Ems operations

EMS Operations

• EMS Operations

• Knowledge of operations and responsibilities to ensure patient, public, and personnel safety.

Vehicle Extrication

• Vehicle Extrication

• Safe vehicle extrication

• Use of simple hand tools

EMS departments must be prepared to respond to a variety of special rescue situations.

• EMS departments must be prepared to respond to a variety of special rescue situations.

• Paramedics are often first on the scene.

All EMS providers require training in rescue techniques.

• All EMS providers require training in rescue techniques.

• Focus of training is awareness.
• The paramedic’s function on-scene varies depending on the company.

A technical rescue incident (TRI) is a complex rescue incident.

• A technical rescue incident (TRI) is a complex rescue incident.

• Three levels of TRI training:

• Awareness
• Operations
• Technician

Be safe.

• Be safe.

• Follow orders.

• Work as a team.

• Think.

• Follow the golden rule of public service.

Preparation

• Preparation

• Response

• Arrival and scene size-up

• Stabilization of the scene

Train with other fire departments and special rescue teams.

• Train with other fire departments and special rescue teams.

• Assess the following:

• Personnel and equipment
• Who will respond
• Familiarity with hazard area

If your department has its own TRI team, it will respond.

• If your department has its own TRI team, it will respond.

• Often the rescue squad comes from an outside agency.
• Contact utility companies as needed.

Information received from initial dispatch call is critical.

• Information received from initial dispatch call is critical.

• Responders must:
• Identify/mitigate life-threatening hazards.
• Inform IC of special resources needed.
• Determine whether the situation is a search, rescue, or recovery.

Be sure all hazards are identified.

• Be sure all hazards are identified.

• First arriving responder assumes command.

• Establish objectives.
• Coordinate resources.
• Unify command between agencies.

Three guidelines to follow:

• Three guidelines to follow:

• Approach the scene cautiously.
• Position apparatus properly.
• Assist specialized team members.

Emergency vehicles

• Emergency vehicles

• Safety is the primary consideration.
• Disrupting traffic creates a hazard.
• Emergency vehicles can act as a barrier.
• Use only essential warning lights.

Control zones

• Control zones

• An outer perimeter protects against public and media; inner perimeter surrounds incident site
• Set up three control zones:
• Hot zone
• Warm zone
• Cold zone

Specific hazards

• Specific hazards

• Use the DOT’s Emergency Response Guide (ERG) as a resource
• Shut off utilities.

Protective equipment

• Protective equipment

• Considerations include:
• Visibility of PPE
• Footwear designed for the environment
• ANSI-approved safety glasses or goggles
• Puncture- or cut-resistant gloves
• Flame- or flash-protective clothing

Accountability

• Accountability

• System tracks personnel on the scene.
• Can be used to:
• Track resources
• Task assignments
• Ensure personnel safety

Patient contact

• Patient contact

• Maintain eye contact.
• Be truthful.
• Communicate at a level that can be understood.
• Be aware of body language.

Patient contact (cont’d)

• Patient contact (cont’d)

• Speak in laymen’s terms.
• Address the patient properly.
• Give time to respond to questions.
• Make the patient comfortable.

Simple access requires hand tools.

• Simple access requires hand tools.

• Complex access requires special tools.

• Gaining access depends on:

• Type of incident
• Nature and severity of injuries

Emergency medical care should begin as soon as the patient is accessed.

• Emergency medical care should begin as soon as the patient is accessed.

• A team member should stay with the patient while they are being disentangled.

• Involves freeing a patient from whatever is trapping them

Preparing for removal involves:

• Preparing for removal involves:

• Controlling life-threatening problems
• Dressing wounds
• Immobilizing fractures and spinal injuries

Expedite removal if:

• Expedite removal if:

• Patient is deteriorating rapidly.
• Hazards are present.

• Packaging: Preparing the patient for movement as a unit

Using a basket stretcher helps move patients to safety.

• Using a basket stretcher helps move patients to safety.

