1. 2-1 The Violent Scene

2. 2-2 Violent Scene Scenes involving armed or potentially hostile persons are among the most dangerous EMS personnel may be mistaken for law enforcement officials Body armor

3. Warning Signs of Danger 2-3 Residences  Unusual silence or darkened residence  Past history of problems or violence  Known drug or gang area  Loud noises or items breaking  Seeing or hearing acts of violence  Presence of alcohol or other drug use  Evidence of dangerous pets

4. Warning Signs of Danger Street Scenes Crowds may quickly become large and unpredictable  Voices become louder  Pushing, shoving  Hostility toward others at scene  Rapid increase in crowd size  Inability of law enforcement to control crowds 2-4

5. Warning Signs of Danger Highway Encounters Disabled vehicle, “man slumped over wheel” calls, motor vehicle crashes  Suspicious movements in vehicle  Grabbing or hiding items  Arguing or fighting between passengers  Lack of activity where activity is likely  Signs of alcohol or drug use  Open or unlatched trunks (may hide people) 2-5

6. 2-6 Crime Scene

7. 2-7 Crime Scene Law enforcement personnel are responsible for gathering evidence EMS personnel are responsible for patient care

8. 2-8 Crime Scene Evidence –Fingerprints –Footprints –Blood and body fluid –Hair –Carpet and clothing fibers

9. 2-9 Crime Scene Be observant Touch only what is required for patient care –If you touch something, remember what you touched and tell police Wear gloves

10. 2-10 Crime Scene Take the same path in and out of the scene Avoid stepping on bloodstains or splatter Disturb victim and victim’s clothing as little as possible

11. 2-11 Crime Scene Avoid cuts to the victim’s clothing that may have been caused by a knife, bullet, or other penetrating weapon Save victim’s clothing and personal items in a paper bag

12. 6-12 Lifting and Moving EMS professionals are injured every year because of improper lifting or moving techniques. In most cases, these injuries are preventable.

13. 6-13 Lifting and Moving There is no one best way to move all patients. Analyze the situation Think of all your options Choose the method that is safest for you, your coworkers, and the patient

14. 6-14 Role of the EMT Patient care will usually be provided in the position in which the patient is found

15. 6-15 Role of the EMT Your responsibilities: –Distinguishing an emergency from a nonemergency situation –Positioning patients to prevent further injury –Recognizing when to call for more help –Assisting other EMS professionals in lifting and moving a patient

16. 6-16 Principles of Moving Patients

17. 6-17 The Big Decision… What is an emergency that requires immediately moving a patient from the area?

18. 6-18 The Big Decision… Indications for an emergency move: –Scene hazards –The inability to reach other patients who need life-saving care –The inability to provide immediate, lifesaving care because of the patient’s location or position

19. 6-19 Indications for an Emergency Move Scene hazards –Fire or the danger of fire –Uncontrolled traffic –Explosives or the danger of an explosion –Electrical hazards –Rising flood water –Toxic gases –Radiation –Structural collapse or the threat of a structural collapse –Potentially violent scenes

20. 6-20 Indications for an Emergency Move The inability to reach other patients who need lifesaving care The inability to provide immediate, lifesaving care because of the patient’s location or position

21. 6-21 Principles of Moving Patients An emergency move may aggravate a spinal injury Always drag the patient in the direction of the length of the body –Never push, pull, or drag a patient sideways Think before you act!

22. 6-22 Principles of Moving Patients Nonurgent move –Type of move performed most often –Use if no immediate threat to life exists –Done with the help of other EMS personnel –Requires communication before, during, and after the lift Work as a team for success

23. 6-23 Body Mechanics and Lifting Techniques

24. 6-24 Body Mechanics Body alignment –Good posture Balance Coordinated body movement

25. 6-25 Balance You can improve your balance by: –Separating your feet to a comfortable distance –Bending your knees –Flexing your hips to reach a squatting position

26. 6-26 Preparation Important factors to consider: –Patient’s weight –Patient’s condition –Hazards or potential hazards –The terrain –Distance the patient must be moved –Your physical abilities and any limitations –Available equipment or additional personnel

