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Title: EMS Operations Lesson 18 Introduction Understand your role


1
EMS Operations
  • Lesson 18

2
Introduction
  • Understand your role, especially in complex
    operations
  • Special responsibilities/operational factors
  • Air transport
  • Extricating patients from wreckage
  • Hazardous material incidents
  • Situations requiring special response teams
  • Personal safety is first priority

3
Phases of a Response
  • Preparation for the Call
  • Dispatch
  • En Route to Scene
  • Arrival at Scene
  • Transferring the Patient
  • After the Run

4
Preparation for the Call
  • Personal preparedness
  • Response vehicle preparedness
  • Equipment Preparation
  • Oxygen cylinders
  • Dressings, bandages, other equipment
  • Follow agency guidelines/local protocol

5
Medical Equipment and Supplies
  • Personal protective equipment
  • Basic supplies, including scissors, cold packs
  • Basic wound care supplies
  • Oral and nasal airways
  • Suction equipment
  • Oxygen equipment
  • AED
  • Splints
  • Backboard
  • Cervical collars
  • Bag mask
  • Obstetrical kit
  • Blanket

6
Miscellaneous Equipment and Supplies
  • Planned routes or comprehensive street maps
  • Flashlight
  • DOT Emergency Response Guidebook
  • Extrication equipment
  • Flares, cones, reflective triangles
  • Fire extinguisher

7
Preplanning
  • Response plan prepared in anticipation of an
    emergency
  • Industrial plants
  • Areas at high risk for an emergency
  • Sports stadiums, theatres, public buildings

8
Dispatch
  • EMS center staffed 24 hours/ day
  • In some cases, you may contact dispatch center to
    request assistance
  • May dispatch you via a variety of communication
    devices

9
Information from Dispatcher
  • Write down this information so that it is
    accessible to you en route
  • Nature of the call
  • Name, location, and callback number of caller
  • Location of patient(s)
  • Number of patients
  • Severity of the problem
  • Other pertinent information, such as help being
    given to the patient

10
En Route to the Scene
  • Gather necessary medical equipment - depart for
    scene
  • Follow local laws/ guidelines for using emergency
    warning equipment
  • In a private vehicle, obey all traffic laws/signs
    and drive safely
  • Wear seat belts and shoulder harnesses
  • Notify dispatch that you are en route
  • Confirm essential information about emergency
  • Check with dispatch if anything is not clear

11
Arrival at the Scene
  • Park safely where your vehicle will not be in way
    of ambulances
  • Keep emergency lights/ flashers on
  • Notify dispatch when you arrive
  • Update dispatcher with information differing from
    original information
  • Size up scene before approaching patient

12
Considerations As You Approach
  • Need for body substance isolation precautions
  • Any need to move patient due to hazards at scene
  • MOI or medical emergency
  • Need for additional help
  • Number of patients

13
Transferring the Patient
  • When EMS personnel arrive, provide patient
    assessment/treatment information
  • Remain with patient and assist other EMS
    personnel as required
  • If labor-intensive procedures are necessary, stay
    with patient
  • Patient Packaging
  • Following stabilization, patient is prepared for
    transport
  • You may assist with this process

14
After the Run
  • Complete any required documentation
  • Clean and disinfect equipment
  • Restock disposable supplies that were used
  • Refuel your vehicle if needed
  • Notify dispatch that you are ready for the next
    call

15
Helicopter Transport
16
Helicopter Transport and Evacuation
  • Uses
  • First Responders responsibilities may include
  • Determining that such transport is required and
    making the request
  • Preparing patient for transport
  • Setting up helicopter landing zone

17
Requesting Air Transport
  • Follow local protocol for requesting a helicopter
  • Consider these factors
  • Will ground transport of a critical patient take
    too long?
  • Will patient extrication be prolonged for an
    unstable patient?
  • Is ground access to patient impossible or may be
    delayed?

