1. Bechtel Environmental, Safety, and Health (BESH) Emergency Response: Assessing the Scene and the Victim(s) Bechtel First Response Training Session 2

2. Bechtel Environmental, Safety, and Health (BESH) Slide 2 Safety is Our Value “We measure safety performance by the number of incidents. But let’s be clear… it’s really not about incident rates…it’s about people. People who have faces, names, families, hopes, and dreams.” -Riley Bechtel August 15, 2001

3. Bechtel Environmental, Safety, and Health (BESH) Slide 3 Assessing the Scene and Victim(s) Enabling Learning Objectives  Defining proper emergency response  Prioritizing safety  Securing the scene  Calling for help  Prioritizing care  Indications for moving victims  Methods of safely repositioning, moving and rescuing victims

4. Bechtel Environmental, Safety, and Health (BESH) Slide 4 Proper Emergency Response  prevents the present situation from getting worse  protects workers from further danger and injury  provides first aid to the injured worker(s)  protects material and equipment from further damage  isolates and secures the area to ensure that nothing is disturbed

5. Bechtel Environmental, Safety, and Health (BESH) Slide 5 Prioritize Your Own Safety  Priority for safety is in the order of: self, site, patient  A responder who becomes one of the injured is not aiding the problem but contributing to it  Personal protective equipment (PPE) must be available and worn –protective gloves, eye and ear protection; maintain your badge on your person at all times  All responders must be familiar with where the first response equipment is located and how to use it  Additional equipment should be added only for a specific reason and by authorization of the Safety & Health Department

6. Bechtel Environmental, Safety, and Health (BESH) Slide 6 Secure the Scene Before Administering Aid  Evaluate the scene for number of injured and nature of the event  Assess the safety of the scene, including the potential for toxic vapors or gases in the air, and other risks such as electrical or fire hazards  Prioritize care when there are several injured  Check victims for medical alert tags  Perform a logical head-to-toe check for injuries  Move the victim only if absolutely necessary to prevent further injury from a hazard at the scene  If possible, leave material where it is found  Secure area until the investigation is completed

7. Bechtel Environmental, Safety, and Health (BESH) Slide 7 Taking Charge  Immediately assess seriousness of situation and size up the scene for: –scene safety, –body substance isolation determination, –mechanism of injury/nature of illness determination, –number of patients, and –resources needed  Priority should be personal injury followed by property damage. Questions to answer immediately: –Can the present situation get worse? –Is anybody injured? –How can damage be minimized?  Eliminate and contain hazards

8. Bechtel Environmental, Safety, and Health (BESH) Slide 8 Making a Mayday Call State your name, location, and nature of the emergency  Registered Nurse will counsel and transport to scene, activate EMS  Provide initial first aid as soon as possible  Continuously monitor the victim(s)  Safety will meet and escort EMS directly to the incident scene  Ensure clear access for EMS  Identify witnesses and immediately make a list of those directly involved in incident, including injured persons. Tell witnesses that their help will be needed later.  Incidents attract onlookers. Direct them away from scene.

9. Bechtel Environmental, Safety, and Health (BESH) Slide 9 Victim Assessment  Perform a logical head-to-toe check for injuries  Assess each victim for –responsiveness, –Airway patency (blockage), –Breathing, –Circulation, and –medical alert necklace or bracelet  Take a victim’s history at the scene, including determining the mechanism of injury

10. Bechtel Environmental, Safety, and Health (BESH) Slide 10 American Heart Association CPR Guidelines 2010 1.Assess the victim 2.Call for help 3.Being Chest Compressions  Push hard and push fast  Perform compressions at the rate of 100 CPM  If trained in CPR, after 30 compressions, open the airway and give 2 breaths  If not trained or if you do not feel comfortable, continue compressions without interruption until other help arrives

11. Bechtel Environmental, Safety, and Health (BESH) Slide 11 Triage Principles  Nurse will assume command of the scene and will triage the injured when she/he arrives on the scene –EMS will assume command of the scene when they arrive  Triage is a system for sorting casualties into priority for treatment by subsequent teams, enables limited resources to be deployed efficiently  Treating a less critically ill patient could deny life-saving interventions to others who may die as a result  Non-medical person has no authority to tag an injured person as deceased –Dead bodies should be left where they are (uncovered)

