EMT Unit 9: EMS Operations

Chapter 38-41

Chapter 38: Transport Operations

• Focus on effective preparation for transport, emphasizing the importance of thorough checks and readiness of equipment prior to departure.

• Understand safe emergency vehicle operations, including the legal responsibilities and best practices for driving emergency vehicles.

• Appropriate transport decisions and patient care techniques during transport are essential for ensuring patient safety and comfort.

• Identify the nine phases of an ambulance call and EMT roles, ensuring all team members clearly understand their responsibilities in each phase.

• Comparison of ground and air transport, including the advantages and limitations of each mode in different emergency scenarios.

• Cleaning and disinfecting procedures following an emergency call to maintain hygiene and compliance with health regulations.

Model Ambulances

Modern Ambulances

• Design Standards: Ambulances are built based on NFPA 1917 guidelines and feedback from EMS personnel to meet operational demands.

• Components:

  • Driver's compartment equipped with advanced navigation and communication systems.

  • Patient's compartment designed to securely accommodate at least two EMTs, one supine patient, and essential medical equipment in an organized manner.

  • Communication tools include state-of-the-art two-way radios for dispatch and mobile data terminals.

  • Safety features involve enhanced structural integrity, adequate seat restraints for EMTs, and patient transport equipment designed for rapid access and egress.

  • Suitable for light extrication procedures with specialized tools readily available.

Ambulance Types

Ambulance Types

• Type I: Typically features a modular design with a separate truck cab. Ideal for larger services needing versatility.

• Type II: A van-type design, primarily used for simple patient transports to medical facilities.

• Type III: Specialized vehicles engineered for advanced life support and critical care transport, featuring medical equipment integration.

• Star of Life: A recognizable symbol identifying vehicles as ambulances, displayed on various vehicle surfaces to ensure quick recognition in emergencies.

Nine Phases of an Ambulance Call

1. Preparation

   • Ensure all equipment and supplies are ready and accessible, with a systematic approach for inventory management that includes medical supplies, PPE, and communication devices.

   • Item placement should be based on urgency, facilitating rapid response during emergencies.

2. Dispatch

   • Dispatcher gathers crucial information about the nature of the call, location, emergency contact numbers, and severity of conditions to provide EMS teams with a clear understanding of the situation.

3. En Route

   • Recognized as the most dangerous phase, where EMTs must wear seatbelts, stay alert, review call details, and assign specific duties to team members for effective response preparation.

4. Arrival at Scene

   • Conduct a thorough scene size-up to identify safety hazards, ascertain the need for additional units, and evaluate the mechanism of injury to develop an effective patient care plan.

   • Park ambulances safely and strategically at least 100 feet from the incident to create a safe buffer zone for operations.

5. Transfer of Patient

   • Secure and lift patients into the ambulance using appropriate devices such as scoop stretchers or backboards to ensure safe transfer without exacerbating injuries.

6. Transport

   • Notify dispatch of critical patient details during transport and continuously monitor patient stability, making adjustments to care as needed.

7. Delivery Phase

   • Effectively transfer patients to hospital staff, providing a comprehensive verbal report of patient status, treatments administered, and any ongoing concerns. Restock supplies and equipment as necessary.

8. En Route to Station

   • Communicate with dispatch to inform them of the team's return to service, ensuring readiness for subsequent emergency calls.

9. Post Run

   • Complete detailed reports of the call, clean and disinfect the ambulance, and perform routine inspections to maintain vehicle functionality and hygiene standards.

Cleaning in Ambulance

Cleaning and Disinfecting Procedures

• Cleaning: Removing visible contaminants to ensure a safe environment for the next patient.

• Disinfecting: Use appropriate chemicals to kill pathogens, ensuring compliance with health and safety guidelines.

• High-level Disinfection: Implementing advanced disinfection techniques to ensure thorough sanitation of medical equipment is essential.

