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Hazardous Terrain

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Require use of hands in climbing. Ropes, aerial apparatus required for access, removal ... Aerial apparatus is NEVER used as a crane to move a litter. Helicopters ... – PowerPoint PPT presentation

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Title: Hazardous Terrain


1
Hazardous Terrain
2
EMS Skills
  • Rescue awareness
  • Types of specialized teams
  • Effective coordination with specialists
  • Hazardous terrain litter evacuations

3
Hazardous Terrain Types
  • High angle
  • Low angle
  • Flat terrain with obstructions

4
High Angle
  • Surfaces inclined gt40o
  • Gorges
  • Cliffs
  • Buildings
  • Very smooth surfaces lt40o
  • Require use of hands in climbing
  • Ropes, aerial apparatus required for access,
    removal
  • Errors can cause life-threatening injury, death

5
Low Angle
  • Surfaces inclined lt40o
  • Accessed by walking, scrambling
  • Difficulty can be affected by presence of
  • Water
  • Ice
  • Boulders
  • Brush, down trees
  • Ropes used to counteract gravity, act as hand
    lines
  • Errors can result in falls, tumbles
  • Presence of obstructions can result in serious
    injury

6
Flat Terrain with Obstructions
  • Examples
  • Trails
  • Paths
  • Creek beds
  • Difficulty may be increased by
  • Downed trees
  • Rocks
  • Slippery leaves
  • Scree (rock debris)
  • Patients can be moved by carrying
  • Least hazardous form of rugged terrain
  • Slips, falls can result in injury

7
Patient Access
8
High Angle
  • Access/removal usually carried out by technical
    teams
  • Additional resources needed to balance
    technical/medical aspects of rescue

9
High Angle
  • Rescuer skills
  • Knot tying
  • Ascending, descending skills
  • Rigging of hauling systems
  • Packaging of patients for evacuation

10
High Angle
  • Specialized Terms
  • Aidedusing means other than hands, feet, body
  • Anchortechnique for securing rescuers to
    vertical face
  • Belaysafeguarding climber by use of a rope
    secured to an anchor
  • Rappeldescend by sliding down a fixed double
    rope

11
Low Angle
  • Access/removal conducted by EMS personnel in many
    systems
  • Still requires appropriate training/equipment

12
Low Angle
  • Skills
  • Assembly/use of harnesses
  • Setting up hasty rope slides
  • Rappelling, ascending by rope
  • Patient packaging
  • Rigging simple hauling systems

13
Patient Packaging
14
Stokes Basket Stretcher
  • Standard litter for rough terrain evacuations
  • Provides rigid frame for patient protection
  • Easy to carry

15
Stokes Basket Stretcher
  • Come in plastic and wire/tubular (military)
    styles
  • Wire/tubular style will NOT accept long spine
    boards
  • Plastic styles weaker, but provide better
    shielding to patients
  • All require additional strapping, use of plastic
    litter shields

16
Stokes Basket Stretcher
During high/low angle evacuations
  • Apply harness to patient
  • Apply leg stirrups to patient
  • Secure patient to litter
  • Tie tail of one litter line to harness
  • Use helmet, litter shield
  • Give fluids
  • Allow accessibility for assessment, management
  • Ensure adequate padding
  • Consider heating/cooling system use
  • Provide gravity tip line to clear airway if
    necessary

17
Patient Removal
18
Flat Terrain
  • When possible, walk patient out!
  • Carrying over flat ground is strenuous under
    ideal conditions

19
Flat Terrain
  • Two to three teams of 6 litter-bearers
  • All approximately same height
  • Leapfrog ahead to save time
  • Webbing straps tied to stretcher frame and pulled
    across rescuer shoulders to free hand can lessen
    load
  • Litter wheel may help on flat ground

20
Low/High Angle
  • Anchors, personnel safety equipment, patient
    packaging, and hauling systems must be checked
    multiple times for safety
  • Hauling systems may require multiple personnel to
    move weight of patient, basket, and ropes

21
Low/High Angle
  • Fire department snorkels can be used for patient
    evacuation
  • Stokes stretcher must be properly belayed to
    snorkel basket
  • Aerial apparatus is NEVER used as a crane to move
    a litter

22
Helicopters
  • Capabilities, policies vary widely
  • Understand policies regarding
  • Loading and unloading practices
  • Restrictions on carrying non-crew
  • Use of winches for rescues
  • Weight restrictions
  • Restrictions on hovering rescues
  • Use, practice of one-skids and toe-ins
  • Use of short hauls and rappel rescues

23
Extended Care Issues
24
Protocols
  • Long-term hydration
  • Dislocation repositioning
  • Wound cleaning/care
  • Impaled object removal
  • Non-pharmacologic pain management
  • Pharmacologic pain management
  • Assessment/care of head/spinal injuries
  • Hypothermia/ hyperthermia management
  • CPR termination
  • Crush/compartment syndrome management

25
Environmental Considerations
  • Weather/Temperature Extremes
  • Risk of hypo/hyperthermia
  • Difficulty in exposing patient for assessment
  • Use of specialized packaging

26
Environmental Considerations
  • Limited Patient Access
  • Inaccessible parts of patient
  • Cramped space
  • Low lighting conditions

27
Environmental Considerations
  • Difficulty Moving Equipment
  • Identify minimum essential equipment
  • Carry in backpack

28
Environmental Considerations
  • Cumbersome PPE
  • Restricted rescuer mobility
  • Temporary removal of PPE to perform procedures

29
Environmental Considerations
  • Patient Exposure
  • Covering for thermal protection
  • Hard protection from sharp objects, debris

30
Environmental Considerations
  • ALS Skills
  • Wires, tubing complicate extrication
  • Limit to absolute necessities
  • Oxygen may have to be given at slower flow rates
    to prolong cylinder life

31
Environmental Considerations
  • Patient Monitoring
  • Modification of procedures (palpated BP)
  • Modification of equipment (compact pulse
    oximeters)
  • Non-use of equipment (ECG monitors)

32
Environmental Considerations
  • Improvisation
  • Splinting using patients uninjured body parts
  • Light-weight splints
  • Downsized or improvised medical gear
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