• Lifted by rope
• Carried by vehicles
• Hand carried

Transport varies depending on:

• Transport varies depending on:

• Severity of the patient’s injuries
• Distance to the medical facility

Use standardized terminology when describing.

• Use standardized terminology when describing.

• Roof posts add support to the roof.

There is an engine compartment and a passenger compartment.

• There is an engine compartment and a passenger compartment.

• Hood covers engine compartment
• Bulkhead divides compartments
• Firewall protects passengers

Two frame types:

• Two frame types:

• Body-over-frame construction
• Unibody construction

Powered by:

• Powered by:

• Electricity
• Electricity/gasoline hybrid
• Fuel

• Secure vehicle as soon as possible.

• Identified by special markings

A car wreck may have additional hazards.

• A car wreck may have additional hazards.

• Follow proper size-up and evaluation processes.

• Responders trained at awareness level may assist special responders.

Categories include:

• Categories include:

• Striking tools
• Leverage/prying/ spreading tools
• Cutting tools
• Lifting/pushing/ pulling tools

Cribbing

• Cribbing

• Designs include:
• Step chocks
• Wedges
• Shims

Vehicles may still move after cribbing.

• Vehicles may still move after cribbing.

• Horizontal
• Vertical
• Roll
• Pitch
• Yaw

Open the door.

• Open the door.

• Try all doors first.
• Ensure locks are released.

• Break tempered glass.

• Use side and rear windows not in close proximity to the patient.

Break tempered glass (cont’d).

• Break tempered glass (cont’d).

• Wear proper PPE.
• First, lower the windows as far as possible.
• Aim for a low corner.
• Give other EMS personnel warning.

Provide initial medical care.

• Provide initial medical care.

• Spine immobilization
• Assessment and management of the ABCs

Study the scene before taking action.

• Study the scene before taking action.

• The order of procedures will be determined by the specifics of the incident.
• Main objective = maintain spinal alignment and immobilization

Air bag safety

• Air bag safety

• Identify undeployed air bags.
• Disable airbags by disconnecting power.

Air bag safety (cont’d)

• Air bag safety (cont’d)

• Most vehicles contain an air bag.
• If the air bag has deployed, it is not a hazard.
• If it did not deploy, disconnect the battery.
• Some newer vehicles have a switch that allows shutting off of the air bags.

Air bag safety (cont’d)

• Air bag safety (cont’d)

• Do not place a hard object between the patient and an undeployed air bag.
• Do not cut a steering wheel if the air bag has not deployed.
• Never get in front of an undeployed air bag.
• Check for side-mounted air bags or curtains.

Displacing the seat

• Displacing the seat

• Relieves pressure on the driver
• Gives rescuers more room to work
• Try simple steps to displace a seat.

Removing the windshield

• Removing the windshield

• Allows for better communication
• Remove in one large piece.
• Essential before removing the roof

Removing the roof

• Removing the roof

• Increases space for care and disentanglement
• Protect the patient and rescuers inside the vehicle.
• Support the roof when cutting posts.

Displacing the dash

• Displacing the dash

• Use the dash roll technique.
• Requires a hydraulic cutter and ram
• Must be done by a trained rescuer

Location surrounded by a structure that is not designed for continuous occupancy.

• Location surrounded by a structure that is not designed for continuous occupancy.

• Limited ventilation

Oxygen deficiency and poisonous gases

• Oxygen deficiency and poisonous gases

• Hydrogen sulfide (H2S)
• Carbon monoxide (CO)
• Carbon dioxide (CO2)
• Methane (CH4)
• Ammonia (NH3)
• Nitrogen dioxide (NO2)

Safe approach

• Safe approach

• Gather information from bystanders.
• Assume IDLH atmosphere.

• Assisting other rescuers

• Share whatever information is discovered.
• Compare conditions with those reported.

Collapse sites are unstable and prone to further collapse.

• Collapse sites are unstable and prone to further collapse.

• Patients should be dug out after shoring has stabilized the site.

