CICRA

EMERGENCY

PROCEDURES

Last updated: September, 2009

Please send comments to Adrian Tejedor ( atejedor@conservacionamazonica.org )

or Jesus Ramos ( jramos@conservacionamazonica.org )

or Sarah Federman ( sf2221@gmail.com )

Medical evacuation

1. CICRA staff and residents stabilize the victim.

2. CICRA staff and residents inform the director or station manager of the accident.

3. CICRA staff and residents quickly locate:

a. the first aid kit in the administrative office

b. the victim's passport or DNI

c. warm clothing, rain gear, food and water for the boat (and a sleeping pad or mattress if the victim will travel prone)

4. CICRA staff and residents transport the victim and the above items to the CICRA dock.

5. CICRA boat driver transports the victim to Boca Amigos, with at least two other CICRA staff, residents, or friends accompanying the victim.

6. Once the boat has left, the CICRA staff or researcher best informed about the condition of the victim contacts the ACCA office via Internet and informs them of the emergency.

7. The medical technician at Boca Amigos inspects the victim in the boat, provides further stabilizing treatment, and collects any other first aid equipment necessary for the evacuation (maximum 10 minutes).

8. From the satellite phone in Boca Amigos, CICRA staff calls the ACCA office in Puerto Maldonado and informs them of the emergency.

9. The CICRA boat driver transports the victim to Laberinto, with at least two CICRA staff or residents accompanying the victim. If necessary, the medical technician from Boca Amigos should also accompany the victim.

10. An ambulance or taxi arranged by the ACCA office in Puerto Maldonado transports the victim from the Laberinto port to the hospital in Puerto Maldonado.

Snakebite

1. Even if the bite seems minor, superficial or dubious, or if there is no obvious reaction, follow the emergency evacuation procedure described above for any person struck by a snake, with the following additional steps.

2. Send the anti-venom from the administrative office along with the evacuated patient and accompanying staff and residents.

3. Do not:

Apply tourniquets or make incisions on or around the snake bite.

Make the patient walk.

Apply venom extractor if the bite is more than 5 minutes old.

Attempt to suck venom out with the mouth.

Inject with anti-venom, unless the medical technician in Boca Amigos decides it is necessary to do so. The anti-venom accompanying the patient is to be applied at the discretion of the doctors upon the victim's arrival in Puerto Maldonado.

Apply ointments or other medications.

4. As a precaution, a snakebite victim may not return to the station for two weeks following initial recovery, even if they have no serious reaction to the bite.

Allergic Reaction

1. In the event of a severe allergic reaction, the victim should be laid on the ground and encouraged to breathe calmly. If it is apparent that the victim is experiencing anaphylaxis or the closing off of his or her airway, epinephrine should be administered immediately as per the instructions of an EPI pen or Anakit. In the event that the victim does not have his or her own EPI pen or Anakit, EPI pens are available on the shelf labeled EPIPEN on the wall in the CICRA dining hall.

a. How to use an Anakit:

i. Remove the blue plastic needle cover

ii. Syringe upright and push plunger to expel air and excess epinephrine. The plunger will stop automatically. NOTE: For children under 12 years of age, you must adjust the dosage. The syringe barrel is marked in 0.1 ml graduations so smaller doses can be given. It is generally easier to expel the volume not required before inserting the needle into the arm or thigh

iii. Rotate the rectangular plunger 1/4 turn to the right. The plunger will stop when aligned with the slot in the barrel of the syringe

iv. Wipe the injection site with alcohol swab

v. Insert needle straight into arm or thigh

vi. Push plunger until it stops. Syringe will inject a 0.3 ml dose for adults and children over 12 years of age

b. How to use an EPI pen:

i. Unscrew the yellow cap and remove EPI pen from storage container.

ii. With black tip pointing down, pull off the gray safety release.

iii. Hold black tip near outer thigh.

iv. Swing and jab black tip firmly at a 90 degree angle into outer thigh until it clicks.

v. Hold against thigh for 10 sec.

vi. Massage injection area for 10 sec.

vii. If symptoms do not subside, a second EPI can be administered.

