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Bomb Squad/E.M.S. Interface 2005 I.A.B.T.I. EMT Training Conference By Sergeant/Paramedic Marty Hietala Davis County Sheriffs Office, Utah.

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Presentation on theme: "Bomb Squad/E.M.S. Interface 2005 I.A.B.T.I. EMT Training Conference By Sergeant/Paramedic Marty Hietala Davis County Sheriffs Office, Utah."— Presentation transcript:

1 Bomb Squad/E.M.S. Interface 2005 I.A.B.T.I. EMT Training Conference By Sergeant/Paramedic Marty Hietala Davis County Sheriffs 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 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 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 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 must be expedient Transport to an appropriate facility Transport to an appropriate facility

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

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

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

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

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

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

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

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

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

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

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

16 Pre-arrival considerations Prior to arrival at the scene Prior to arrival at the scene Notify medical control Notify medical control Notify trauma center Notify trauma center Use standing orders Use standing orders Consider staging a medical helicopter 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… Advise EMS/fire personnel what types of hazards the technician may encounter so they can prepare… R.F.I. Hazards R.F.I. Hazards Turn off radios Turn off radios Turn off cellular phones Turn off cellular phones Turn off pagers Turn off pagers

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

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

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

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

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

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30

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

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

33 Bomb Technician Hazards Blast Effects

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

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

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

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

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

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

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

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

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

43 Questions? Comments? Sergeant/Paramedic Marty Hietala Davis County Sheriffs Office 800 West State Street Farmington, Utah Office Fax Cellular


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