1. © 2011 National Safety Council 24-1 EMS RESPONSE AND OPERATIONS LESSON 24

2. © 2011 National Safety Council 24-2 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. © 2011 National Safety Council 24-3 Phases of a Response Preparation for the call Dispatch En route to scene Arrival at scene Transferring the patient After the run

4. © 2011 National Safety Council 24-4 Preparation for the Call Personal preparedness Response vehicle preparedness -Inspect and service regularly -Tire inflation, fuel and engine fluid levels Equipment preparation -Oxygen cylinders -Dressings, bandages, other equipment -Follow agency guidelines and local protocols

5. © 2011 National Safety Council 24-5 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. © 2011 National Safety Council 24-6 Miscellaneous Equipment and Supplies Safety vests Planned routes or comprehensive street maps Flashlight DOT Emergency Response Guidebook Extrication equipment Flares, cones, reflective triangles Fire extinguisher

7. © 2011 National Safety Council 24-7 Preplanning Response plan prepared in anticipation of emergency -Industrial plants -Areas at high risk for an emergency -Sports stadiums, theatres, public buildings Plans identify: -Key personnel -Locations of supplies -Mechanism for notifying EMS -Evacuation routes

8. © 2011 National Safety Council 24-8 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. © 2011 National Safety Council 24-9 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 problem Other pertinent information, such as help being given to patient

10. © 2011 National Safety Council 24-10 En Route to the Scene Gather necessary medical equipment - depart for scene Properly secure all equipment Follow local laws and 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. © 2011 National Safety Council 24-11 En Route to the Scene (continued) Be especially cautious in high-risk situations: Intersections Highway access points Inclement weather Aggressive drivers Unpaved roadways When responding alone or when fatigued

12. © 2011 National Safety Council 24-12 En Route to the Scene (continued) Avoid distractions that can affect driving: Mobile computer Global Positioning System (GPS) Mobile radio Wireless devices Vehicle stereo Eating or drinking

13. © 2011 National Safety Council 24-13 Arrival at the Scene Park safely where your vehicle will not be in way of ambulances Keep emergency lights/flashers on when appropriate Notify dispatch when you arrive Update dispatcher with information differing from original information Size up scene before approaching patient Remember personal safety is first priority

14. © 2011 National Safety Council 24-14 If Your Role Includes Controlling Traffic Ensure proper positioning of emergency vehicles Use lights and other warning devices Set up protective barrier Designate a traffic control person

15. © 2011 National Safety Council 24-15 Considerations As You Approach Need for personal protective equipment Any need to move patient due to hazards at scene MOI or medical emergency Need for additional help Number of patients

16. © 2011 National Safety Council 24-16 Transferring the Patient When EMS personnel arrive, provide patient assessment and 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

17. © 2011 National Safety Council 24-17 Leaving the Scene Ensure all hazards have been eliminated or controlled Pick up and dispose of all equipment properly Turn scene over to appropriate authority before leaving (law enforcement, fire suppression, highway department, etc.)

18. © 2011 National Safety Council 24-18 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 next call

19. © 2011 National Safety Council 24-19 Helicopter Transport

20. © 2011 National Safety Council 24-20 Helicopter Transport and Evacuation Uses EMRs responsibilities may include: -Determining that such transport is required and making the request -Preparing patient for transport -Setting up helicopter landing zone

21. © 2011 National Safety Council 24-21 Benefits of Air Transport Faster access to specialized care (skills, equipment and supplies) More rapid transport to hospital helipad Better access in remote areas

22. © 2011 National Safety Council 24-22 Disadvantages of Air Transport Limitations due to weather or environmental considerations Altitude or airspeed limitations Limited aircraft cabin size Difficult terrain Higher costs

23. © 2011 National Safety Council 24-23 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?

24. © 2011 National Safety Council 24-24 Preparing the Patient for Helicopter Transport Secure anything that may be disturbed by high winds Protect patient and yourself against blown debris and dirt Use eye protection and protect exposed skin Assist helicopter crew to secure patient to stretcher Patient may be placed in ambulance in preparation for transport to helicopter

25. © 2011 National Safety Council 24-25 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 -Safe distance from emergency scene -At least 100 feet by 100 feet -Free of loose objects

26. © 2011 National Safety Council 24-26 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) -Don’t point vehicle headlights toward center of zone -If police vehicles are present, they may be used to mark corners with their emergency red lights Communicate with pilot and describe landing zone and corner markings

27. © 2011 National Safety Council 24-27 Helicopter Safety Guidelines Keep other rescuers and 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 front Stay low when approaching helicopter, do not raise your arms over your head On a slope, approach from downhill