18
Preparing the Patient for Helicopter Transport
  • Secure anything that may be disturbed by high
    winds
  • Protect the patient and yourself against
    debris/dirt blown
  • Use eye protection and protect exposed skin
  • Assist the helicopter crew to secure patient to
    stretcher
  • Patient may be placed in ambulance in preparation
    for transport to helicopter

19
Setting Up the Landing Zone
  • Should be set up by trained personnel following
    local protocols, state requirements, and other
    recommendations
  • Landing zone should be flat area free of
    obstructions
  • A safe distance from emergency scene
  • At least 100 feet by 100 feet
  • Select an area free of loose objects

20
Setting Up the Landing Zone continued
  • Corners of landing zone marked with clearly
    visible objects
  • At night, mark corners with strobe lights,
    chemical light sticks, or flares if no fire risk
    (but not railroad flares)
  • Dont point vehicle headlights toward the center
    of zone
  • If police vehicles are present, they may be used
    to mark the corners with their emergency red
    lights
  • Communicate with the pilot and describe landing
    zone and corner markings

21
Helicopter Safety Guidelines
  • Keep other rescuers/ bystanders far away from
    landing zone
  • Close doors and windows of nearby vehicles
  • Do not let any bright lights shine upward or
    toward helicopter as it lands
  • Never approach helicopter until pilot signals
    that it is safe
  • Approach only from the front
  • Stay low when approaching the helicopter, do not
    raise your arms over your head

22
Patient Extrication
23
Patient Extrication
  • Patients frequently trapped inside wrecked
    vehicles, buildings, etc.
  • Your responsibility may include assisting with
    extrication
  • Special training required for all but simple
    forms of extrication

24
Patient Extrication from a Wrecked Vehicle
  • Rescue more complicated if patient pinned by
    wreckage
  • Your personal safety is highest priority,
    followed by patients safety
  • Administer necessary care to patient before
    extrication
  • Ensure patient is removed in a way to minimize
    further injury
  • A chain of command should be established to
    ensure patient care priorities

25
Assess Extrication Scene
  • First concern is always your/bystanders safety
  • Approach carefully. Retreat if scene unsafe
  • Assess scene to determine
  • What happened
  • Number of patients
  • Whether any hazards are present
  • What specialized rescue personnel, equipment, and
    tools will be required

26
Extrication Decision
  • After assessment, call dispatch for additional
    personnel
  • Never attempt a rescue for which you are not
    trained
  • Never attempt a rescue with improper/ inadequate
    safety/ rescue equipment
  • Evaluate the scene to ensure your/bystanders
    safety

27
Extrication Decision continued
  • Wear appropriate protective devices
  • Dont attempt to do anything you are not trained
    to do
  • If you have not already done so, call for
    additional personnel
  • Check scene for other patients
  • Control scene while waiting for other rescuers

28
Stabilizing Vehicles
29
Stabilizing the Vehicle
  • Before accessing patient, ensure vehicle is
    stable
  • If safe, put upright vehicles automatic
    transmission in park
  • If safe, set emergency brake remove key from
    ignition
  • If it may move in any way, try to stabilize
    wheels

30
Vehicle on its Side
  • Head/neck injuries common when the vehicle has
    rolled onto its side
  • Dont attempt to return car to upright position
    before removing patients
  • If possible, stabilize vehicle using ropes,
    tires, blocks, etc.
  • Dont climb on top to open a door/window
    instead, break rear window

31
Vehicle That Has Flipped Upside-Down
  • Dont attempt to right vehicle, prevent
    bystanders from doing so
  • If fuel is leaking, clear scene
  • Dont allow smoking anywhere near rescue
    operation
  • Try to access patient after stabilizing vehicle

32
Gaining Access
33
Tools for Gaining Access to Patient in Vehicle
  • Protective clothing, leather gloves, protective
    goggles
  • Pliers
  • Pocket knife
  • Jack
  • Jack handle
  • Rope
  • Screwdriver
  • Hammers
  • Hacksaw
  • Pry bar
  • Spring-loaded center punch
  • Slim Jim

34
Route of Entry Into Vehicle
  • Try vehicle doors first. If one is locked, check
    others
  • If all doors are locked, ask patient to unlock
    one
  • If needed, use a special tool designed for
    unlocking vehicle doors
  • If you cannot access patient through a door, try
    to enter through a window

35
Route of Entry Into Vehicle continued
  • Ask patient to open window if possible. If not,
    window must be removed
  • Breaking glass is dangerous for patient/rescuer

36
Breaking Safety Glass
  • Use proper protective equipment
  • If protective equipment is unavailable
  • Cover window with blanket, coat, or tarp
  • Use pointed object to puncture glass
  • Make entry in corner farthest from patient
  • Tape window first
  • Remove glass until opening is large enough
  • Once inside, you may be able to unlock/ force
    open door

