Presentation on theme: "Rescue. Introduction Rescue = “Act of delivering from danger or imprisonment” In EMS, Rescue = Extricating or disentangling victims who will become your."— Presentation transcript:
Introduction Rescue = “Act of delivering from danger or imprisonment” In EMS, Rescue = Extricating or disentangling victims who will become your patients
Paramedic Rescue Roles Vary from area to area All paramedics need “rescue awareness” – Ability to recognize hazards – Knowledge of specialized capabilities and when to call for them Rescue awareness necessary to avoid injury/death of paramedics/patients
Paramedic Rescue Roles Some systems require paramedic training in rescue beyond awareness level
Paramedic Rescue Roles All paramedics should have training and equipment to allow them to: – Assess hazards associated with various environments – Establish incident command – Access patients – Provide assessment/initial care – Provide medical balance to the skills of the technical rescuers
Topics Paramedic Roles Personal Protective Equipment Phases of Rescue Operations Types and Processes of Rescues – Surface Water – Hazardous Atmospheres (Confined Space, Trench) – Highway Operations – Hazardous Terrains
Gloves Leather gloves for cut/puncture protection Surgical gloves (latex and non-latex) for body fluid protection
Foot Protection High-top, steel-toed boot with coarse lug soles Laced boots are preferable to pull-on types In colder environments boots should be insulated
Flash/Flame Protection Turnout gear, coveralls, jump suits Nomex ®, PBI ®, flame retardant cotton Bright colors with reflective trim and symbols Insulation in cold environments
Personal Flotation Devices Should be worn when operating on/around water Coast Guard-approved Type III PFD approved for rescue work Should have attached knife, strobe light, and whistle
Lighting Flashlight Headlamp attachable to helmet
HAZMAT Suits/SCBA Level A, B, C, D Level selected depends on nature of product, area of incident in which personnel are operating, personnel responsibilities Requires proper training to use EMS personnel should know how to remove
Backcountry/Wilderness Protection PPE for inclement weather Water purification supplies (iodine, filters) Snacks (energy gels or bars) Temporary shelter (tents, tarps, bivouac sacks) Butane lighter Extra flashlight, batteries
Protective Shielding Backboards Specially-designed basket stretcher shields Better shielding of patients = Difficulty in patient care access
Safety Procedures Steps in curbing “heroics” and maintaining optimum safety include: – Rescue SOPs – Crew assignments – Preplanning – Training exercises
Rescue SOPs Include sections on all anticipated rescue types For each rescue type list – Required safety equipment – Required actions – Prohibited actions – Specific assignment modifications Always provide for a Safety Officer
All operations include 7 basic phases Use phases to form mental picture of how operation will be carried out
Rescue Operations Phase One — Arrival and Size-Up Phase Two — Hazard Control Phase Three — Patient Access Phase Four — Medical Treatment Phase Five — Disentanglement Phase Six—Preparation for Removal Phase Seven—Removal
Phase 1: Size-Up Begins at moment of dispatch Continues throughout rescue In route: – Think through the 7 steps – Decide what you are going to do first When you arrive: – Avoid being caught up in the situation – Step back, survey scene
Phase 1: Size-Up Goals – Establish medical command – Rapid evaluate Hazards Nature of rescue situation Appropriate additional resources
Phase 1: Size-Up Specialized Resources – Is additional assistance needed? – If you need something, call for it! – Stay ahead of incident! – If you routinely work with other agencies, have plan of operations worked out in advance
Phase 2: Hazard Control Are there potential hazards to you? Are there potential hazards to other responders? Are bystanders at risk? Is the patient in danger? Dead Rescuers Don’t Help Anyone!
Phase 2: Hazard Control Goals – Identify hazards – Manage by: Correcting them Moving patient away from them Calling for specialized resources
Phase 2: Hazard Control Weather Unstable structures, vehicles Electrical hazards Fire hazards Traffic Hazardous materials Infection risks Swift water Confined spaces Heights Emotionally unstable patients, bystanders, rescuers
Phase 3: Patient Access First phase that requires application of technical rescue skills IMS should be in place Access should be based on plan approved by Incident Commander and Safety Officer All personnel should understand plan before it is implemented
Phase 3: Gaining Access Goals – Get to the patient safely – Assess patient, begin care Formulate access plan based on – Terrain – Personnel knowledge – Extent of patient injuries – Technical rescue expertise
Phase 3: Gaining Access Formulate access plan based on: – Safety considerations – Terrain – Extent of patient injuries – Personal capabilities – Technical rescue expertise Try before you pry! Work from simple to complex! A different strategy or route may have to be used for patient removal.
Phase 4: Medical Treatment Goals – Initiate assessment ASAP – Identify, correct life-threats – Maintain care during disentanglement – Accompany patient during removal, transport
Phase 4: Medical Treatment Initial Assessment – Rapidly evaluate patient’s condition – Immediate threats are: Hypoxia Shock – At this point, why patient isn’t oxygenating or perfusing is irrelevant
Phase 4: Medical Treatment Life-Saving Care – If ABCs compromised, correct problem! – If you cannot correct problem: Support oxygenation, ventilation Work with technical rescue specialists to develop a rapid extrication plan Rapidly extricate patient Evacuate
Phase 4: Medical Treatment On-going Assessment and Management – Identify, care for existing problems – Anticipate changing patient conditions during prolonged operations – Continually reevaluate risks to patient and rescuers – Provide psychological support to patient during prolonged operations
Phase 4: Medical Treatment Psychological Support – Learn, use patient’s name – Be sure other rescuers use patient’s name – Be sure patient knows your name – Avoid negative comments where patient can hear – Explain delays to patient – Explain technical aspects of rescue to patient – Do NOT lie to patient – Stay calm
Phase 5: Disentanglement Goal: To release patient from entrapment Most technical, time-consuming part of rescue
Phase 5: Disentanglement Patient-centered Keep someone with patient to: – Monitor condition – Ensure technical rescue procedures do not endanger patient Protect patient at all times – Use appropriate PPE – Talk to him – Explain what is happening
Phase 5: Disentanglement Do NOT do anything unless you know EXACTLY what result will be Evaluate risk vs. benefit in all decisions
Phase 6: Preparation for Removal Goal: Package patient so: – All injuries stabilized – Patient moves as single unit through route of egress
Phase 6: Preparation for Removal Packaging methods must consider – Patient condition – Safety issues – Environmental issues – Technical considerations in moving patient
Phase 7: Removal/Transport Goal: Remove packaged patient, transport to appropriate care. Considerations – Patient condition – Environmental issues – Air vs. Ground transport
Conclusion Successful rescues are based on planning, practice. Know what community’s target hazards are. Have plan for managing them. Know who you will be working with; train with them. Know what kinds of help are available. Do NOT be afraid to call for help if you need it!
Conclusion The challenge is NOT to be innovative in a crisis. The challenge is to be well-trained and well- disciplined enough to FOLLOW THE RULES!
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