EMT Crash Course Chapter EMS Operations (2-4, 34-38)

EMT Crash Course Chapter 2-4, 34-38 (Ambulance and Air Medical Operations, Vehicle Extrication, Hazardous Materals, Incident Management & Mass Casualty Incidents, Terrorism and Weapons of Mass Destruction)

Contemporary ambulances should meet all of the following criteria

- Separate compartments for driver and patient
- Room for at least two EMS providers and two patients
- All necessary medical equipment for the scope of practice being provided
- Radio communication with dispatchers, and the capability to establish online medical direction
- Compliant with local and federal safety requirements
- Compliant with local ambulance certification requirements
- Typically, a displayed six-pointed "Star of Life" emblem

Type I ambulance

truck chassis with modular ambulance body

Type II ambulance

standard van design

Type III ambulance

specialty van design with a square patient compartment mounted on the chassis

Preparation Phase

Inspect the ambulance every day and after each shift change

Dispatch Phase

Determine the nature of the call, location, and number of patients

En Route to Scene

- Notify dispatch you are responding.
- Operate the ambulance according to state and local laws and agency policies.
- All emergency vehicle operators must drive with due regard for the safety of others.

Arrival at Scene/Patient Contact Phase

- Notify dispatch you are on scene
- Upon arrival at a scene, the ambulance should be positioned to allow for safe egress and patient loading
- If necessary, use the ambulance as a barrier to protect the scene.
- The ambulance may be used to provide additional lighting if needed

Transport to Receiving Facility

- Notify dispatch you are transporting the patient and specify where
- Notify the receiving hospital according to local protocol
- Determine whether emergency transport is warranted
- Confirm patient is being transported to appropriate receiving facility

Arrival at Hospital/Transfer of Care

- Notify dispatch you have arrived at the hospital
- Provide verbal report to appropriate hospital personnel of equal or higher medical authority.
- Provide copy of written patient care record
- Obtain signature verifying transfer of care

Post run Phase/Return to Service Phase

Ensure all necessary equipment is restocked and ready for use on the next call and Ensure ambulance and equipment is adequately cleaned, disinfected, or sterilized per local protocol.

The quality of patient care is far more important than

the speed of the response. Do not sacrifice safety for speed. Everyone must be properly restrained whenever the vehicle is traveling.

All equipment on the ambulance should be

properly secured

Emergency vehicles should usually travel in the

far left lane.

When driving an ambulance, scan the road

frequently and several car lengths ahead of you

Pass on the

left when possible.

Recognize that ambulances typically have a

high center of gravity.

Lights and sirens should be used

together

Air ambulances include

rotor-wing aircraft (helicopters) or fixed-wing aircraft (planes). Fixed-wing aircraft

Landing Zones for Rotor-Wing Aircraft

Takeoff and landing is the most dangerous part of flight; Tanding zone (LZ) should be secured well/remain secured until the aircraft is completely clear of the scene and traveling away; measures >=100 feet by 100 feet and be on firm, level ground; Ensure there are no overhead obstructions near the LZ, such as power lines; Clear all loose debris; radio contact between the aircraft and someone on the ground to relay critical information during approach, landing, and takeoff

Operating Around Rotor-Wing Aircraft

- Never approach the aircraft without permission or from the rear
- Make sure all loose items are secured before approaching a running aircraft or loading patients.

EMT's primary responsibilities at a scene involving vehicle extrication or special operations

personal safety and delivery of patient care once it is safe to do so

Leather gloves should also be used over (not instead of)

regular gloves if handling glass, sharp objects, rope, etc

Federal law requires EMS workers to

wear an approved highly reflective traffic safety vest when working on roadways, around traffic, or at an accident scene.