• Sterilization: Typically uses heat or chemical agents to completely remove microbial contamination from equipment.

• Post-call procedures include stripping linens, utilizing EPA registered solutions, and detailed cleaning protocols for surfaces and equipment.

Defensive Driving Techniques for EMTs

• Participation in defensive driving programs is highly encouraged to enhance skill levels.

• Emphasis on physical fitness, alertness, and emotional stability, crucial for safe driving under pressure.

• Safe driving practices include:

  • Always wearing seat belts to protect all occupants.

  • Reacting defensively and anticipating actions of other vehicles on the road to avoid accidents.

  • Understanding vehicle dynamics, particularly maneuvering in emergency situations, to maintain control.

• Sirens and Lights: EMTs should prioritize patient comfort and minimize anxiety when activating sirens, ensuring operational safety for both the patient and the public.

• Types of Air Ambulances:

• Fixed wing aircraft for long-distance transports, equipped with advanced medical technology.

• Rotary wing helicopters for shorter distances, allowing quick access to rural or congested areas.

Landing Zone

• Landing Zone: Ground EMS crew responsibilities include setting up and securing landing zones, maintaining safe distances, and clearing any hazards to ensure safe helicopter landings.

Jump Kits

• Jump Kit: A collection of essential tools and supplies needed for initial patient contact and triage within the first five minutes of an emergency call.

Patient Care Equipment

• Patient Care Equipment: Equipment such as Stokes baskets and wheeled stretchers designed to facilitate safe patient handling during transport.

• It is critical to understand and comply with local laws and regulations governing emergency vehicle operations to ensure safety and avoid legal consequences.

Chapter 39: Vehicle Extrication

• Describe EMS rescue operations, emphasizing each phase of vehicle extrication.

• Understand specialized components of EMS operations, including tactical EMS, trench rescue, high-angle rescue, and how each requires specific training and equipment.

• Identify the roles of EMTs and the importance of communication and coordination with other emergency responders during rescues.

Safety Considerations

• Safety Considerations

  • EMTs assist with extrication; however, full rescue requires advanced training and collaboration with specialized teams.

  • Priority:

    • Patient care must remain the foremost concern; EMTs need to administer quick, effective medical care while assessing the scene.

    • Personal safety must be emphasized, requiring EMTs to wear appropriate protective gear and follow safety protocols.

    • Team safety is critical; clear communication among team members can prevent accidents and ensure a coordinated response.

  • Equipment and protective gear selection depends on specific scene hazards identified during an initial size-up, which includes assessing the environment and potential threats.

• Vehicle Safety Systems

Hazards post-collision can include features such as shock-absorbing bumpers, airbags, and other components designed for passenger safety but pose risks during extrication.

Airbag safety specifics:

• Side airbags: maintain a minimum of 5-inch clearance from the deployment zone to avoid injury.

• Driver’s side airbags: maintain at least a 10-inch clearance to ensure safety when disabling the system.

• Passenger side airbags: require a 20-inch clearance to prevent accidental deployment hazards.

Extrication

• Extrication: the process of removing individuals from danger or entrapment scenarios following incidents, such as vehicle collisions.

• The EMT's role extends beyond patient care to:

  • Assess and provide comprehensive medical care, ensuring the patient is stable enough for transport.

  • Triage patients based on the severity of their injuries, often using standardized assessment protocols.

  • Package patients appropriately, ensuring comfort and injury stabilization during transfer.

  • Provide safe transport to medical facilities, maintaining ongoing communication with receiving hospitals.

Rescue Team Role

• Rescue team roles: include stabilizing the vehicle, removing obstructions for access, and ensuring a safe method of extricating patients from vehicles.

10 Phases of Extrication

• 10 Phases of Extrication

  • Preparation: Involves pre-incident training exercises, tool checks, and ensuring readiness for various types of rescue scenarios, including awareness of advanced extrication techniques.

