; first aid treatment
5-Tier
 DOA/DyOA – Victim is dead or dying.
 Emergent – life threatening injuries, needs immediate attention
 Urgent – must be treated within 1-2 hours
 Non-Urgent – Ambulatory, walking-wounded
 No Injury – No treatment is necessary

EXTERNAL TRIAGE (Pre-Hospital Triage)

During times of catastrophic disaster, where the resources of all available systems are overwhelmed, there is a defined system
that some have termed tactical military or disaster triage. The goal of this type of triage is to meet the needs of the largest
number of victims possible, by delaying care to selected patients who have little hope of survival or who would consume too
many resources. In most instances these types of decisions would be made in each prehospital care arena; however, nursing
staff must be familiar with the system in order to effectively function during times of acute disaster.

COLOR TYPICAL CONDITIONS

Sucking chest wound, airway obstruction secondary to mechanical cause, shock, hemothorax,
Red tension pneumothorax, asphyxia, unstable chest and abdominal wounds, incomplete amputations,
open fractures of long bones, and 2nd/3rd degree burns of 15–40% total body surface area.
Stable abdominal wounds without evidence of significant hemorrhage; soft tissue injuries;
maxillofacial wounds without airway compromise; vascular injuries with adequate collateral
Yellow
circulation; genitourinary tract disruption; fractures requiring open reduction, débridement, and
external fixation; most eye and CNS injuries.
Upper extremity fractures, minor burns, sprains, small lacerations without significant bleeding,
Green
behavioral disorders or psychological disturbances.

Unresponsive patients with penetrating head wounds, high spinal cord injuries, wounds involving
multiple anatomical sites and organs, 2nd/3rd degree burns in excess of 60% of body surface area,
Black
seizures or vomiting within 24 hr after radiation exposure, profound shock with multiple injuries,
agonal respirations; no pulse, no BP, pupils fixed and dilated.

TRIAGE Critical Points

Never move a casualty backward (against the flow).
Never hold a critical patient for further care.
Salvage life over limb.
Triage providers do not stop to treat patients.
Never move patients before triage except in cases of:
-Risks due to bad weather.
-Impending darkness or darkness has fallen.
-A continued risk of injury.
-Medical facilities are immediately available.
(Shortcut)
1. Go with flow 4. Don’t go limp
2. Don’t go slow 5. Don’t move patients before triage, except in cases of risks
3. Life over limb 6. Triage first, don’t make it worst

Internal Hospital Disasters

Phases:
1. Alert phase - during which staff remain at their regular positions, service provision is uninterrupted, and faculty and staff await
further instructions from their supervisors
2. Response phase - Response phase, during which designated staff report to supervisors or the command post for instructions, the
response plan is activated, and nonessential services are suspended
3. Expanded response phase - when additional personnel are required, off-duty staff are called in, and existing staff may be reassigned
based on patient needs

Emergency Management Cycle

1. Pre-impact
2. Impact
3. Post-impact

Types of Disaster Planning

1. Agent-specific approach focus the preparedness activities on the most likely threats to occur based on the geographic
location (e.g., hurricanes in Florida).
2. All-hazards approach incorporates disaster management components that are consistent across all major types of
disaster events to maximize resources, expenditures, and planning efforts

Zones for disaster triage

1. Hot
o Immediately adjacent to the location of the incident
o Minimal triage and medical care; activities are limited to airway and hemorrhage control, administration of antidotes, and
identification of expectant cases
o All staff are in protective gear in this zone
2. Warm
o More than 300 feet from the outer edge of the Hot Zone, and uphill/upwind from the contamination area
o Rapid triage takes place to sort victims into critical, urgent, delayed, or expectant categories
o Priority is to commence decontamination
o All staff must wear the appropriate PPE
3. Cold
o Adjacent to the Warm Zone, and uphill/upwind from the contamination area
o Decontaminated patients enter this area where a more thorough triage is performed; then patients are directed to
treatment areas based on the severity and nature of illness or injury
o Personnel may wear PPE in case the wind changes or victims arrive who have been improperly decontaminated