Rescue

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

• Flame protection
• Personal flotation
• Lighting
• HAZMAT suits/SCBA
• Wilderness protection

• Helmets
• Eye protection
• Hearing protection
• Respiratory protection
• Gloves
• Foot 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
Rescue Operations

• 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 SixPreparation for Removal
• Phase SevenRemoval

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 Dont 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 patients condition
• Immediate threats are
• Hypoxia
• Shock
• At this point, why patient isnt 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 patients name
• Be sure other rescuers use patients 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 communitys 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!