  • En route to the scene: EMTs must follow established ambulance call procedures, emphasizing efficient response and readiness for potential rescue conditions.

  • Arrival and scene size-up:

    • Block the scene from traffic by positioning rescue vehicles appropriately, ensuring personal protective equipment (PPE) is donned, and conducting a 360-degree walk-around of the scene.

    • Assess hazards, including the mechanism of injury, environmental concerns, and the number of patients requiring attention.

    • Document findings, including vital information that may impact patient care decisions and safety protocols.

  • Hazard control: Manage potential risks such as downed power lines, unstable vehicles, and create a safe operational environment.

  • Gaining access: Assess vehicle stability and patient location; utilize appropriate access methods while considering the safest approach for patient and rescuer.

  • Support operations: Implement necessary operations, including providing adequate lighting, establishing staging areas, and identifying safe helicopter landing zones for rapid patient transfer if needed.

  • Rapid vehicle extrication: Conduct methods for critical patients needing immediate care, ensuring they are safely and efficiently removed from the vehicles.

  • Emergency care: Perform a thorough primary assessment and provide emergency care while maintaining safety for both the patient and responders.

  • Removal of patient: Coordinate rescuer efforts for safe and effective patient removal, recognizing the need for consistency and communication throughout the process.

  • Transfer: Ensure a smooth transition of care to medical facilities; continuously re-evaluate patient status during transfer, prioritizing ongoing assessment for potential deterioration of condition or need for care adjustments.

• Specialized Rescue Situations

• Certain situations necessitate specialized training, including cave, confined space, trench, and water rescues, highlighting the importance of preparedness for unique challenges.

• SWAT team involvement may be necessary in tactical emergencies where security and specialized extraction techniques are required.

• Structural collapse rescues require coordination with specialized rescue teams, and EMTs must adhere to safety protocols to protect themselves and victims during these precarious efforts.

Trench Rescue Guidelines

• Trench Rescue Guidelines

  • Trench collapses present significant risks; response vehicles must maintain a distance of no less than 500 feet from the collapse site.

  • No entry is permitted without proper shoring in place to ensure the safety of rescuers.

  • Medical personnel will manage victims following extrication, providing emergency medical care and support post-incident.

Tactical Emergency Medical Support

• Tactical Emergency Medical Support

  • EMTs must wait for scenes to be secured by law enforcement before commencing operations, recognizing the nature of tactical environments that may pose risks.

  • Effective coordination with incident commanders and thorough planning for safety are critical components for successful tactical EMS operations.

Structures Fires and EMS Response

• Structures Fires and EMS Response

  • Ambulances should be dispatched to structure fires in conjunction with fire department responses, prepared for involvement in both active and standby roles.

  • EMS responsibilities may involve active triage and treatment upon discovering potential patients, emphasizing the need for efficient assessment techniques.

  • Hazards can include toxic substances released from burning materials, making awareness and preparedness essential for all EMS personnel on scene.

Chapter 40: Incident Management

• Focus on the National Incident Management System (NIMS) as a critical framework for coordinating response efforts across various agencies and sectors during emergencies.

• Understanding the distinct roles and responsibilities within the incident command structure is essential for efficient response and recovery, reducing confusion and improving outcomes in mass casualty incidents (MCIs).

• Incident management also encompasses the thorough documentation of actions and decisions made during an incident to ensure accountability, learning, and improvement in future responses.

National Incident Management Systems (NIMS)

National Incident Management System (NIMS)

• Implemented by the Secretary of Homeland Security in February 2004 to unify and streamline incident management processes across federal, state, and local levels.

• Serves as a framework facilitating effective collaboration among government entities, private sector organizations, and non-governmental organizations (NGOs) during emergencies, ensuring a cohesive and well-coordinated response.

Components of NIMS

• Communication Management: Establishing clear channels and protocols for information flow among responders and stakeholders.