Shock-Absorbing Bumpers

become compressed during an accident and spontaneously release, injuring anyone standing in front of them; EMS approach vehicles from the sides, not the front

Supplemental Restraint System (SRS)

Airbags inflate at up to 200 miles per hour if triggered during an accident

Front airbags typically begin deflating as soon as

they are fully inflated

Side- impact airbags may remain inflated longer due to

the possibility of a rollover

Airbags not previously deployed may inflate

spontaneously after an accident. This poses a risk to anyone within the vehicle, such as EMTs caring for patients

Maintain about two feet of clearance

between you and undeployed airbags when- ever possible

Assume airbags can still deploy even after

the car battery has been disconnected

Children under 12 years of age should

not be placed in the front seat of a vehicle with SRS airbags

Never place an infant in the

front seat of a vehicle with an SRS airbag

In MVCs, Occupants may experience

minor abrasions or contusions due to airbag deployment.

Orthopedic injury to the hands or arms of drivers may also occur due to

airbag deployment.

When assessing the mechanism of injury (MOI), remember to look

under deployed airbags when it is safe to do so.

Phases of extrication

- Preparation
- En Route to Scene
- Arrival
- Control of Hazards
- Support Ops
- Gaining Access
- Patient
- Removal of Patient
- Patient transfer
- Conclusion of Extrication

Arrival phase

Position vehicle in a safe location. Use vehicle to increase scene safety if needed, Assess the scene for hazards, number of patients, etc, and perform 360 degree walk-around if safe to do so

Examples of hazards

traffic, downed power lines, fuel leaks, and hazardous materials

Control of hazards

common practice to disconnect the vehicle's battery during extrication operations. Do not attempt this without proper training. Electric vehicles and alternative-fuel vehicles can present special challenges and hazards.

Examples of Support Ops

scene lighting, helicopter landing zones, and staging areas

Gaining access

EMTs without additional training do not typically gain access to patients if there are special hazards, specialized tools, or equipment required and EMTs may assist in keeping the patient safe while rescuers attempt to gain access or extricate the patient. This may include providing eye protection or cov- ering with a blanket.

Patient care

If safe to do so, patient care may begin before extrication is completed; Perform a standard primary assessment by taking manual cervical-spine (c- spine) precautions and assessing airway, breathing, and circulation (ABCs).

Simple Access

gaining access to the patient without any tools or the need to break glass.

Complex Access

requires the use of special tools and training; EMTs without additional training should not attempt complex access

Extrication

the removal of the patient from entrapment

Entrapment

when a person is trapped in an enclosed space.

Emergency move

used when the scene is dangerous and the patient must be moved immediately and before providing patient care.

Urgent move

Used when the patient has potentially life-threatening injuries or illness and must be moved quickly for evaluation and transport.

Rapid extrication

An urgent move used for patients in a motor vehicle; requires multiple rescuers and a long backboard; Patient is rotated onto a long spine board with manual c-spine and re- moved from vehicle

Patient Transfer

Once the patient is freed, perform a complete assessment

Conclusion of Extrication

Units return to service.

Special rescue situations

- technical rescue or search and rescue
- water rescue
- structure fires
- tactical situations involving law enforcement operations
- hazardous materials incidents
- mass casualty incidents

Hazardous materials (also called hazmats)

solids, liquids, or gases that pose a threat to people, property, or the environment

Risks of exposure to hazardous materials depend on

the dose, concentration, route of exposure, and duration of contact

EMT's primary responsibilities at a hazardous materials incident

personal safety, notification of appropriate authorities, and the safety of the patient and public

Diamond Placards

display a four-digit United Nations (UN) identification number. All UN numbers are listed in the Emergency Response Guidebook (ERG), which can be used to identify the substances and access other essential information

What to do about diamond placards

- Report this information, if possible, when requesting additional resources. Do not enter an unsafe area to look for a placard.
- Fixed storage locations for hazardous materials should display a diamond placard with four smaller placards within. Each one provides different information through the use of color, numbers, & symbols

Blue diamond

provides information about health hazards

Red diamond

provides information about fire hazard

Yellow diamond

provides information about reactivity hazards

White diamond

displays symbols indicating special hazards, such as ra- dioactivity and reactivity to water.

The higher the number (0 to 4) within the blue, red, or yellow diamonds

the greater the hazard is within that category.