2. Once normal breathing has been restored, evacuate victim.

Visitors with a known severe allergy should inform the director of the station of this allergy and the location of their EPI pen or Anakit.

Missing person

1. CICRA staff and residents notice from the sign-out board that someone did not return from the field and inform the director or station manager of the situation.

2. CICRA staff and residents check the sign-out board and question station residents about where the missing person was working.

3. CICRA staff and residents check the various areas at CICRA where the person might be (laboratories, dormitory, cabins, etc.).

4. CICRA staff and residents form as many search parties as feasible, each consisting of two people and equipped with flashlights, extra batteries, first aid kits, water, food, and whistles.

5. Search parties map out, discuss, and then walk individual routes that intersect at a determined point, calling and blowing whistles.

6. If the person is not found by morning, CICRA staff call CM1 by radio to request the promotores' help in forming additional search parties, and call the ACCA office in Puerto Maldonado to inform them of the emergency.

Fire

1. The person who spots a fire informs the rest of the people in the building and the rest of camp by shouting "Fire! Incendio!"

2. Everyone in the building is evacuated to a safe distance.

3. If CICRA staff judge that the fire is out of control, the building on fire and all other buildings are evacuated to a safe distance. One person is stationed at each adjacent building in order to alert others if the fire spreads.

4. CICRA staff count heads to ensure that everyone in camp is accounted for.

5. If CICRA staff judge that it is likely they can extinguish the fire, CICRA staff and residents attempt to put it out with the closest extinguishers available.

6. Those not fighting the fire bring additional extinguishers from other buildings around camp, and where safety permits remove explosive objects from the building on fire to a safe distance.

7. All generators and electrical systems in camp are switched off.

8. Do not:

Remove valuable equipment and belongings from a building that the CICRA staff have determined to be unsafe.

Boat accident

1. The most common accidents on the Madre de Dios and Los Amigos rivers happen when a boat's hull is punctured by a submerged log. The boat will come to a jolting stop and fill rapidly with water. It may start to roll and tilt slowly, but it is unlikely to overturn violently.

2. Passengers, boat driver, and assistant should remain with the boat until they determine that it is safe to abandon it. In general, passengers who remain calm at this point are much more helpful than passengers who take dramatic action. Passengers should:

Listen for and follow the instructions of the boat driver and his assistant.

Pass on those instructions to neighboring passengers who may not understand Spanish.

Check with neighboring passengers to see if anyone was injured by the impact.

Check that their own and others' life jackets are fastened correctly, and heavy shoes are off.

3. Even if the boat is swamped, the boat driver and assistant will try to maneuver it to a nearby beach or other safe place. If that is not possible, passengers should follow the boat driver's instructions regarding the safest way to remain with the boat until help arrives.

4. Passengers who find themselves separated from the others should make their way to the nearest beach and stay there until help arrives.

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5. Passengers should not:

Abandon the boat unless the boat driver instructs them to.

Try to save luggage or other belongings that are floating away.

Move about the boat unnecessarily.

Leave the boat to save a passenger in the water unless they are trained in lifesaving.

Worry about dangerous animals in the water; rivers in Madre de Dios are safe for swimming.

6. The boat driver will remain with the passengers in a safe place until help arrives in the form of a passing boat. Once help arrives, all passengers at the boat and on the beaches will be transferred to the rescue boat and transported to the nearest town. If any of the passengers are not accounted for, the boat driver and/or assistant will coordinate an immediate search for them.

7. If any of the passengers are seriously injured, the boat driver and/or assistant will take them to the town's clinic for stabilization, and then evacuate them to Laberinto via an express boat hired in the town, with at least three people (including the town's medical technician) accompanying the victim.

8. Remaining CICRA staff and passengers should communicate news of the accident to CICRA (radio frequency 6965 superior, call tag "La Colorada), to the ACCA office in Puerto Maldonado (telephone number 082-573-237), and to the Peruvian navy base in Laberinto. Depending on the situation, ACCA staff will determine whether to transport the remaining passengers to CICRA or to Puerto Maldonado.