27. 6-27 Power Grip Palms up Hands comfortable distance apart –About 10 inches Palms and fingers in complete contact with the object

28. 6-28 Guidelines for Safe Lifting

29. 6-29 Guidelines for Safe Lifting Keep your back aligned and use your leg strength Maintain your center of balance while lifting Consider the weight to be lifted Know your physical ability and limitations Plan –How will you move the patient? –Where will you move him? –Make sure path is clear

30. 6-30 Guidelines for Safe Lifting Determine in advance who will direct the move –Usually the person at the patient’s head “On my count, lift on three: one, two, three” “On my count, turn on three: one, two, three”

31. 6-31 Guidelines for Safe Lifting Key Point Agree in advance that if anyone involved in the move says “no” the move is immediately stopped

32. 6-32 Guidelines for Safe Lifting Position your feet a comfortable width apart Bend at the knees and hips, not at your waist –Keep your back straight –Use your legs to lift, not your back

33. 6-33 Guidelines for Safe Lifting Lift using a smooth, continuous motion Do not jerk or twist when lifting Keep the weight close to you When possible, move forward rather than backward Walk slowly using short steps Look where you are going Communicate clearly and frequently with others throughout the move

34. 6-34 Power Lift

35. 6-35 Carrying Patients and Equipment

36. 6-36 Carrying Patients and Equipment Whenever possible, transport patients on devices that can be rolled. Know or find out the weight to be lifted. Know your physical abilities and limitations and that of your crew. Work in a coordinated manner. Communicate frequently with your partner and the patient.

37. 6-37 Carrying Patients and Equipment Keep the weight as close to the body as possible. Keep your back in a locked-in position and avoid twisting. Flex at the hips, not at the waist Bend at the knees. Do not lean back from the waist.

38. 6-38 Carrying Procedure on Stairs

39. 6-39 Carrying Procedure on Stairs When possible, use a stair chair Make sure that the stairway is free of obstructions. Use a guide or “spotter” Secure the patient to the stair chair before lifting Carry the patient head first up the stairs and feet first down the stairs

40. 6-40 Carrying Procedure on Stairs Keep your back in a locked-in position. Flex at the hips, not at the waist, and bend at the knees. Keep the weight and your arms as close to your body as possible. Always communicate with your partner during the move.

41. 6-41 Guidelines for Safe Reaching

42. 6-42 Guidelines for Safe Reaching Keep your back straight Avoid stretching or leaning back from your waist when reaching overhead –Lean from your hips Avoid twisting Avoid reaching more than 15 to 20 inches in front of you Avoid situations where prolonged strenuous effort (more than a minute) is needed

43. 6-43 Logroll Keep your back straight while leaning over the patient. Lean from the hips. Use your shoulder muscles to help with the roll.

44. 6-44 Guidelines for Safe Pushing and Pulling

45. 6-45 Guidelines for Safe Pushing and Pulling Push, rather than pull, whenever possible. Keep your back straight. Keep the line of the pull through the center of your body by bending your knees. Keep the weight close to your body.

46. 6-46 Guidelines for Safe Pushing and Pulling Keep your elbows bent and your arms close to your sides. Push at a level between your waist and shoulders. –If the weight is below your waist, kneel to push or pull. –If possible, avoid pushing or pulling from an overhead position.

47. 6-47 Emergency Moves

48. 6-48 Drags A good way to move patients already on the ground Try to stabilize the patient’s head and neck as much as possible before the move Use the clothes drag or blanket drag when injury to head or spine is suspected

49. 6-49 Drags Always pull along the length of the spine Never pull the patient’s head away from her neck and shoulders

50. 6-50 Clothes Drag

51. 6-51 Blanket Drag

52. 6-52 Shoulder Drag

53. 6-53 Forearm Drag

54. Ankle Drag Not recommended –Patient’s head is not supported –Patient’s head may bounce if the patient is not pulled over a smooth surface 6-54

55. 6-55 Firefighter’s Drag

56. 6-56 Remember: Always drag the patient along the length (the long axis) of the spine. Never drag a patient sideways. Never pull the patient’s head away from her neck and shoulders.