1. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Chapter 30 Special Operations Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

2. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 1.Define key terms introduced in this chapter. 3737 2.Describe common locations and situations in which hazardous materials are encountered. 9-109-10 3.Recognize the U.S. Department of Transportation (DOT) and National Fire Protection Association (NFPA) 704 systems of placards to identify hazardous materials. 11-1211-12 4.Use the DOT Emergency Response Guidebook to find information about hazardous materials. 10-1110-11

3. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 5.Discuss other sources of information on hazardous materials. 1111 6.Describe the hot, warm, and cold zones of hazardous materials incidents. 1414 7.Explain the EMR’s role at a hazardous materials incident. 9-149-14 8.Discuss the goals of managing multiple casualty incidents (MCIs). 17-1917-19 9.Given several descriptions of patients in an MCI, use the START and JumpSTART triage systems to categorize patients. 20-2320-23

4. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 10.Describe the EMR’s role in vehicle extrication. 24-2824-28 11.Explain the key components of vehicle extrication. 24- 2824- 28 12.Recognize indications for aeromedical transport. 29-3129-31 13.Discuss the considerations of setting up an appropriate landing zone. 3232 14.Explain the safety considerations associated with approaching a medical aircraft. 3333

5. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer MULTIMEDIA DIRECTORY Slide 28Rapidly Extricating Patients Video

6. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer TOPICS Hazardous Materials Mass Casualty Incidents (MCI) Triage Extrication Aeromedical Rescue

7. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer INTRODUCTION Situations requiring special operations –Hazmat –Mass casualty incident –Aeromedical evacuation

8. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Call Dispatch –Called to busy intersection for a MVC –18-wheeler tanker truck struck minivan –Heavy damage to the minivan –You survey the scene from a safe distance –Tanker is intact with no damage –Placard reveals truck is carrying gasoline –You ask dispatch for fire and hazmat –You move upwind and uphill

9. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Hazardous Materials Back to Topics

10. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Back to Objectives

11. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Placard Materials classified into nine categories Four-digit identification number Additional sources of information –Shipping papers –Bills of lading Placards are not always displayed U.S. Department of Transportation Placard System Back to Objectives

12. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer NFPA 704 Placard System for Buildings Back to Objectives

13. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Material Safety Data Sheets Employers are required to maintain current MSDS Attempt to retrieve MSDS if it is safe to do so

14. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Hazardous Materials Incident Safety Zones of a hazmat incident –Hot zone –Warm zone –Cold zone Back to Objectives

15. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response Two additional fire companies arrive and secure the scene The chief of the fire company designates you as the triage officer The driver of the truck is carrying a bill of lading as you approach He tells you the minivan ran a red light, and he hit it Several people in the minivan need help CONTINUED

16. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response, continued Six patients are in the minivan The driver is pinned You realize that you have an MCI and call for three additional units You begin to use the START triage system to sort the patients

17. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Mass Casualty Incidents (MCI) Back to Topics

18. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

19. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Mass Casualty Incident (MCI) Incident that overwhelms the resources of the responders on scene Work as a team Quickly and effectively triage, treat, and transport patients Back to Objectives

20. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Triage Back to Topics

21. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Figure 30-9a from EMR Complete

22. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Examples of the Use of START Triage Simple Triage and Rapid Treatment (START) –Accomplished with no equipment and minimal training –Jump START triage for pediatric patients

23. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer The JumpSTART System Back to Objectives

24. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Extrication Back to Topics

25. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

26. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Vehicle Stabilization Personal Protective Equipment (PPE) Pinned Entrapment Cribbing

27. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Gaining Access “Try before you pry” Center punch Halligan tool or pry bar Hydraulic tools Only done by qualified personnel

28. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Rapidly Extricating Patients Click on the screenshot to view a video about rapidly extricating patients. Back to DirectoryBack to Objectives

29. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Aeromedical Rescue Back to Topics

30. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: Maria A. H Lyle

31. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Head trauma Spinal trauma Chest trauma Abdominal trauma Heart attack Stroke Indications for Aeromedical Transport Back to Objectives

32. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer The Landing Zone (LZ) Flat area 100 feet by 100 feet Slope not greater than eight degrees Free of utility lines Radio exact location and LZ description –Terrain –Landmarks –Major hazards Back to Objectives

33. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Approaching the Aircraft Always approach from the front with direct view of the pilot NEVER approach from the rear around the tail rotor Back to Objectives

34. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Transition All patients are extricated except for the driver who remains pinned You take cervical spine stabilization as the team prepares for extrication The vehicle is stabilized The windshield is removed and the posts holding the roof are cut The roof is flapped back to allow access CONTINUED

35. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Transition, continued The dashboard is rolled back and the patient is free The patient is moved onto a long backboard and secured She is moved to an ambulance for transport to the LZ Paramedics ask you to begin BVM ventilations CONTINUED

36. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Transition, continued Paramedics place an advanced airway into the patient’s trachea You arrive at the LZ, and the paramedic gives report to the flight crew via radio The aircraft lands 200 feet from the ambulance You assist in loading the patient as the aircraft is still running You watch as the helicopter flies off

37. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –Placard –Material safety data sheet –Mass casualty incident –START system –Extrication –Pinned –Entrapment –Aeromedical transport Back to Objectives

38. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER The U.S. DOT defines a hazardous material as a)a poison or chemical that could harm you. b)any substance or material in a form that poses an unreasonable risk to health. c)a substance that must be marked with a placard to be shipped or stored. d)a poison or chemical that is not harmful to you. CONTINUED

39. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER The National Fire Protection 704 system is used to mark buildings for _____________ with a multicolored diamond sign. a)occupancy b)hazards c)flammable materials d)chemical materials CONTINUED

40. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER The term triage means to a)separate. b)sort. c)categorize. d)count. CONTINUED

41. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER The START triage system begins with an assessment of a)level of consciousness. b)airway. c)breathing. d)pulse.

42. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Discussion 1.Describe common locations and situations in which hazardous materials are encountered. 2.Discuss the sources of information on hazardous materials. 3.Discuss what an appropriate landing zone should include.

43. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Please visit www.bradybooks.com www.bradybooks.com and click on the mykit links to access content for this text. REINFORCE AND REVIEW