1. Bomb Squad/E.M.S. Interface
2005 I.A.B.T.I.
EMT Training Conference By
Sergeant/Paramedic Marty Hietala
Davis County Sheriff’s Office, Utah

2. Goals Understand levels of emergency medical care
Understand trauma centers and burn centers
Understand the Incident Command System
Articulate potential hazards for EMS and Fire personnel
Articulate potential hazards and mechanisms of injury for the bomb technician
Demonstrate emergency doffing of the bomb suit and chemical suit

3. Why?
To ensure that emergency medical personnel and fire personnel will provide the highest level of medical care in the shortest amount of time
The golden hour

4. The Golden Hour?
After a traumatic event, a patient will have the best outcome if rapid stabilization and surgical intervention is made within an hour of sustaining the injury
Transport must be expedient
Transport to an appropriate facility

5. What EMS support is available in your jurisdiction?
Is this your ambulance?
Will EMS need additional resources?

6. What type of Fire Dept. support is available in your jurisdiction?
Is this the local fire engine?
Will the fire service need additional resources?

7. Levels of Emergency Medical Care
Basic life support
Advanced life support
Hospital emergency room
Trauma center
Burn center

8. Basic Life Support Bandaging Splinting Spinal precautions
Oxygen therapy
Cardiopulmonary resuscitation
Automatic external defibrillator
Transportation

9. Advanced Life Support Basic life support Intravenous access
Advanced cardiac life support
Advanced trauma life support
Pharmacological intervention
EKG interpretation
Advanced airway placement
Endotracheal Intubation

10. Advanced Life Support Advanced invasive procedures
Surgical cricothyrotomy
Chest tube placement
Central line insertion
Intraosseous infusion
External jugular vein cannulation
Nasogastric tube placement

11. Trauma Centers
A designation made for a hospital that meets stringent requirements for providing care to trauma patients
Board certified emergency physicians
In-house neurosurgeon
In-house surgical staff
In-house radiology staff

12. Burn Centers Positive pressure isolation Hydrotherapy
Hyperbaric therapy
Surgical staff
Debridement
Skin harvesting
Skin grafting

13. Incident Command System
A standardized system used by emergency services to manage incidents, regardless of size
Initiated by first arriving assets and branches out based on primary duties
Required by OSHA

14. Staging Where should the command post, EMS and fire assets stage?
Uphill
Upwind
Cold zone

15. Hazards to EMS/Fire personnel
What are the potential hazards that EMS and fire personnel may face at the incident?
Secondary devices
Fragmentation
Chemical, biological, radiological exposure
Exposure to residues
Blast pressure

16. Pre-arrival considerations
Prior to arrival at the scene
Notify medical control
Notify trauma center
Use standing orders
Consider staging a medical helicopter

17. Pre-arrival considerations
Advise EMS/fire personnel what types of hazards the technician may encounter so they can prepare…
R.F.I. Hazards
Turn off radios
Turn off cellular phones
Turn off pagers

18. Medical history data
Each technician should have information on scene for EMS providers
Medical history
Medications
Allergies to medications
Blood type
Normal vital signs

19. Bomb Technician Hazards
Blast pressure
Ear injury
Lung damage
Traumatic amputation
Internal hemorrhaging

20. Bomb Technician Hazards
Fragmentation
Possibility of fragments traveling in excess of 8900fps

21. Size Does Not Matter
Effects of a Dry Ice Bomb
Never underestimate the power of an explosive device by it’s size.
Even small explosive devices can cause death or serious injury.
This injury was caused by a dry ice bomb.

22. Explosive Injuries
Blasting cap injury

23. Injuries Continued
Effects of improvised fireworks

24. Explosive Force
Pressure and Fragmentation effects of high explosives

25. Russian Bomb Technician attempting to disarm a backpack device

26. Blast Over Pressure Injuries

27. Blast Over Pressure Injuries

28. The results of trying to crimp a blasting cap with your teeth

31. Blast Over Pressure Blast Injuries 5 PSI over pressure
Slight chance of eardrum rupture (without hearing protection)
15 PSI over pressure
50% chance of eardrum rupture
30 to 40 PSI over pressure
Slight chance of lunge damage

32. Blast Over Pressure Blast Injuries continued 80 PSI overpressure
Severe Lung damage
100 to 120 PSI overpressure
Slight chance of death
130 to 180 PSI overpressure
50% chance of death
200 to 250 PSI overpressure
Nearly 100% chance of death

33. Bomb Technician Hazards Blast Effects

34. Bomb Technician Hazards
Spinal injury
EMS should know how the bomb suit ensemble is donned/doffed
When the bomb technician’s safety is at risk, the suit may need to be cut

35. Bomb Technician Hazards
Burns
Chemical or thermal burns
Second or third degree burns greater than 10% of body surface area will require transport to a burn center
Circumferential burns, burns to hands, face, groin or respiratory tract will require transport to a burn center

36. Bomb Technician Hazards
Heat stress
Monitor vitals signs
HR >100, diastolic BP>110 should rehab prior to donning PPE
Monitor core temperature, 105F degrees can be life threatening

37. Bomb Technician Hazards
Heat stress injuries
Cramps
Heat exhaustion
Heat stroke
Heat stroke is life threatening

38. Bomb Technician Hazards
Heat stress prevention
Hydration
Cooling
Shade
Air conditioning
Cooling systems

39. Fire Department Concerns
Utility locations
Gas
Power
Sewer
Water lines, hydrants

40. Fire Department Concerns
Hazardous chemicals
Combustible gases
Fire load
Weather
Decontamination

41. Fire Department Concerns
Staging location for a rapid intervention team (RIT)
Protected location
Hose lines connected
Water supply ready
PPE/SCBA donned

42. Summary Levels of EMS Trauma centers Hazards for EMS/fire personnel
Hazards for the bomb technician
Importance of vital sign monitoring
Donning/doffing of PPE

43. Questions? Comments? Sergeant/Paramedic Marty Hietala
Davis County Sheriff’s Office
800 West State Street
Farmington, Utah 84025
Office
Fax
Cellular