• Resource Management: Efficiently obtaining, allocating, and managing resources, including personnel and equipment necessary for incident response.

• Command Management: Setting up a structured hierarchy that delineates authority and decision-making responsibilities.

• Promotes standardized terminology, training, and certification for responders to enhance interoperability across different jurisdictions and disciplines.

• Emphasizes interoperability and mutual aid agreements among agencies, allowing for seamless communication and collaboration across various levels of government and emergency services.

Incident Command System (ICS)

• Successfully used to achieve responder safety and effective resource management during emergencies, providing a structured approach to incident management.

• Common terminology and clear communications are emphasized to ensure all responding agencies can work together effectively and understand each other's operational tactics and strategies.

• Organizational principles include:

  • Limiting Span of Control: Ensuring that each supervisor only manages a limited number of subordinates to maintain clarity and effectiveness in command.

  • Hierarchical Structure: Incorporating sections, divisions, and groups that delineate roles and responsibilities, fostering efficiency in decision-making and operational execution.

Roles and Responsiblities in ICS

Roles and Responsibilities in ICS

• General Staff includes:

  • Command: Overall decision-making authority during an incident.

  • Finance: Managing fiscal resources and tracking expenditures for reimbursement.

  • Operations: Directing and overseeing tactical operations at the incident scene.

  • Logistics: Coordinating communications, supplies, and resource allocation for effective operations.

  • Planning: Developing Incident Action Plans (IAPs) and anticipating future needs based on evolving conditions.

Command Stuff

• Command Staff includes:

  • Public Information Officer (PIO): Responsible for disseminating information to the public and media.

  • Safety Officer: Ensures the safety of all personnel involved in the response.

  • Liaison Officer: Acts as a point of contact for other agencies and organizations involved in the incident response.

Command Structure

Command Structure

• Incident Commander (IC): Plays a pivotal role in overseeing overall incident management and ensuring strategies align with response objectives.

• Unified Command: Utilized in large incidents involving multiple agencies, allowing for collaborative decision-making without compromising the integrity of each agency's operational protocols.

• Importance of knowing command post location and communication protocols to ensure efficiency and coordination among diverse responding agencies.

• Finance Section: Critical for documenting expenditures for reimbursement, maintaining accountability and fiscal responsibility during large-scale responses.

• Logistics Section: Vital for managing resources like communications, supplies, and equipment to meet the operational needs of responders on the ground.

• Operations Section: Directs tactical operations on the scene, including resource deployment, strategy execution, and real-time adjustments based on situational updates.

• Planning Section: Develops comprehensive Incident Action Plans (IAPs) that outline objectives, strategies, and resource allocations necessary for successful incident resolution.

EMS Response in Incident Command

• Preparation involves thorough planning for likely disasters, ensuring that EMS responders are ready to act efficiently and effectively.

• Initial Scene Size-Up: Critical first step to assess resources, determine operational needs, and establish a clear command structure as soon as possible.

• Communication: Emphasizes minimizing radio chatter; direct face-to-face communication is encouraged to enhance clarity and prevent miscommunication.

• EMS units should check-in with command for task assignments, ensuring that all responders are aware of their roles and responsibilities before proceeding with operations.

• Accountability within the incident includes keeping supervisors informed of personnel locations, ongoing actions, and task progress to ensure situational awareness among all responders.

Triage Procedures in MCIs

Triage Procedures in MCIs

• Triage Definition: An essential process of sorting patients based on the severity of their injuries to prioritize treatment and resource allocation during MCIs.

• Triage Categories:

  • Immediate (Red): Patients in critical condition who require urgent medical attention to survive.

  • Delayed (Yellow): Serious but not immediately life-threatening injuries that require treatment but can wait for a short period.

  • Minor (Green): Patients who are walking wounded with less serious injuries that can be treated after more critical individuals.

  • Expectant (Black): Patients who are unlikely to survive given the resources available and thus receive minimal care to allow resources to focus on others.

