SCENE TECHNIQUES

Lesson Objective : Describe the fundamental concepts required for rescue and extrication to include hazardous materials and multi-patient scenario.

SCENE TECHNIQUES ä Overview: ä 1. Role of the EMT-B ä 2. Fundamental of Extrication ä 3. Introduction to Hazardous Materials ä 4. Incident Management System ä 5. Multiple-Casualty Situations

Role of the EMT-B ä Nonrescue EMS ä Administer care to the patient before extrication ä Patient care precedes extrication ä Work together with the providers of rescue. ä Cooperate the activities of the rescuers.

ROLE OF THE EMT-B ä Rescue EMS ä EMS providers can also be the rescue providers. ä A chain of command should be establish to ensure patient care priorities. ä Administer care to the patient

Role of the EMT-B ä Patient care precedes extrication unless delayed movement would endanger the life of the patient or rescuer.

Fundamentals of Extrication ä Definition : An aspect of rescue, a method of freeing patients from that which binds or restrains by means of force, ingenuity or both.

Extrication ä Equipment ä Personal safety ä Rescue & Extrication - requires mental and physical preparation of self ä Safety begins with proper mind set and protective equipment

Extrication ä Protective clothing ä Sturdy shoes or work boots ä Long underwear, hat, etc... ä Leather gloves, hard hat with protective shield

Extrication ä Patient Safety ä Inform the patient ä Protect the patient. ä Lighting is of the utmost importance

Gaining Access ä What type of accident? ä Is the patient in a vehicle? In some other structure? ä Is the vehicle or structure severally damaged? ä In what position is the vehicle? On what surface? ä Is the patient injured? ä Is the environment hazardous or threatening?

Getting to the patient ä Simple access ä Complex access ä Specialized access techniques

Provide emergency medical care ä Evaluation and treatment ä Do not interrupt evaluation ä Establish and maintain an open airway with C-spine stabilization. ä Artificial ventilation ä Control accessible bleeding ä CPR

Provide emergency medical care ä Complete initial assessment ä Provide critical intervention ä Immobilize spine securely ä Short spine board ä Rapid extrication considerations ä Move the patient not the immobilization device use sufficient personnel ä choose path of least resistance

Provide emergency medical care ä Disentanglement of patient ä Treat injuries and correct life threatening problems ä Do not forget toe re-evaluate the patient’s status ä Disentanglement involves use of : ä A great deal of common sense ä Ingenuity in use of available tools and method

Preparation of the patient for transfer ä Ensure all injury are treated ä All fractures splinted ä All wounds dressed ä Cervical spine immobilized ä Improvise if you have to

Prep of Pt’s for transfer ä Package patient for removal ä Best accomplished by use of spine board ä Move patient as a unit ä Use ingenuity, common sense and mechanical knowledge when the situation dictates

Hazardous Materials ä If you even suspect possible hazardous materials at the accident scene, you must first step back and assess situation, then call for a trained HazMat team.

Hazardous Materials ä Common problem - People are killed or injured before the danger is identified. ä Primary concern - Safety ä The EMT-B and crew ä Patient ä Public

Hazardous Materials ä Identification - Different kind of hazards have different colors and shaped labels. ä Law ä Shipping papers or packing - will have same number ä Drivers -must carry shipping paper with the same number

Hazardous Material ä Pay attention - to your own senses. strange looking fumes, funny odor from a wrecked vehicle ä Only trained - to handle this incidents should enter the area or hazards you as an EMT-B are not. ä Consider the cargo of an overturn semitrailer truck.

Hazardous Material ä General Procedures ä Park upwind/uphill from the incident, safe distance ä Keep unnecessary people away from area ä Isolate the area ä (1) Keep people out ä (2) Do not enter unless fully protected with proper equipment and SCBA

Hazardous Material ä Avoid contact with material ä Remove patients to a safe zone, if no risk to EMT-B. ä Resources ä (1) Local hazardous material response team ä (2) CHEMTREC ä (3) Hazardous Materials, The Emergency Response Handbook

Incident Management System ä Has been developed to assist with control, direction, and coordination of emergency response resources.

Incident Management System ä Structure - After an incident manager is determined, EMS sectors are established as needed: ä Extrication sector ä Triage sector. ä Treatment sector

Incident Management System ä Transportation sector ä Staging sector ä Supply sector ä Mobile command center

Role ä Individuals at the scene will be assigned to particular roles in one of the sectors. ä Upon arrival, the EMT-B should report to the sector officer for specific duties. ä Once assigned a specific task, the EMT-B should complete the task and report back to the sector officer.

Multiple Casualty Situations (MCS) ä Definition - An event that places a great demand on resources, be it equipment or personnel. ä Basic triage - sorting multiple-casualties into priorities for emergency care or transportation to definitive care. Priorities are given in four levels.

Triage ä Highest priority (RED) ä Airway and breathing difficulties ä Uncontrolled or severe bleeding ä Decreased mental status ä Patients with severe medical problems ä Shock (hypoperfusion) ä Severe burns

Triage ä Second priority (YELLOW) ä Burns without airway problems ä Major or multiple bone or joint injuries ä Back injuries with or without spinal cord damage

Triage ä Lowest priority (Green) ä Minor painful, swollen, deformed extremities ä Minor soft tissue injuries Lowest priority (BLACK) ä Death ä Obviously mortal wounds, open brain trauma, full cardiac arrest

Triage ä The cardinal rule of triage is to do the greatest good for the greatest number. ä Triage is on - going process, therefore triage priority may change.

Triage Procedures ä Most knowledgeable EMS provider arriving on-scene first becomes triage officer ä Additional help should be requested ä Perform initial assessment on all patients first. ä Assign available personnel and equipment to priority one patients.

Triage Procedures ä Patients transport decisions are based on a variety of factors. ä (1) Prioritization ä (2) Destination facilities ä (3) Transportation resources ä Triage officer remains at scene to assign and coordinate personnel, supplies, and vehicles.

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Summary: ä Role of the EMT-B ä Non rescue ä Rescue ä Fundamental of extrication ä Equipment ä Getting to the patient ä Providing emergency care

Summary ä Hazardous Materials ä Common Problem ä Primary concerns ä Identification ä General Procedures ä Incident Management System ä Role ä Structure

Summary ä Multiple-Casualty Situations ä Basic triage categories ä Triage procedures