1. Chapter 18: EMS Operations

2. Cognitive Objectives
7-1.1 Discuss the medical and nonmedical equipment needed to respond to a call.
7-1.2 List the phases of an out-of-hospital call.
7-1.3 Discuss the role of the First Responder in extrication.
7-1.4 List various methods of gaining access to the patient.
(1 of 3)

3. Cognitive Objectives
7-1.5 Distinguish between simple and complex access.
7-1.6 Describe what the First Responder should do if there is reason to believe that there is a hazard at the scene.
7-1.7 State the role the First Responder should perform until appropriately trained personnel arrive at the scene of a hazardous materials situation.
(2 of 3)

4. Cognitive Objectives
7-1.8 Describe the criteria for a multiple-casualty situation.
7-1.9 Discuss the role of the First Responder in the multiple-casualty situation.
Summarize the components of basic triage.
(3 of 3)

5. Affective Objective
Explain the rationale for having the unit prepared
to respond.

6. Psychomotor Objective
Given a scenario of a mass-casualty incident, perform triage.

7. Knowledge and Attitude Objectives
Explain the medical and nonmedical equipment needed to respond to a call.
List the five phases of an emergency call for a first responder.
Discuss the role of a first responder in extrication.
List the seven steps in the extrication process.
(1 of 4)

8. Knowledge and Attitude Objectives
List the various methods of gaining access to a patient.
Describe the simple extrication procedures that a first responder can perform.
List the complex extrication procedures that require specially trained personnel.
(2 of 4)

9. Knowledge and Attitude Objectives
State the responsibilities of the first responder in incidents where hazardous materials are present.
Describe the actions that a first responder should take in hazardous materials incidents before the arrival of specially trained personnel.
Define a multiple-casualty incident.
(3 of 4)

10. Knowledge and Attitude Objectives
Describe the role of a first responder in a multiple-casualty incident.
Describe the purpose of the National Incident Management System.
Describe the steps in the START triage system.
(4 of 4)

11. Skill Objectives
Perform simple procedures for gaining access to a wrecked vehicle.
Triage a simulated multiple-casualty incident using the START triage system.

12. EMS Operations Be prepared to respond with the proper equipment.
Know simple extrication procedures and the basics of air medical response.
Understand the purpose of the incident management system and NIMS.
Understand basic triage and the START system.

13. Preparing for a Call Be prepared to respond promptly.
Use the most direct route.
Have the proper equipment to perform your job.
Equipment must be stocked and maintained on a regular basis.

14. First Responder Life Support Kit
Patient examination equipment
Personal safety equipment
Resuscitation equipment
Bandaging and dressing equipment
Patient immobilization equipment
Extrication equipment
Miscellaneous equipment
(1 of 2)

15. First Responder Life Support Kit
(2 of 2)

16. Five Phases of Response
Dispatch
Response to scene
Arrival at scene
Transferring patient care to other EMS personnel
Postrun activities

17. Dispatch Dispatch facility
The center that citizens call to request emergency medical care
Most centers are part of a system that dispatches for fire, police, and EMS.
(1 of 2)

18. Dispatch Information from dispatch should include: Nature of the call
Name and location of patient
Number of patients
Any special problems
Call-back number from the caller
(2 of 2)

19. Response to the Scene Get there quickly and safely.
Follow safety procedures
Use seatbelts.
Proper use of vehicle warning devices
Drive so you are not involved in an accident.

20. Arrival at the Scene Place your vehicle in a safe location.
Use your vehicle warning lights.
Consider scene safety.
Determine if additional help is needed.
Follow the patient assessment sequence.

21. Transferring Patient Care
Transfer care to more highly trained personnel.
Give brief report.
Offer assistance.

22. Postrun Activities Complete necessary paperwork. Clean equipment.
Replace supplies.
Notify dispatch when you are ready for another call.

23. Helicopter Operations
Helicopters are used to reach patients in inaccessible areas.
Obtain a copy of the ground operations procedure.
Schedule an orientation session.
Courtesy of Duke Life Flight

24. Helicopter Safety Guidelines
Main rotor may be just 4 feet from the ground.
Tail rotor may be invisible.
Rotors can generate a “wash” equivalent to winds of 60–80 mph.

25. Setting Up Landing Zones
Landing zone should be flat and free of debris.
Check carefully for nearby wires.
Zone should be at least 100 feet x 100 feet.

26. Loading Patients into Helicopters
Secure all loose clothing, sheets, and instruments.
Use eye protection.
Approach from the front.
Follow the helicopter crew’s instructions.

27. Approaching Helicopters

28. Extrication
Simple techniques to access, treat, and extricate patients who are trapped in vehicles
Primary goals for first responders:
Obtain safe access to patients.
Ensure patient stabilization.
(1 of 2)

29. Extrication Know your limitations. Identify hazards.
Control hazards if trained.
Gain access to patients.
Provide patient care and stabilization.
Move patients only if necessary.
(2 of 2)

30. 7 Steps of Extrication Conduct overview of scene.
Stabilize scene; control hazards.
Gain access to patients.
Provide initial emergency care.
Help disentangle patients.
Help prepare patients for removal.
Help remove patients.