37
Breaking Safety Glass
  • Removing Windshield
  • Use screwdriver/pry bar to remove liner
  • Pry window free - remove it

38
Other Ways to Access Patient
  • If you cannot access a patient safely, wait for
    additional rescuers
  • Cut doors open, remove parts of roof
  • If patient pinned under vehicle, wait for rescue
    squad with special equipment
  • If patient's life is in danger, attempt to lift
    car slightly with help of others
  • If a patient in imminent danger is trapped by
    wheel or vehicle frame, try jacking car up,
    blocking it, and sliding patient out
  • Never crawl under the vehicle yourself
  • After Accessing the Vehicle
  • Turn off the ignition to reduce the risk of fire

39
Providing Emergency Care After Accessing Patient
  • Provide basic emergency care while patient is in
    vehicle
  • Perform BLS skills required until additional EMS
    personnel arrive
  • Unless explosion is possible, administer
    supplemental oxygen
  • If scene is dangerous, consider an emergency move

40
Disentanglement of Patient
  • Freeing patients generally not a First Responder
    responsibility
  • Paramedics may give Advanced Life Support
    procedures while patient is trapped
  • Remain at scene during disentanglement process to
    assist

41
Removal of Patient
  • Remove patient after being stabilized and
    packaged
  • Spine immobilized and critical interventions
    given
  • If patient has life-threatening trauma EMS may
    remove patient immediately for transport
  • Removal not a First Responder responsibility,
    but you may assist

42
Hazardous Materials
43
Hazardous Materials Incidents
  • Hazardous materials are common and pose a special
    hazard
  • Hazardous materials include
  • Poisonous substances
  • Explosives
  • Flammable gases, liquids, and solids
  • Chemicals and substances that react with other
    substances
  • Radioactive materials

44
Assessing for Hazardous Materials
  • Check for clues
  • A spilled chemical or liquid
  • Smoke or vapors
  • The smell of fumes
  • Hazardous materials are not limited to industrial
    sites or vehicles transporting substances
  • Homes contain potentially hazardous materials
  • Some hazardous materials are explosion hazards

45
Hazardous Materials Placards
Those who transport/store hazardous materials
must post placards that identify material
46
Hazardous Materials Placards
  • If You Do Not See a Placard But Suspect a
    Hazardous Material
  • Try to obtain additional information before
    approaching scene
  • Do not enter scene. Retreat and call for help
  • Most fire departments have specially trained
    hazmat teams for managing hazardous materials
    incidents
  • Hazardous materials spills under the jurisdiction
    of National Incident Management System (NIMS)

47
When Hazardous Material Is Present
  • Primary responsibility is personal safety,
    maintaining safety for bystanders and the patient
  • Manage scene and keep others from scene while
    awaiting the hazmat team
  • Try to identify the substance involved, give this
    information to dispatch and arriving EMS
    personnel
  • Remain upwind of the scene

48
Hazardous Materials Training
  • Do not attempt to manage the hazardous substance
  • Typical levels of training
  • Hazardous materials awareness training
  • Hazardous materials operations training
  • Hazardous materials technician
  • Hazardous materials specialist
  • Hazmat guidelines mandated by Occupational
    Safety and Health Administration (OSHA)

49
Managing the Scene
  • Never enter a scene unless trained as hazardous
    materials technician and fully protected
  • Park upwind or uphill at a safe distance
  • Goal is to isolate area and keep unnecessary
    people away
  • Avoid any contact with material
  • Dont provide ignition source

50
Managing the Scene
  • Move at-risk patients to safe area only if no
    exposure risk to yourself
  • Patient who has been exposed should be
    decontaminated
  • Once a patient is removed, perform basic care

51
Identifying Hazardous Material
  • If you are first on scene, try to identify the
    specific hazardous material
  • Federal regulations require that hazardous
    materials are clearly labeled

52
Identifying Hazardous Material
  • Drivers carrying hazardous materials must have
    shipping papers that identify substance
  • All vehicles transporting hazardous materials
    must have placards identifying material/hazards

53
Placards
  • The color and design indicate hazard
  • Four-digit number on the placard identifies
    material
  • Try to read placard from safe distance using
    binoculars
  • Report this information to hazmat team and other
    personnel on site
  • The Emergency Response Guidebook identifies
    hazardous materials codes

54
NFPA Warnings
  • The National Fire Protection Association system
    used on storage and industrial buildings.
  • These placards identify the specific hazard by
    color
  • Red - flammable
  • Blue - health hazard
  • Yellow - instability hazard such as explosive or
    unstable material
  • White - other information
  • The placards also rate hazard level , ranging
    from very low hazard (0) to a very high hazard
    (4).

