Type of extrication only used when patient is deteriorating, Hazards are present and endanger the pt or the rescuers, immediate danger.
Rapid extrication
Where do truck drivers keep their papers for materials located on their truck?
Usually kept in the cab within reach of the driver, called bill of loading
What to do in the case of papers/ bill of loading are no longer available due to scene safety being compromised.
Use the placards or the cameo system, or the ERG guidebook
ICS: responsibility of hazmat spills (awareness level)
-we don't contain or clean up any sort of hazmat
-recognize potential hazards
-Initiate the emergency response plan
Request additional response resources--give as much information as possible.
How do we move handguns on a crime scene
Gloved hands, Law enforcement should secure any weapon found on scene.
-try not to interfere with any crime scene unless necessary.
Why is decontamination used?
undertaken to reduce the dose of hazardous material in contact with the patient and to decrease the risk of secondary contamination to others.
secondary contamination
transfer of a hazardous substance to a non-contaminated person or item via contact with someone or something already contaminated by the substance.
Dilution
Copius amounts of water to flush any contaminant from the pt
-tincture of green soap may be used
-isopropyl alcohol to help remove isocyanates
-Vegetable oil is sometimes used if contaminant is water-reactive
Absorption
Large pads that soak up liquid and remove it from the pt
neutralization
use of chemical to change the haz mat into less harmful substance, almost never used because of risk of exothermic reactions
disposal
getting rid of as much clothing and equipment as possible to reduce the magnitude of the problem
What to do if you are first to arrive at a haz mat situation
Never immediately begin care, remember the idiot cop that passed out because he did this and may have died.
-Always protect yourself before the pt and call for more resources
-wait for help to arrive before any treatment is provided
Why should the ICS be used and organized in your standard guidlines/precedures?
Organized structure can be adapted to intensity of the incident
-makes the best use of all resources
-control duplication of effort and freelancing
Hard areas of decontamination of a pt
Arm pits, between fingers and toes, groin, scalp, between butt
START
Simple
Triage
And
Rapid
Treatment
Priority level Green
Walking wounded
Priority level Yellow
Delayed care (not critical)
Priority level Red
Immediate care (critical)
Where to park vehicle?
1 foot per 1 mph
-if no MPH given, usually 100 ft
-If first on scene, park behind accident to block traffic with ambulance
-If PD or engine on scene already, park in front of accident with doors towards patient
Contact and cover
Never assume you will not be harmed
-protect central body
-any cover is better than nothing
-use brick walls, vehicles, trees, look for the most solid large area
-run zig zag if you need to move
-One rescuer make contact with pt to provide care, partner w
Hot Zone
Contamination zone, immediately surrounds dangers of the site
only hazmat specialists, or other trained rescuers wearing appropriate ppe allowed inside, entry teams and rescue teams only
Warm zone
Decon corridor
-trained haz mat specialist wearing ppe, decon area, urgent life saving care may be performed here
cold zone
further buffer from hazards, medics perform triage and pt treatment, staging of vehicles and equipment
primary contamination
Direct exposure of pt to haz mat
Greatest limitation of feild decon of haz mat
never completely decontaminated, takes more time.
Singular command
One person is in charge, even if multiple agencies have responded
-one agency has majority of responsibility
-short duration
-limited incidences that require services of single agency
Unified command
response plan in place for all cooperating agencies designating the lead and support agencies for several ikinds of MCIs,
-Large MCIs, Long duration, Multiple agencies and jurisdicitons involved
Nitrile gloves
gloves that Offer best protection against haz mat
Clandestine drug labs
Drug labs to get away from ASAP and call haz mat team
Flat water rescue
Little or no current during the rescue attempt
-greatest risk factors
---getting caught on something under the water
---not being able to see the submerged pt
---diving accidents, shallow water spinal injury
Causes of grass fires involving cars
Cadillac converters get very hot so they can start grass fires when parked for long periods of time
Low head dams, why are they so dangerous?