31. Overview of the Scene Anticipate and plan for what you might find.
Overview the scene before exiting your vehicle.
Determine
Extent of incident
Number of patients
If any hazards exist
Call for assistance.
(1 of 2)

32. Overview of the Scene
Courtesy of District Chief Chris E. Mickal/New Orleans Fire Department, Photo Unit
As you approach an accident, look over the entire scene.
(2 of 2)

33. Stabilize Scene and Hazards
Infectious diseases
Traffic hazards
Bystanders
Spilled gasoline
Automobile batteries
Downed electrical wires
Unstable vehicles
Vehicle fires

34. Hazards A single accident scene may contain many hazards. (1 of 5)
© Jack Dagley/ShutterStock, Inc.
A single accident scene may contain many hazards.
(1 of 5)

35. Hazards Infectious diseases Follow BSI precautions.
Wear heavy rescue gloves.
Traffic hazards
Park vehicles so they protect the scene and warn other motorists.
(2 of 5)

36. Hazards
Bystanders
Give specific directions about where they should move to.
Spilled gasoline
Call fire department.
Consider covering with dirt.
(3 of 5)

37. Hazards Automobile batteries
Turn off vehicle’s ignition to reduce possibility of electrical short circuit.
Downed electrical wires
Locate wires but avoid contact.
Keep trapped persons inside vehicle and all bystanders away from scene.
(4 of 5)

38. Hazards Unstable vehicles On their wheels
On their sides or upside-down
Vehicle fires
Use dry chemical fire extinguisher.
Remove patients as quickly as possible.
(5 of 5)

39. Gain Access to Patients
Access through doors
Always try doors first!
Start with least damaged door.
(1 of 2)

40. Gain Access to Patients
Access through windows
Break side windows rather than windshield.
Wear proper safety equipment.
(2 of 2)

41. Provide Initial Emergency Care
Conduct a patient assessment.
Monitor ABCs.
Control bleeding.
Treat for shock.
Stabilize cervical spine.
(1 of 2)

42. Provide Initial Emergency Care
Provide psychological reassurance.
Maintain patient’s body temperature.
Leave the patient in vehicle unless in immediate danger.
Keep patients stabilized and immobilized until properly packaged and removed.
(2 of 2)

43. Assist With Patient Removal
Help disentangle patients.
Help prepare patients for removal.
Access route may not be large enough for extrication.
Help remove patients.

44. The Golden Hour
The less time spent on scene with a seriously injured patient, the better.
Chance for survival increases if rescuers get the patient to a trauma center within 1 hour of injury.

45. Review of the Extrication Process
Call for help.
Specify types of vehicles involved.
Identify and contain hazards.
Park your vehicle so headlights and warning lights can be used to protect scene.
(1 of 2)

46. Review of the Extrication Process
Clear a working area around the accident.
Remember to try opening the doors first.
Once you gain access, assess and monitor patients.
Keep your cool!
(2 of 2)

47. HazMat Incidents Your first priority is to protect yourself.
The most important step is to identify the substance.
Unless you have received training, you should keep away from the hot zone.
Wait for the help of trained personnel.
(1 of 2)

48. HazMat Incidents Patients with HazMat injuries
Very few specific antidotes or treatments
Emergency treatment usually aimed at supportive care
Constantly evaluate patient’s vital signs.
(2 of 2)

49. Multiple-Casualty Incidents
Multiple-casualty incidents: Situations with more than one sick or injured individual
Provide the greatest medical benefit for the greatest number of people.
Triage: Sorting of patients into groups according to their need for treatment
Should be simple and fast

50. Visual Survey
Prepare yourself mentally and force yourself to stay calm.
Visually assess:
Number of patients
Severity of injuries
How much help is needed

51. Initial Radio Report Location of incident Type of incident Hazards
Approximate number of victims
Type of assistance needed
Be as specific as possible.

52. Sorting Patients
Do not become involved in treating the first or second patient you see.
Triage
Get to each patient quickly.
Conduct rapid assessment.
Do not stop except to correct airway and severe bleeding problems.

53. START System Simple Triage And Rapid Treatment
Based on breathing, circulation, and mental status (BCM)
Designed to help identify the most seriously injured patients

54. Four Colors of Triage
Priority One (Red tag): Immediate care/life threatening
Priority Two (Yellow tag): Urgent care/can delay up to 1 hour
Priority Three (Green tag): Delayed care/can delay up to 3 hours
Priority Four (Gray/Black tag): Patient is dead/no care required.

55. Triage Tags

56. START Steps Step 1: Get up and walk. Step 2: Begin where you stand.
Breathing: It all starts here.
Circulation: Is oxygen getting around?
Mental status: Open your eyes.

57. Working at Mass-Casualty Incidents
Report to incident commander (IC).
IC will assign you an area.
Effective incident command system (ICS) depends on integrated, agreed-upon protocols and procedures.
Learn the ICS used in your area.

58. National Incident Management System
Developed by U.S. Department of Homeland Security
Provides a consistent and unified approach to handling emergency incidents
(1 of 2)

59. National Incident Management System
Role of first responder falls into Command and Management area.
Federal government requires many agencies to utilize NIMS.
You may be required to be trained.
(2 of 2)