55
Water Rescue
56
Water and Ice Rescue
  • Emergency involving person in water/ ice is
    dangerous
  • If you cannot safely approach, stay away and call
    for specialized help
  • A crew with appropriate training/ equipment will
    be dispatched

57
Water Rescue Situations
  • A non-swimmer may have gotten into deep water
  • A swimmer may have sustained injury or sudden
    illness
  • Any victim of hypothermia
  • If someone in deep water cannot reach safety
  • An unresponsive person as a result of drowning,
    injury, or illness usually needs immediate BLS
    after rescue
  • Choice of Water Rescue Technique Depends On
  • Type of situation
  • Equipment /objects at hand
  • Circumstances

58
Stay Out of the Water
  • Resist temptation to jump immediately into water
    to save person
  • Drowning person is panicked
  • Lifeguards receive special training in how to
    break a victims hold
  • It may be appropriate to swim to an unresponsive
    victim

59
Safe Water Rescue Techniques
  • Reach-throw-go priority

60
Reach Rescue
  • Let responsive person hold on to pole while you
    slowly pull him/her to edge
  • Hook an unresponsive victims body and pull to
    safety
  • Use anything available to reach to the victim
  • If the victim is close enough, you may reach with
    your body

61
Throw Rescue
  • Throw anything that floats to a responsive person
  • Swimming pool/boating equipment may include a
    life ring, rescue tube, or life jacket
  • Some boats carry a throw bag
  • If no throwable rescue device is available, use
    anything that will float

62
Go Rescue
  • Dont enter water to go to victim except a small
    child or unresponsive victim
  • Look for other ways to go to the victim
  • Wear a personal flotation device, take something
    person can hold on to

63
Unresponsive Patients in Water
  • An unresponsive patient should be assumed to have
    a potential spinal injury
  • Stabilize head/neck
  • Turn patient face up to allow breathing or rescue
    breathing
  • If patient is breathing, do not attempt removal
    alone - wait for other EMS
  • If alone, stabilize the patients head and back

64
Unresponsive Patients in Water
  • With two responders, one holds patient at
    shoulder and hips while other supports head and
    neck in line
  • If patient is not breathing and you are alone,
    float patient into shallow water for rescue
    breathing
  • Check patients pulse
  • Dont remove patient with a pulse, continue
    rescue breathing until additional EMS personnel
    arrive
  • If patient is pulseless, remove him or her from
    the water to give CPR
  • Try to support the patients head /spine during
    removal

65
Turning A Patient in Water Using a Head Splint
  • 1. Bring patients arms along both sides of his
    / her head
  • Holding both of patients arms against sides of
    head, rotate the patient toward you
  • Maintain the head stabilization while assessing
    breathing

66
Walking Assist With Sloping Bottom
  • Once at depth where he/she can stand, help
    patient exit with a walking assist
  • Support the patient as you walk patient out of
    the water

67
Beach Drag
  • Remove unresponsive patient from shallow water on
    a gradual shoreline with beach drag
  • Slowly back out of the water, dragging patient
    out

68
Ice Rescue
  • Ice rescues are dangerous
  • Cold-water immersion is very serious
  • Call immediately to summon appropriate emergency
    personnel
  • Attempt ice rescue using same priorities as a
    water rescue reach-throw-go

69
Ice Rescue Reach-Throw-Go
  • Use pole or tree limb to reach to person who
    has broken through ice
  • Throw a rope or any buoyant object tied to a rope
  • Only as an extreme last resort try to go to the
    person
  • Lie down to distribute your weight over a larger
    surface area
  • Push a branch or other object ahead of you to the
    victim
  • Patient is likely to need treatment for
    hypothermia

70
Special Response Situations
71
Special Response Situations
  • Many emergencies/rescues require teams with
    special training and equipment
  • Call for assistance and to provide as much
    information as possible