28. © 2011 National Safety Council 24-28 Patient Extrication

29. © 2011 National Safety Council 24-29 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

30. © 2011 National Safety Council 24-30 Patient Extrication from a Wrecked Vehicle Rescue more complicated if patient pinned by wreckage Your personal safety is highest priority, followed by patient’s safety Administer necessary care to patient before extrication Ensure patient is removed in a way to minimize further injury Chain of command should be established to ensure patient care priorities

31. © 2011 National Safety Council 24-31 Assess Extrication Scene First concern is always your and bystanders’ safety Approach carefully, sizing up scene Retreat if scene is 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

32. © 2011 National Safety Council 24-32 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 or inadequate safety and rescue equipment Evaluate the scene to ensure your and bystanders’ safety

33. © 2011 National Safety Council 24-33 Extrication Decision (continued) Wear appropriate protective devices Don’t attempt to do anything you are not trained to do Be aware of unique vehicle hazards If you have not already done so, call for additional personnel Check scene for other patients Control scene while waiting for other rescuers

34. © 2011 National Safety Council 24-34 Consider the Need for Extrication equipment Fire suppression equipment Law enforcement HAZMAT team Utility company crew Air medical transport

35. © 2011 National Safety Council 24-35 Stabilizing Vehicles

36. © 2011 National Safety Council 24-36 Stabilizing the Vehicle Before accessing patient, ensure vehicle is stable If safe, put upright vehicle’s automatic transmission in park If safe, set emergency brake Turn off ignition If it may move in any way, try to stabilize wheels

37. © 2011 National Safety Council 24-37 Vehicle on its Side Head and neck injuries common when vehicle has rolled onto its side Don’t attempt to return car to upright position before removing patients If possible, stabilize vehicle using specialized equipment such as chocks or cribbing, ropes, tires, blocks, etc. Don’t climb on top to open a door or window; instead, break rear window

38. © 2011 National Safety Council 24-38 Vehicle That Has Flipped Upside-Down Don’t attempt to right vehicle, prevent bystanders from doing so If fuel is leaking, clear scene Don’t allow smoking anywhere near rescue operation Try to access patient after stabilizing vehicle Keep patients informed of your actions and protect them from further harm Plan extrication before acting

39. © 2011 National Safety Council 24-39 Gaining Access

40. © 2011 National Safety Council 24-40 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 Other tool with special training

41. © 2011 National Safety Council 24-41 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 or lower window 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

42. © 2011 National Safety Council 24-42 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 and rescuer If you can access the interior, move seats back for better patient access and roll down windows Check for and avoid interior hazardous safety components

43. © 2011 National Safety Council 24-43 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 to reach door or enter -Once inside, you may be able to unlock or force open door

44. © 2011 National Safety Council 24-44 Breaking Safety Glass (continued) Removing windshield Use screwdriver or pry bar to remove liner Pry window free and remove it

45. © 2011 National Safety Council 24-45 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 patient in imminent danger is trapped by wheel or vehicle frame, try jacking car up, blocking it and sliding patient out Never crawl under vehicle yourself After accessing vehicle, turn off ignition to reduce risk of fire

46. © 2011 National Safety Council 24-46 Providing Emergency Care After Accessing Patient Perform primary assessment and provide basic emergency care while patient is in vehicle Perform BLS skills required until additional EMS personnel arrive Maintain manual cervical spine stabilization Unless explosion is possible, administer supplemental oxygen If scene is dangerous, consider an emergency move

47. © 2011 National Safety Council 24-47 Assisting with Rapid Extrication Process of removing patient from vehicle in safe manner, protecting spine You may be trained to assist with certain equipment such as a KED

48. © 2011 National Safety Council 24-48 Guidelines for Extrication Device Apply device while patient is being stabilized Move patient, not device  stay focused on patient Use enough personnel to perform extrication safely Use path of least resistance for move

49. © 2011 National Safety Council 24-49 Skill: Assisting with a KED 1.Manually stabilize patient’s head and apply cervical collar 2.Insert KED, head end first and position it 3.Fasten middle strap first, then lower strap and finally upper strap 4.Position each groin strap and fasten it  when both are in place, tighten them 5.Secure patient’s head to head flaps of KED 6.Secure head strap

50. © 2011 National Safety Council 24-50 Disentanglement of Patient Freeing patients generally not an EMR responsibility Paramedics may give advanced life support procedures while patient is trapped Remain at scene during disentanglement process to assist

51. © 2011 National Safety Council 24-51 Removal of Patient Remove patient ideally 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 an EMR responsibility, but you may assist