1. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Operations Chapter 14

2. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline Phases of a Response Air Medical Transport Extrication Hazardous Materials Mass Casualty Incidents Phases of a Response Air Medical Transport Extrication Hazardous Materials Mass Casualty Incidents

3. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Having a basic understanding of the operations of an EMS system will help the First Responder in his or her interactions with other personnel in the system. Understanding the local EMS system helps establish knowledge of the resources available and the best way to access them. Having a basic understanding of the operations of an EMS system will help the First Responder in his or her interactions with other personnel in the system. Understanding the local EMS system helps establish knowledge of the resources available and the best way to access them.

4. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Phases of a Response

5. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Phases of a Response Preparation Dispatch En route Arrival Transport After the call Preparation Dispatch En route Arrival Transport After the call

6. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Preparation Anticipate receiving a call at anytime while on-duty or on- call Equipment and supplies must be available and in good repair –Medical and non-medical Personnel must be ready to respond in a safe manner Anticipate receiving a call at anytime while on-duty or on- call Equipment and supplies must be available and in good repair –Medical and non-medical Personnel must be ready to respond in a safe manner

7. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Medical Supplies Oral and nasal airways Suction equipment Artificial ventilation devices Basic wound care supplies Other items required or permitted by protocol or regulation Oral and nasal airways Suction equipment Artificial ventilation devices Basic wound care supplies Other items required or permitted by protocol or regulation

8. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Non-Medical Supplies MapsPPE

9. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Personnel Must be able to respond to calls immediately Know your required response time Maintain professionalism Must be able to respond to calls immediately Know your required response time Maintain professionalism

10. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Dispatch Begins when someone activates the EMS system Must have the following features: –Central access –24-hour availability –Trained personnel –Systematic information collection from the caller Begins when someone activates the EMS system Must have the following features: –Central access –24-hour availability –Trained personnel –Systematic information collection from the caller

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12. Dispatch Central access is best accomplished through a 9-1-1 system The system must be accessible 24-hours a day Emergency medical dispatchers must have specialized training to communicate with callers, make dispatch decisions and provide pre-arrival instructions Central access is best accomplished through a 9-1-1 system The system must be accessible 24-hours a day Emergency medical dispatchers must have specialized training to communicate with callers, make dispatch decisions and provide pre-arrival instructions Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Dispatch Dispatch information includes: –Nature of the call –Name, location, and callback number of the caller –Location of the patient –Number of patients and how serious the situation –Other special circumstances (e.g., is an assailant still on the scene, is there a hazardous material involved, etc.) Dispatch information includes: –Nature of the call –Name, location, and callback number of the caller –Location of the patient –Number of patients and how serious the situation –Other special circumstances (e.g., is an assailant still on the scene, is there a hazardous material involved, etc.)

14. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. En Route Acknowledge the call and that you are en route Exercise due regard for safety when driving an emergency vehicle Acknowledge the call and that you are en route Exercise due regard for safety when driving an emergency vehicle

15. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Arrival Upon arrival –Notify dispatch –Perform a scene size-up –Manage the scene –Treat the patient Upon arrival –Notify dispatch –Perform a scene size-up –Manage the scene –Treat the patient

16. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Transport FR not generally involved in transport, but must transfer patient care –Give hand-off report –Assist transporting crew as requested –Assist with preparing the patient for transport –Assistthe crew en route to the hospital if required FR not generally involved in transport, but must transfer patient care –Give hand-off report –Assist transporting crew as requested –Assist with preparing the patient for transport –Assistthe crew en route to the hospital if required

17. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. After the Call Prepare for the next call –Clean and disinfect equipment –Restock disposable supplies –Refuel the vehicle –Complete any paperwork or electronic logging of information –Notify dispatch of readiness for next call Prepare for the next call –Clean and disinfect equipment –Restock disposable supplies –Refuel the vehicle –Complete any paperwork or electronic logging of information –Notify dispatch of readiness for next call

18. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Air Medical Transport

19. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Rotary-Wing Aircraft Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

20. Interior Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

21. Do not approach the aircraft unless you have been cleared to do so by the pilot. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

22. Air Medical Transport Be aware of local criteria for requesting air medical transport Know the flight service protocols for selection of a landing zone Be aware of local criteria for requesting air medical transport Know the flight service protocols for selection of a landing zone

23. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Safe Approach Zones

24. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Extrication

25. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Extrication The process of removing an entrapped patient There is a balance between the need for immediate patient interventions and the need to remove the patient The process of removing an entrapped patient There is a balance between the need for immediate patient interventions and the need to remove the patient

26. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Role of the FR Provide necessary care to the patient prior to extrication and to ensure that extrication proceeds in a manner to minimize further injury.

27. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Extrication The safety of the First Responder is a primary responsibility Special protective gear is usually needed –Protection from broken glass, jagged metal –Protection from heat loss The safety of the First Responder is a primary responsibility Special protective gear is usually needed –Protection from broken glass, jagged metal –Protection from heat loss

28. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Extrication Can be simple or complex

29. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Extrication Simple –Try opening each of the vehicle doors –Check to see if the doors are locked Complex –Special extrication tools will be needed A First Responder should never attempt to use rescue tools without specific training in extrication techniques Simple –Try opening each of the vehicle doors –Check to see if the doors are locked Complex –Special extrication tools will be needed A First Responder should never attempt to use rescue tools without specific training in extrication techniques

30. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Extrication Once the patient is disentangled, the First Responder will work under the direction of EMTs or paramedics on the scene to remove the patient from the vehicle while protecting the cervical spine Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

31. Hazardous Materials

32. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hazardous Materials Transportation industry incidents Industrial and manufacturing settings Farming industry Illegal drug manufacturing labs Always size-up the scene; not all hazards are apparent at a casual glance Transportation industry incidents Industrial and manufacturing settings Farming industry Illegal drug manufacturing labs Always size-up the scene; not all hazards are apparent at a casual glance

33. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hazardous Materials Safety is the first concern –Safety of the First Responder –Safety of the patient –Safety of the public Safety is the first concern –Safety of the First Responder –Safety of the patient –Safety of the public

34. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hazardous Materials Can be identified in a number of ways –Placards –Shipment papers –Visual evidence –Signs and symptoms Can be identified in a number of ways –Placards –Shipment papers –Visual evidence –Signs and symptoms

35. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

36. Look for labels

37. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

38. Hazardous Materials Maintain a distance; do not enter the scene Park up-hill/up-wind, at a safe distance Isolate the area Avoid contact with the material Use the Emergency Response Guidebook Notify local hazardous materials team Maintain a distance; do not enter the scene Park up-hill/up-wind, at a safe distance Isolate the area Avoid contact with the material Use the Emergency Response Guidebook Notify local hazardous materials team

39. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. DOT Emergency Response Guidebook Should be in every emergency vehicle

40. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mass Casualty Incidents

41. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mass Casualty Incidents An event involving more patients than resources

42. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mass Casualty Incidents Requires Triage

43. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Triage There are different triage schemes in existence One is a 3 level system sorting patients into highest, second, and lowest priority There are different triage schemes in existence One is a 3 level system sorting patients into highest, second, and lowest priority

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45. Triage Highest priority –Problems with airway or breathing –Uncontrolled or severe bleeding –Decreased level of consciousness Highest priority –Problems with airway or breathing –Uncontrolled or severe bleeding –Decreased level of consciousness Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

46. Triage Second priority –Burns without airway problems –Major or multiple extremity injuries –Spinal injuries without airway o breathing problems Second priority –Burns without airway problems –Major or multiple extremity injuries –Spinal injuries without airway o breathing problems Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

47. Triage Lowest priority –Minor extremity injuries –Minor soft tissue injuries –Cardiac arrest –Dead or with obvious mortal wounds Lowest priority –Minor extremity injuries –Minor soft tissue injuries –Cardiac arrest –Dead or with obvious mortal wounds Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

48. Incident Command System The most knowledgeable EMS provider on the scene is the triage officer –Confirms the incident to dispatch, establishes a command post, and requests additional resources –Performs an initial assessment on each patient without performing treatment and starts a triage tag for each The most knowledgeable EMS provider on the scene is the triage officer –Confirms the incident to dispatch, establishes a command post, and requests additional resources –Performs an initial assessment on each patient without performing treatment and starts a triage tag for each

49. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mass Casualty Incidents The triage officer assigns available personnel and equipment to priority patients and remains at the scene to coordinate personnel, supplies and vehicles

50. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Summary The First Responder is usually not responsible for special rescue and operations, but must have a fundamental understanding of the procedures of such operations. Understanding these fundamentals will help the First Responder in carrying out the priorities of safety and patient care, and in interacting with other personnel and resources in the system. The First Responder is usually not responsible for special rescue and operations, but must have a fundamental understanding of the procedures of such operations. Understanding these fundamentals will help the First Responder in carrying out the priorities of safety and patient care, and in interacting with other personnel and resources in the system.

51. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.