1. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Division 5 Special Considerations/ Operations

2. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 48, Operations Part 3 Rescue Awareness and Operations

3. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Phases and Aspects of Rescue Operations PPE Needed for Rescue Operations Types of Rescues Process of Various Rescues

4. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Introduction Rescue is the “act of delivering from danger or imprisonment.” In EMS, rescue means extricating and/or disentangling the victims who will become your patients.

5. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Role of the Paramedic The role of EMS in rescue varies from area to area. Some areas may require training beyond the awareness level. In general, all paramedics should have the proper training and personal protective equipment (PPE) to allow them access to the patient, to provide assessment, and establish incident command.

6. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Rescue is a dangerous activity, and safety is the number one priority. © Jeff Forster

7. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Personal protection equipment can minimize risk of exposure to infectious diseases.

8. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Rescuer’s Protective Equipment Helmets Eye protection Hearing protection Respiratory protection Gloves Flame protection Personal flotation devices Lighting Hazmat suits Wilderness protection As a minimum, rescuers should have the following equipment available:

9. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Patient Protection Eye protection Hearing and respiratory protection Protective blankets Protective shielding

10. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Safety Procedures Steps in curbing “heroics” and maintaining optimum safety include: – Rescue SOPs – Crew assignments – Preplanning

11. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Dangerous techniques should be practiced frequently. © Kenneth Kerr

12. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Rescue Operations Phase One—Arrival and size-up Phase Two—Hazard control Phase Three—Patient access Phase Four—Medical treatment Phase Five—Disentanglement

13. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The first step of a rescue operation is arrival and scene size-up.

14. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Phase 2 On-scene hazards must be identified with speed and clarity. A sampling of dangerous conditions you may encounter: – Poisonous substances – Biological agents – Swift-moving currents – Extreme heights

15. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The third step of a rescue operation is gaining access to the patient.

16. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The fourth step in a rescue operation is patient treatment. © Kenneth Kerr

17. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Goals of Rescue Assessment Identify and care for existing problems. Anticipate changing patient conditions and determine in advance the assistance and equipment needed.

18. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ In responding to rescues, you must be prepared to “shift gears” mentally to an extended-care situation.

19. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The fifth step in a rescue operation is disentanglement. © Kenneth Kerr

20. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The sixth step in a rescue operation is packaging and removal of the patient. © Kenneth Kerr

21. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The seventh, and final, step in a rescue operation is transport of the patient.

22. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Surface Water Rescues Water rescues may involve many kinds of water bodies—pools, rivers, streams, lakes, canals, flooded gravel pits, or even the ocean. It is imperative that paramedics participating in water rescues are trained and equipped properly.

23. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A personal flotation device (PFD) is mandatory equipment for any water- related rescue.

24. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Safe ice rescue requires proper equipment and protective clothing.

25. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The basic water rescue model is: REACH THROW ROW GO

26. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Moving Water By far the most dangerous water rescues involve water that is moving. Competency at handling the power and dynamics of swift-water rescues comes only with extensive training and experience.

27. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The movement of currents can create a “drowning machine.”

28. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Currents can force a person up against a “strainer.”

29. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

30. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Water rescue with possible spinal injury

31. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hazardous Atmosphere Rescues Confined-space rescues present any number of potentially fatal threats, but one of the most serious is an oxygen- deficient environment. 60% of all fatalities associated with confined spaces are people attempting to rescue a victim!

32. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Look for warning signs.

33. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Treat a culvert for what it is— a dangerous confined space.

34. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Confined spaces, such as utility vaults, may be hazardous.

35. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Entering confined spaces, such as silos, requires training, equipment, and experience. © Michal Heron

36. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Confined-Space Hazards Oxygen-deficient atmospheres Toxic or explosive chemicals Engulfment Machinery entrapment Electricity Structural concerns

37. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Trenches should comply with OSHA regulations to minimize the possibility of collapse.

38. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Highway Operations and Vehicle Rescues Traffic hazards –Staging –Positioning of apparatus –Emergency lighting –Redirection of traffic –High visibility Other hazards –Fire and fuel –Alternative fuel systems –Sharp objects –Electric power –Energy-absorbing bumpers –Air bags –Hazardous cargoes –Rolling vehicles –Unstable vehicles

39. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Danger zone from downed electrical wires

40. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Auto Anatomy Motor Vehicle Collisions (MVCs) present EMS with the most common access and extrication problems. You must know some basic information about automobile construction or “anatomy.” Considerations include: –Frame/construction –Firewall/engine-compartment components –Types of glass –Doors

41. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Rescue Strategies Perform initial scene size-up. Control hazards. Assess the degree of entrapment. Establish circles of operation. Treatment, packaging, removal.

42. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Vehicle Stabilization Equipment

43. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hazardous Terrain Rescues Activities such as mountain climbing, rock climbing, cross-country skiing, snowboarding, and hiking have drawn more people into rugged areas.

44. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 3 Types of Hazardous Terrain Steep slope or low-angle terrain Vertical or high-angle terrain Flat terrain with obstructions

45. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ High-angle rescue is dangerous and difficult.

46. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Low-angle situations are not as difficult and are often used for training. © Kenneth Kerr

47. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A basket stretcher

48. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A basket stretcher is often used to carry patients over rough terrain.

49. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Use of Helicopters Helicopters can be useful in hazardous terrain rescues. You must understand the capabilities of helicopters along with their advantages and disadvantages. More information on this topic appears in Chapter 48.

50. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Extended Care Assessment (Such as During Wilderness Operations) Consider protocols addressing the following areas: –Long-term hydration management –Repositioning of dislocations –Cleansing and care of wounds –Removal of impaled objects

51. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Phases and Aspects of Rescue Operations PPE Needed for Rescue Operations Types of Rescues Process of Various Rescues