• START Triage: A simple, fast method used for adults to sort patients; involves immediate identification of all walking wounded and quick assessments of breathing, pulse, and neurological status to determine triage categorization.

• JumpSTART: A pediatric version of triage, accommodating the specific needs and assessment criteria for young children affected in incidents.

Disaster Response

Disaster Response

• Disaster: Defined as a widespread event severely disrupting community functions, which can occur with or without injuries, necessitating organized emergency interventions.

• Elected officials are responsible for declaring disasters, a process that may invoke specific emergency procedures and allocate necessary resources.

• Casualty collection areas may be established to efficiently triage and treat victims while ensuring that resources are managed effectively throughout the incident.

HazMat Incidents

Hazardous Materials (HazMat) Incidents

• The initial assessment of the scene is crucial to determine safety and ensure responders do not encounter unseen dangers before approaching.

• Hazardous Materials: Includes any substances that pose significant risks to health, property, or the environment, which require strict protocols and protection measures.

• Identification: Utilize visual indicators and engage in cautious assessments of potential hazards present in the environment.

Control Zones

• Control Zones: Establishing distinct hot, warm, and cold zones is essential for maintaining safety and promoting effective operational efficiency:

  • Hot Zone: The most contaminated area, where immediate hazards exist and stringent precautions are necessary.

  • Warm Zone: Established for decontamination processes and area transition, where some precautions are still necessary.

Cold Zone: A safe area designated for non-hazardous operations, ensuring a clear delineation of zones for safety and efficiency

• Personal Protective Equipment (PPE)

• Personal Protective Equipment (PPE): Levels range from A (highest, fully encapsulated protection) to D (minimal protection which may involve regular work uniforms), used based on the hazards present.

Emergency Response Guidelines

Emergency Response Guidelines

• Utilize the Emergency Response Guidebook (ERG) for effective management of hazardous materials incidents, ensuring responders are well-versed in handling specific threats and challenges.

• Familiarize with Material Safety Data Sheets (MSDS) for in-depth chemical safety information, which guide responders in identifying risks and proper handling procedures.

• Use shipping papers to ascertain details about the transported materials, aiding in quick identification and response planning during incidents involving hazardous materials.

Chapter 41: Terrorism

• Objectives:

  • Understand the complexities of terrorism and the specific roles and responsibilities of EMTs in response scenarios.

  • Recognize various weapons of mass destruction, their agents, and effective safety measures during disaster management, including triage strategies and patient care in contaminated environments.

Terrorism

• Definition:

  • Involves violent acts directed against civilian populations with the intent of intimidation, coercion, or influencing government policy or actions.

  • Differentiated into:

  • International Terrorism: Acts occurring outside the U.S. jurisdiction, often linked to global terrorist organizations.

  • Domestic Terrorism: Acts perpetrated by individuals or groups within the U.S. aimed at domestic targets, reflecting localized grievances or ideologies.

Examples of Terrorist Groups

• Examples of Terrorist Groups:

  • Religious extremists, who might justify violence through ideological beliefs, such as jihadist groups.

  • Doomsday cults that prepare for apocalyptic scenarios, potentially leading to violent reactions as a means of protest.

  • Violent supremacist groups, motivated by racist or xenophobic ideologies.

  • Lone wolf terrorists, often acting independently and influenced by extremist propaganda online.

Lone Wolf Terrorism

Lone Wolf Terrorism

• Definition:

  • Terrorism executed by an individual without direct support from larger organizations, making it harder to detect and prevent.

• Trends:

  • A noted increase in frequency within the U.S., with many incidents involving firearms and targeting locations such as schools, public gatherings, and concerts.

THREAT Acronym

• Recommended Response: Utilize the THREAT acronym when addressing Active Shooter Events:

  • Threat suppression through immediate intervention.

  • Hemorrhage control using tourniquets and direct pressure.