Safe approach

• Safe approach

• Stay away from the edges of the site.
• Shut off all heavy equipment.
• Stop or divert nearby traffic if needed.
• Avoid disturbing the spoil pile.
• Prioritize your personal safety.

Be aware of self-rescue techniques.

• Be aware of self-rescue techniques.

• Minimum PPE includes:
• Personal flotation device (PFD)
• Thermal protection
• Whistle

• If immersed in fast-moving water, adopt the self-rescue position.

Cold water rescue

• Cold water rescue

• Hypothermia can quickly progress.
• Assume the heat-escape-lessening position (HELP).
• Patient may survive underwater due to the mammalian diving reflex.

Other water rescue situations

• Other water rescue situations

• Special hazards of surface water:
• Hydraulics
• “Strainers”
• Dams and hydroelectric sites

Safe approach

• Safe approach

• Wear appropriate PPE.
• Do not exceed your level of training.
• Use the reach-throw-row-go approach.
• Use specialized equipment for ice rescues.

Suspect spinal injury if:

• Suspect spinal injury if:

• Diving mishap or fall
• Unconscious patient with no information to rule out neck injury
• Conscious patient reporting weakness, paralysis, or numbness in arms and/or legs
• You have any other reason to suspect spinal injury

Types of rope rescue:

• Types of rope rescue:

• Low-angle operations: slope of the ground is less than 45°
• High-angle operations: slope of the ground is greater than 45°

Safe approach

• Safe approach

• Set up equipment properly.
• Put distance between you and any loose materials.
• Move bystanders out of the way.

Two parts to search and rescue (SAR)

• Two parts to search and rescue (SAR)

• Search (looking for lost persons)
• Rescue (removal of patient from environment)

Safe approach

• Safe approach

• Be aware that factors will vary.
• Bring drinking water, food, clothing, and PPE.
• Use a handheld strobe light.
• Be aware of physical limitations.

Set up a search base.

• Set up a search base.

• Prepare equipment ahead of time.
• Monitor progress via radio.
• Safe approach
• Distribute equipment among personnel.
• Stick together.
• Consider relocating ambulance.

Determine route.

• Determine route.

• The IC will determine an appropriate parking spot for the ambulance.

• Determine if there are injured patients or if you are on stand-by.

Safe approach

• Safe approach

• Stay with the ambulance.
• Remain present even after the fire is out.
• Unless transporting a patient or released by IC

Visit local farms and industrial plants and learn about:

• Visit local farms and industrial plants and learn about:

• Equipment that is used
• How it operates
• How an operator can become entrapped

• Over time, protective shields and guards may be damaged or removed.

Safe approach

• Safe approach

• Master cribbing.
• Take apart machines made of strong metal (rather than cutting).
• Isolate the injury site.

Safe approach (cont’d)

• Safe approach (cont’d)

• Determine alternative methods of disentangling.
• Assess patient while rescue personnel plan disentanglement.
• Be aware of differences in industrial and farm settings.

Law enforcement may call in the SWAT team in tactical situations.

• Law enforcement may call in the SWAT team in tactical situations.

• Tactical paramedics receive additional training.

Tactical paramedics must be able to provide medical care under adverse circumstances.

• Tactical paramedics must be able to provide medical care under adverse circumstances.

• Provide immediate medical care to persons who become injured during an incident.
• Often before the scene is declared safe

Many medical and trauma conditions are assessed during the rescue process.

• Many medical and trauma conditions are assessed during the rescue process.

• Crush syndrome: Large muscle groups are compressed for a prolonged period of time
• High-flow oxygen therapy or positive pressure ventilations
• Administration of sodium bicarbonate, calcium chloride, fluid bolus

Use nonpharmacologic methods in the field

• Use nonpharmacologic methods in the field

• Splinting
• Gentle handling
• Talking to patients

Basket stretcher (Stokes basket)

• Basket stretcher (Stokes basket)

• Two types of basket stretchers (Stokes)
• Wire basket
• Plastic/fiberglass baskets

Packaging obstacles:

• Packaging obstacles:

• Patients with fractured pelvises
• Secure to a full-body vacuum mattress
• Spine-immobilized patients
• Place the patient in a Kendrick Extrication Device (KED)

Consider all patient needs:

• Consider all patient needs:

• Portable oxygen tank
• IV lines
• Warmth
• Head and eye protection
• KED or KED/SKED

“Rescue” means to deliver from danger or imprisonment.

