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

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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?

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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

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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

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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

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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

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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

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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

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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

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Stabilizing Vehicles
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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

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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

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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

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Gaining Access
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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

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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

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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

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Breaking Safety Glass

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

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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

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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

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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

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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)

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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)

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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

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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

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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

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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).

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Water Rescue
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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

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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

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Safe Water Rescue Techniques

• Reach-throw-go priority

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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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