1. Rescue

2. Introduction Rescue = “Act of delivering from danger or imprisonment” In EMS, Rescue = Extricating or disentangling victims who will become your patients

3. 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

4. Paramedic Rescue Roles Some systems require paramedic training in rescue beyond awareness level

5. 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

6. 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

7. Rescuer PPE Helmets Eye protection Hearing protection Respiratory protection Gloves Foot protection Flame protection Personal flotation Lighting HAZMAT suits/SCBA Wilderness protection

8. Helmets Four-point, non-elastic suspension No non-removable “duck bills” in back Needs vary with situations – Vehicle/Structural: NFPA firefighting helmet – Confined Space/Vertical: Climbing helmet – Water: Padded rafting or kayaking helmet

9. Eye Protection ANSI approved, vented goggles or industrial safety glasses Do NOT rely on fire helmet face shields

10. Hearing Protection Choice depends on practicability, convenience, environmental considerations Options – High quality earmuff protectors – Multi-baffled rubber earplugs – Sponge-like disposable earplugs

11. Respiratory Protection Surgical masks Commercial dust masks

12. Gloves Leather gloves for cut/puncture protection Surgical gloves (latex and non-latex) for body fluid protection

13. 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

14. Flash/Flame Protection Turnout gear, coveralls, jump suits Nomex ®, PBI ®, flame retardant cotton Bright colors with reflective trim and symbols Insulation in cold environments

15. 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

16. Lighting Flashlight Headlamp attachable to helmet

17. 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

18. 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

19. Patient PPE Helmets Eye protection Hearing, respiratory protection Protective blankets Protective shielding

20. Helmets Two-point suspension construction-style helmets appropriate for most circumstances Rescuer-quality helmets may be required in caving, climbing situations

21. Eye Protection Vented goggles with elastic band Workshop face shields

22. Hearing/Respiratory Protection Disposable earplugs Surgical mask or industrial dust mask

23. Protective Blankets Water, weather, most debris: Vinyl blankets Fire, heat, glass dust: Aluminized blankets Cold: Commercially-available wool blankets or 55-gallon trash drum liners

24. Protective Shielding Backboards Specially-designed basket stretcher shields Better shielding of patients = Difficulty in patient care access

25. Safety Procedures Steps in curbing “heroics” and maintaining optimum safety include: – Rescue SOPs – Crew assignments – Preplanning – Training exercises

26. 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

27. Crew Assignments Physical screening Psychological screening

28. PrePlanning Identify potential rescue locations, structures, activities Evaluate specific training, equipment to manage potential rescues

29. PrePlanning Provide for personnel maintenance, rotation Protected “stand-by” sites Hydration (diluted sports drinks) Food (complex carbohydrates

30. Training Exercises Base scenarios on likely events Include all agencies likely to respond Integrate IMS, technical rescue, patient care Use exercise results to modify plans, procedures

31. Rescue Operations

32. All operations include 7 basic phases Use phases to form mental picture of how operation will be carried out

33. 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

34. 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

35. Phase 1: Size-Up Goals – Establish medical command – Rapid evaluate Hazards Nature of rescue situation Appropriate additional resources

36. 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

37. 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!

38. Phase 2: Hazard Control Goals – Identify hazards – Manage by: Correcting them Moving patient away from them Calling for specialized resources

39. 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

40. 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

41. 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

42. 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.

43. Phase 4: Medical Treatment Goals – Initiate assessment ASAP – Identify, correct life-threats – Maintain care during disentanglement – Accompany patient during removal, transport

44. 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

45. 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

46. 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

47. 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

48. Phase 5: Disentanglement Goal: To release patient from entrapment Most technical, time-consuming part of rescue

49. 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

50. Phase 5: Disentanglement Do NOT do anything unless you know EXACTLY what result will be Evaluate risk vs. benefit in all decisions

51. Phase 6: Preparation for Removal Goal: Package patient so: – All injuries stabilized – Patient moves as single unit through route of egress

52. Phase 6: Preparation for Removal Packaging methods must consider – Patient condition – Safety issues – Environmental issues – Technical considerations in moving patient

53. Phase 7: Removal/Transport Goal: Remove packaged patient, transport to appropriate care. Considerations – Patient condition – Environmental issues – Air vs. Ground transport

54. 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!

55. 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!