  • Rapid extrication to safety for injured individuals.

  • Assessment by medical providers to ensure proper care and triage.

  • Transport to definitive care facilities for further medical treatment.

Weapons of Mass Destruction

Weapons of Mass Destruction (WMD)

• Definition:

  • Weapons specifically designed to inflict massive casualties or destruction, potentially affecting large populations.

• Acronyms for Types:

  • Be NICE:

  • Biological, Nuclear, Incendiary, Chemical, and Explosive agents.

  • CBRNE:

  • Chemical, Biological, Radiologic, Nuclear, and Explosive threats that require specific response protocols.

• Preferred Weapons: Explosives are commonly favored due to their relative availability and devastating potential, making them a prime choice for various terrorist groups.

Chemical Agents (different types)

Types of Chemical Agents

• Categories:

  • Vesicants (Blister Agents):

  • Cause severe skin blisters upon contact. Example: Sulfur mustard (mustard gas), known for its long-lasting effects on the skin and respiratory system.

  • Pulmonary Agents (Choking Agents):

  • Cause significant respiratory distress; examples include Chlorine gas and Phosgene, which can have immediate and delayed effects on health.

  • Nerve Agents:

  • Highly toxic substances that disrupt the nervous system. Examples: Sarin and VX, both able to cause rapid incapacitation and death.

  • Metabolic Agents:

  • These agents interfere with the body’s ability to utilize oxygen. Example: Cyanide, which can rapidly lead to respiratory failure and death if not treated promptly.

EMT Response Protocol

EMT Response Protocol

• Situational Awareness:

  • EMTs must consistently recognize terrorism indicators, such as unusual behavior, unfamiliar individuals in secure areas, or the presence of hazardous materials on every call to ensure proactive measures.

• Safety Measures:

  • Position vehicles upwind and uphill from incidents to minimize exposure to harmful agents.

  • Wait for scene security confirmation before entering potentially hazardous environments to ensure personal safety.

  • Maintain vigilance for potential secondary devices that could cause additional harm.

• Command Establishment:

  • The first responder must establish command until additional resources arrive, and EMTs may need to take on various supervisory roles in managing the situation effectively.

Decontamination and Patient Care

Decontamination and Patient Care

• Initial Actions:

  • Promptly notify dispatch about potential WMD events, clearly indicating the nature of the incident and anticipated patient care needs, including decontamination procedures.

• Personal Protective Equipment (PPE):

  • Essential for the safety of responders against contamination from hazardous materials; EMTs must wear appropriate PPE and be prepared for scenarios involving multiple devices or simultaneous incidents.

ROutes of Entry

• Routes of Entry:

  • Differentiate between vapor hazards (primarily inhalation-related risks) versus contact hazards (skin exposure), as well as persistent agents (which linger for an extended period) versus non-persistent agents (which evaporate quickly).

Treatment of Agents

Treatment of Agents

• Vesicants:

  • There are no specific antidotes for vesicant exposure; treatment focuses on thorough decontamination, along with supportive care in a specialized burn unit.

• Pulmonary Agents:

  • Immediate removal from exposure is critical; managing airway, breathing, and circulation (ABCs) aggressively is vital for patient survival.

• Nerve Agents:

  • The use of DuoDote auto-injector is essential for treatment; maintaining oxygenation and providing ventilation support are key components of care.

• Metabolic Agents (Cyanides):

  • Prompt removal from exposure is critical; prioritize decontamination and manage patients for respiratory support and potential induced hypoxia.

Biological Agents

Biological Agents

• Types:

  • Various pathogens including viruses (e.g., Smallpox), bacteria (e.g., Anthrax, Plague), and neurotoxins (e.g., Botulinum toxin, Ricin) present specific challenges in diagnosis and treatment.

• Transmission:

  • Biological agents can spread through various means, including airborne transmission and direct contact; many can be undetectable initially, complicating response efforts.