12. Bechtel Environmental, Safety, and Health (BESH) Slide 12 Emergency Rescue  Moving a victim from a dangerous location to a place of safety  Procedure: –Avoid unnecessary disturbances –Ensure open airway –Control bleeding –Check for injury –Immobilize injured parts before moving –Transport

13. Bechtel Environmental, Safety, and Health (BESH) Slide 13 Indications for moving Victims Victims who are in immediate danger should be moved away from the danger at once by whatever means possible. Indications:  Fire, danger of explosion  Danger of asphyxia due to lack of O 2 or gas  Serious traffic hazard  Risk of drowning  Exposure to cold/heat  Possibility of injury from collapsing walls or building  Electrical injury or potential injury  Pinning by machinery

14. Bechtel Environmental, Safety, and Health (BESH) Slide 14 Moving Victims  Victims who are NOT in immediate danger should be moved only after they have been stabilized  Position to prevent aggravating injuries or to prevent additional injuries  Be prepared to assist other rescuers with lifting and moving victims

15. Bechtel Environmental, Safety, and Health (BESH) Slide 15 Positioning Victims  Reposition the head to open the airway  Stabilize patient in position found until all assessments are complete, bleeding is controlled, and injuries are splinted  Roll unresponsive people onto their left side into the recovery position  Patient who is nauseated or vomiting should be allowed to remain in a position of comfort  Non-trauma patients can be positioned as found

16. Bechtel Environmental, Safety, and Health (BESH) Slide 16 Methods of Transfer  Pulling the Victim  Lifting the Victim  Supporting the Victim  Two Man Carry  Blanket Lift  Three Man Hammock Carry

17. Bechtel Environmental, Safety, and Health (BESH) Slide 17 Moving the Injured  Keep patient’s head in line with the body  Pull patient in the direction of the long axis of the body to provide as much protection to the spine as possible  Greatest danger when moving a patient quickly is the possibility of aggravating a spinal injury or compromising the patient’s airway  1st protect yourself  2nd protect the airway  3rd protect the breathing  4th protect the circulation  5th protect the spine  6th protect the rest of the body

18. Bechtel Environmental, Safety, and Health (BESH) Slide 18 Three Man Hammock Carry

19. Bechtel Environmental, Safety, and Health (BESH) Slide 19 Backboard  Backboard is used as a method of preventing an injured neck/back from getting worse and as a way to move an injured person that is suspected of having a neck/back injury without making the injury worse.  Nurse will use symptoms, mechanism of injury (e.g. how far did they fall) and medical knowledge to decide if a backboard is necessary

20. Bechtel Environmental, Safety, and Health (BESH) Slide 20 Stokes Basket  Normal position: horizontal or feet down  Start with splinting/wound management  Padding beneath patient in a Stokes basket  Under knees, between legs, along sides, around head  Not under neck  Never leave patient unattended, always have plan if need to tip patient  Strap patient in tight, don’t depend on seat belts  On-going care: pedal pulse/vitals  Ask patient if they feel numbness/tingling/hot spots (indicates straps too tight or loose)  Rescuer at the head is in charge  Feet first, rescuer at patient’s head looks forward

21. Bechtel Environmental, Safety, and Health (BESH) Slide 21 Assessing the Scene Review Questions 1.If you encounter another person in immediate danger, what is the first priority? SELF 2.Name three situations that require emergency move of a victim. –Fire, danger of explosion –Danger of asphyxia due to lack of O 2 or gas –Serious traffic hazard –Risk of drowning –Exposure to cold/heat –Possibility of injury from collapsing walls or building –Electrical injury or potential injury –Pinning by machinery 3.What is the sequence followed when performing an initial assessment? 1. Perform a logical head-to-toe check for injuries 2. Assess responsiveness 3. Airway patency (blockage) 4. Breathing 5. Circulation 6. medical alert necklace or bracelet

22. Bechtel Environmental, Safety, and Health (BESH) Slide 22 We value your Safety and Health Questions? Speak with your Project Nurse or Safety Professional

23. Bechtel Environmental, Safety, and Health (BESH) Slide 23 Learn More about Assessing Scene Safety  American Heart Association (AHA.org)  Centers for Disease Control (CDC.gov)  National Institute for Occupational Safety & Health (NIOSH.org)  National Safety Council (NSC.org)  Occupational Safety & Health Administration (OSHA.gov)  U.S. Department of Health and Human Services (HHS.gov)  U.S Department of Homeland Security (DHS.gov)