• “Rescue” means to deliver from danger or imprisonment.

• The most difficult process in any rescue is the coordination and balance of rescue and treatment.

• A technical rescue incident (TRI) is a complex rescue incident that requires specially trained personnel and special equipment.

Technical rescue training occurs on three levels: awareness, operations, and technician.

• Technical rescue training occurs on three levels: awareness, operations, and technician.

• When assisting rescue team members:

• Be safe.
• Follow orders.
• Work as a team.
• Think.
• Follow the golden rule of public service.

All rescuers should perform the following steps to perform special rescues safely:

• All rescuers should perform the following steps to perform special rescues safely:

• Preparation
• Response
• Arrival and scene size-up
• Stabilization of the scene
• Access
• Disentanglement
• Removal
• Transport

At a technical rescue incident, it is critically important to slow down and properly evaluate the situation.

• At a technical rescue incident, it is critically important to slow down and properly evaluate the situation.

• The first arriving officer at a rescue scene should immediately assume command and start using the incident management system.

Whenever possible, park emergency vehicles in a manner that will ensure safety and not disrupt traffic any more than necessary.

• Whenever possible, park emergency vehicles in a manner that will ensure safety and not disrupt traffic any more than necessary.

• Accountability should be practiced at all emergencies, no matter how small.

Basket stretchers facilitate moving patients to safety and can be used in a variety of situations.

• Basket stretchers facilitate moving patients to safety and can be used in a variety of situations.

• Vehicle extrication is commonly necessary.

• There are many hazards associated with alternative powered vehicles.

• You should have a thorough working knowledge of the basic simple hand tools.

Cribbing should be used regardless of the position of the vehicle.

• Cribbing should be used regardless of the position of the vehicle.

• Simple vehicle extrication techniques include opening the door, breaking tempered glass, and providing initial medical care to the patients.

• During disentanglement, responders need to be mindful of undeployed air bags.

Many vehicle extrication techniques require the use of specialized skills and training.

• Many vehicle extrication techniques require the use of specialized skills and training.

• A confined space is a location surrounded by a structure that is not designed for continuous occupancy.

• Confined spaces may have limited ventilation to provide air circulation and exchange.

Trench rescues may become necessary when earth is removed for placement of a utility line or for other construction and the sides of the excavation collapse.

• Trench rescues may become necessary when earth is removed for placement of a utility line or for other construction and the sides of the excavation collapse.

• You should know how to properly don a personal flotation device as well as how to use the self-rescue position.

Rope rescue incidents are divided into low-angle and high-angle operations.

• Rope rescue incidents are divided into low-angle and high-angle operations.

• Wilderness search and rescue (SAR) missions consist of two parts: looking for a lost or overdue person and removing a patient from a hostile environment.

• During lost person search and rescue, your role is to stand by at the search base until the lost person or people have been found.

You should always stay with your ambulance during a structure fire.

• You should always stay with your ambulance during a structure fire.

• If an incident develops into a tactical situation, law enforcement agencies may deploy use of specialized law enforcement tactical units or the SWAT team.

• Pain control in rescue situations should take the form of nonpharmacologic methods.

A number of special patient packaging tools are available to help extricate patients out of their situation and up, down, or out to the ambulance.

• A number of special patient packaging tools are available to help extricate patients out of their situation and up, down, or out to the ambulance.

Chapter opener: © Corbis

• Chapter opener: © Corbis

• Backgrounds: Green—Jones & Bartlett Learning; Red—© Margo Harrison/ShutterStock, Inc.; Lime—© Photodisc; Purple—Courtesy of Rhonda Beck.

• Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.