72
Confined Space Emergencies
  • Hazards may include
  • low oxygen levels
  • toxic or explosive gasses
  • risk of collapse
  • hypothermia or heat stroke
  • Rescue teams are organized by fire departments,
    industrial organizations, and other agencies
  • Special equipment/ training are needed
  • Report the situation, keep bystanders out of the
    area, and provide support to the rescue team
  • After the removal of patients, assist other EMS
    personnel in providing care

73
Rural and Agricultural Settings
  • Emergency response may differ from that in urban
    areas
  • Longer response times
  • Limited cellular telephone coverage
  • Workers often alone and not immediately
    discovered
  • First Responders/EMS personnel are frequently
    volunteers

74
Differences in Rural EMS and Healthcare Facilities
  • May not have sophisticated equipment or advanced
    training
  • Small rural hospitals may not have continuous
    emergency department coverage or lack resources
  • Patients may let chronic medical problems become
    emergencies

75
Agricultural Hazards and Injuries
  • Deaths among farm workers are higher than almost
    all other occupations
  • Equipment entanglement may involve lengthy
    extrication procedures
  • Hazardous chemicals are common
  • Temperature extremes frequently contribute stress
    in emergencies

76
First Responders in Rural and Agricultural
Settings
  • Be prepared for patient conditions that have
    deteriorated because of response time
  • Get to know the area/types of hazards
  • Get training for medical care needed during
    longer periods awaiting EMS resources
  • Have right equipment/supplies
  • Get advanced training in special skills such as
    hazardous materials incidents
  • Recognize the need to keep your skills updated

77
Industrial Settings
  • Particularly hazardous due to hazardous
    machinery /equipment
  • Presence of hazardous materials
  • Risks of fire/explosion
  • Confined spaces
  • An industrial response team is often present,
    with specialized training

78
First Responders in Industrial Settings
  • Learn about special industrial response teams and
    how to contact them
  • If site has emergency plan, ensure it is
    activated
  • Your personal safety is your first priority
  • Talk to on-site managers/staff to learn about
    specific hazards before entering scene
  • Be aware of potential for multiple patients in an
    industrial incident, activate Incident Command
    System

79
Natural Disasters
  • Natural disasters often cause widespread damage/
    injury.

80
Natural Disasters
  • First Responders reporting to Incident Command
    System may have many roles
  • NIMS directs response involving state/local
    disaster agencies
  • Report within command structure and focus on your
    specific task assignments

81
Terrorist Acts
  • NIMS has planned response to wide range of
    possible attacks
  • First Responders receive special training about
    their role in different types of attacks

82
First Responder Awareness
  • Maintain awareness of different types of
    terrorist attacks
  • Be observant whenever responding to an unusual
    emergency scene
  • Be watchful/suspect a terrorist incident when
    arriving at scene involving
  • A large number of patients
  • Patients with unusual signs and symptoms possibly
    related to an exposure
  • Any incident at a facility or public place that
    may be targeted by terrorists
  • Other unusual incidents

83
Secondary Explosive Devices
  • Be aware of possibility of secondary device
  • Devices are timed to explode later to injure
    emergency personnel

84
First Responsibilities at the Emergency Scene
  • Maintain personal safety
  • Evaluate scene carefully before entering
  • Report emergency as quickly/ fully as possible
  • Protect bystanders and help maintain scene
    safety
  • Follow your chain of command for large-scale
    incidents
  • Assist other emergency personnel at the scene

85
Terrorist Acts
  • Threat of terrorist acts omnipresent
  • Possible attacks include
  • Explosions in structures
  • Nuclear explosions
  • Crashes of airliners, trains, ships, other
    vehicles of mass conveyance
  • Release of biological agents
  • Release of chemical agents
  • Release of radioactive material

86
Terrorist Acts continued
  • Suspect a terrorist incident in emergency
    scenes involving
  • Large number of patients
  • Patients with unusual signs and symptoms related
    to an exposure
  • Any incident at a facility or public place that
    may be targeted by terrorists
  • Other unusual incidents

87
First Responder Responsibilities
  • Maintain personal safety
  • Evaluate the scene carefully before entering
  • Report the emergency quickly and fully
  • Protect bystanders and help maintain scene safety
  • Follow chain of command
  • Assist other emergency personnel with triage,
    patient care
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