Water current picture from book and ppt
-Recirculating current (the boil) underwater, away from dam, back to surface---repeating...
the currant can trap victims in the water by a powerful current
Primary triage
initial triage done in the field--briefly assess and tag with traige tag
secondary triage
done as patients are brought to treatment area
Strainers in water
water intakes at the base of the dam
How to properly approach a helicopter
Don't approach until signaled to do so by the pilot
-if possible, all rotors should bestopped
-always approach from the front and keep the pilot in view
-follow crews instructions on arrival
Haz mad identification
Identify from a distance with binoculars, use placards, use ERG guidbooks
signs of Critical stress response
Fatigue, Altered thinking patterns, complete collapse
Where does secondary haz mat contamination take place?
when solids or liquids accumulate on a person, clothes, or object but doesn't normally occur with diffusion of toxic gas
Incident commander
Should be the most experienced person on scene, usually putting the least experienced person in triage. If your first to arrive and your superior arrives, brief him on what is happening and transfer your command.
How to handle someone who has suffered critical stress
Defuse the situation, debrief them, have them talk to someone or go to a seminar of some sort to help cope with the situation
Why you would want and Incident commander on an MCI
They help control the situation making it more organized, they help limit the span of control again helping with organization, they develop a plan to manage the incident
Hazards of trench and cave rescue
asphyxia from pressure or weight of dirt on the patient in which they are trapped, secondary collapse (usually on the edge of a trench or the walls of a cave or trench)
A posts in a vehicle
Windshield and front door
B post in a vehicle
front door and back window
C post in a vehicle
back door and rear window
When and why we restock and check off the ambulance
Restock at the beginning of each shift and after each call if possible
-this makes sure the truck is properly equipped to respond to each and every call
-your unit is available and in working order
-Makes sure medications are current and not expired
-make
threshold limit values (TLV)
max concentration of a toxin that someone can be exposed to for a 40 hr work week
Threshold limit value short term permisible limit
concentration that a person can be exposed to for a limited number of brief time periods
off road medical packs, what should be in it?
strobe light, gloves, reflective/protective clothing, binoculars, chalk/stray paint, compass, gps, whistle, first aid kid (atleast), light sticks, proper footwear/clothes
tempered glass
breaks easily, breaks into small pieces, all windows except windshield
laminated glass
difficult to break, two sheets of glass filled with special flexible plastic, windshield
CFLOP
-Command- incharch of incident
-finance-responsible for documenting all expenditures at an incident for reimbursement
-Logistics-comms equipment, facilities, food, water, fuel, lightning, medical equipment and supplies
-ops-managing tactical ops, supervis
pesticide exposure
-nerve agents
-organophosphates-cause body organs to become overstimulated and burn out (SLUDGE)
-treat with MARK 1 kit, contains atropine and 2-PAM chloride
MARK-1 kit
-2-PAM chloride, atropine
---atropine blocks nerve agent's overstimulation of the body
---2-PAM helps eliminateagent from body, effectivelyu relieves resp muscle paralysis and twitching caused by nerve agent
Open incident
uncontained, number of casualties not yet located, ongoing incident
closed incident
contained, situation not expected to produce any more casualties or injuries
minimum number of personel to get a pt over rough terrain
6 people required
START phases (in order)
First: call out to walking wounded
Second: Non walking pts, RPM (resp, pulse, mental status)
RPM
Resp less than 30 = not critical
Cap refill less than 2 seconds, radial pulse present = not critical
patient follows comands = not critical
Safe way to deactivate airbags
cut the negative of the battery
EMS' definition of rescue
remove from peril or confinement for every pt we encounter
rules of emergency driving
use due regard, does not exempt you from traffic laws
don't use escorts
travel in correct lane, watch your speed
account for all lanes of traffic at intersections
Definition of a MCI
Event in which the number of pts exceeds the resources available to the initial responders
How to shield from alpha products
Least harmful to body, human skin can easily stop it, doesn't travel fast
How to shield from beta products
requires layer of clothing to stop it, slightly more penetrating
How to shield from Gamma rays
X-rays, need several layers and inches of lead or concrete to stop it
HELP
heat, escape, lessening position
--face above water, protect your head, hug your self, draw legs as far up as possible
How to stabilize and treat a pt in a vehivle
crib the vehicle (stabilze)
--Step blocks/flatten tires or use wedges
--gain access, always try to open the door before you pry, break glass furthest away from pt, force the door open, remove seats, remove windshield, remove dash up and forward, remove ro
Air Medical Activation
Does the pt's condition warrant the risk?
will use of this resource truly save any time?