When in doubt

request additional resources, such as the fire department, law enforcement, and hazardous materials teams

First Responder Awareness

trains responders to recognize potential hazards, call for appropriate resources, and prevent others from entering the scene. Federal law requires EMTs receive First Responder Awareness level training

First Responder Operations

training is designed for those who initially respond to hazmat scenes. Operations-level personnel are trained to protect people, property, and the environment. They are also trained in the use of specialized personal pro- tective equipment (PPE).

Hazardous Materials Technicians

receive significant training related to stopping the release or spread of hazardous materials

Hazardous Materials Specialists

have the most advanced knowledge and skills. They typically provide assistance at the command level

EMT's First priority

personal safety

EMT's Second priority

patient care in a safe zone

Hot zone

contaminated area; Appropriate PPE is required, as determined by hazmat personnel; Regardless of patient condition, those without proper training and PPE are not permitted ; Patient care does not take place in .

Warm zone

area between the hot and cold zones; Appropriate PPE is required; Only life-threatening conditions are treated in the warm zone.; Everyone must be decontaminated in the warm zone before entering the cold zone

Cold zone

most treatment is performed & EMS remain in

Decontamination

essential to prevent spreading the hazardous material. Any of the following may become contaminated and require decontamination

National Incident Management System (NIMS)

provides an adaptive, standardized approach to any domestic incident and standardizes the command structure, terminology, training, etc

Standardization of NIMS

allows for effective communication and interaction among multiple and diverse agencies at local, state, and federal levels

The adaptability of NIMS allows it to be used with

any type of domestic incident (terrorism, natural disaster, hazardous materials, etc.) of any size.

Components of NIMS

Prepardness, Communications & Information, Command & Management, Resource Management, and Ongoing Management

Preparedness

helps agencies and responders proactively prepare for an incident

Communications and Information

coordinates effective communication and information sharing

Command and Management

provides oversight of the incident for all participating agencies.

Resource Management

coordinates acquisition, tracking, and recovery of resources and equipment needed during an incident

Ongoing Management

coordinates continuous quality improvement of NIMS

National Incident Management System (NIMS) Role & Responsibilities

Command, Finance, Logistics, Operations, Planning

Command Section

includes the incident commander (IC), public information officer (PIO), safety officer, and liaison officer

Finance Section

tracks all expenditures during an incident; usually needed only on large incidents

Operations

responsible for tactical operations on larger incidents. On smaller incidents, this responsibility usually rests with the IC

Planning

helps to develop an action plan for the incident and solve problems as they arise during the incident.

EMS agencies should have written disaster plans that are

routinely practiced, reviewed, and improved

EMS facilities should have adequate resources to be

fully self-sufficient for at least 72 hours

Incident Management Control Scene Size-Up

- What is the incident?
- Confirm incident location, identify scene safety considerations, estimate number of casualties
- What do you need to do? First priorities are personal safety, partner safety, other rescuer's safety, patients' safety, bystanders' and public's safety
- What resources do you need to do it?
- Incident command is established by the highest-ranking person on the scene. Request additional resources as needed

Medical Incident Command Functions

Triage, Treatment, Transportation

Triage

sorting of patients based on the severity of injury; triage supervisor identifies the number and severity of patients; On larger incidents, several responders may be needed to conduct triage; During triage, patients are moved to the appropriate treatment area; Treatment does not begin until all patients are triaged.

Treatment

treatment supervisor establishes the necessary treatment areas based on patient priorities; Secondary triage should be completed within each treatment area. iii. Treatment area personnel assist with movement of patients to the transportation area.

Transportation

transportation supervisor coordinates transportation of patients to the appropriate destinations and must ensure receiving hospitals are not overwhelmed

mass casualty incident (MCI)

broadly defined as an incident that taxes the locally available resources or requires a multijurisdictional response.

Primary Triage

done quickly to determine the patient's basic condition and needs and typically done wherever the patient is located; patient's condition is identified through the use of a triage tag and avoids accidental duplication of effort.

Secondary triage

assessment is done once the patient arrives in the appropriate treatment area

4 triage categories

immediate (red), delayed (yellow), minor (green), dead/dying (black)

Immediate (red tagged)

highest patient priority; have primary assessment problems or exhibit signs and symptoms of head injury or shock