---prolonged extrication, traffic congestion, spinal injury over rough terrain, DON'T USE FOR CARDIAC ARREST PATIENTS
Type 1 Ambulance
Heavy duty, truck cab, body can be interchanged as needed
Type 2 ambulance
Standard van, forward control integral cab body (vanbulance)
type 3 ambulance
specialty van, forward control integral cab, van front with a box
cold/swift water rescue technique
Reach, Throw, Row, Go
--Metabolism and everything else slows down
How to safely approach a vehivle parked on the side of the road
Driver stays in ambulance and partner approaches the vehicle
Hazards associated with highway
Traffic, downed power lines, underground feeds, energy absorbing bumpers can explode, undeployed airbags, flammable fuel vapors
concealment
offers some protection but penetrable by bullets
(tall grass, shrubs, shadows
cover
offers protection that is impenetrable to bullets (trees, poles, dumpsters, ground depressions
whats hard to improvise in the wilderness
basic airway adjuncts
benefits of activating air med
reduce transport time, spinal injury over rough terrain
best locations of a command post at a large incident
well marked so everyone knows where it is, away from incident
always stay alert during domestic disputes
dangerous situations, watch what you say, actions, be respectful
new stokes basket vs old military
new stokes baskets allow for backboard placement
phases of a rescue operation
Response, arrival/scene size up, stabilization, access, disentanglement, removal, transport, security of scene/prep for next call, post incident analysis
most technical/time consuming:stabilization and disentanglement
confined space definition
location surrounded by a structure that isn't designed for continuous occupancy
examples: grain silos, industrial pits, tanks, below groundstructures, septic tanks, cisterns, wells
level a suit
fully encapsulated, SCBA, level 4 or level 3 toxicity
used in the hot zone
level b suit
protection from splashes and inhalation worn with scba, used for level 3 toxicity levels--decon teams
level c suit
protects against known agent, worn with air purifying respirator with specific filters for that agent, can be used in transport of potential secondary contamination, used for level 1 and 2 toxicity levels
level d suit
ppe offered by fire fighters/turnout gear, not worn at haz mat incidents, used in cold zone and for level 0 toxicity levels
threshold limit value
max concentration of toxin can be exposed to for a 40 hour work week
machinery entrapment
consider the potential for stored electical energy in any machinery, don't attempt rescue unless properly trained
what to do if a physician shows up on scene
place him in the treatment sector, treatment and medical direction as appropriate, secondary triage decisions, deciding priority of transport
gross negligence
willful, wanton, intentional or reckless negligence
Haz mat, most common routes of exposure
inhalation, dermal, parenteral(injected), gastrointestinal (swallowed)
How to build step chalks
box cribbing that can be used like step blocks or air bags
trains, times they are on the tracks and predictability
they are reliable for when they are going to be on the tracks by their scheduled times
dangers of power lines and electrical boxes
treat all downed lines as if they are still charged until clearance is provided, can be above or below ground, park at least one truck span away from them, be aware of potenctial for additional falling poles, don't touch any metal they may be touching, wa
what might make people think you are a cop?
the badge
def of disater management
planned, coordinated response to a disaster that involves cooperation of multiple responders and agencies and enables effective triage and provision of care accoding to triage decisions
what is the most emotionally difficult out of triage, treatment, and transport
triage is most emotionally draining
NFPA 704
NFPA ranks haz mat according to health hazards or toxicity levels, fire hazards, chemical reactive hazards, and special hazards for permanent facilities that store has mat.
transfer of command
takes place in an orderly manner and if possible face to face. Can be done by phone, readio, or email in extreme conditions