bomb squad/e.m.s. interface 2005 i.a.b.t.i. emt training conference by sergeant/paramedic marty...
TRANSCRIPT
Bomb Squad/E.M.S. Interface
2005 I.A.B.T.I. 2005 I.A.B.T.I.
EMT Training Conference EMT Training Conference
ByBy
Sergeant/Paramedic Marty HietalaSergeant/Paramedic Marty Hietala
Davis County Sheriff’s Office, UtahDavis County Sheriff’s Office, Utah
Goals
Understand levels of emergency medical care
Understand trauma centers and burn centers
Understand the Incident Command System
Articulate potential hazards for EMS and Fire personnel
Articulate potential hazards and mechanisms of injury for the bomb technician
Demonstrate emergency doffing of the bomb suit and chemical suit
Why?
To ensure that emergency medical To ensure that emergency medical personnel and fire personnel will provide personnel and fire personnel will provide the highest level of medical care in the the highest level of medical care in the shortest amount of timeshortest amount of time
The golden hourThe golden hour
The Golden Hour?
After a traumatic event, a patient will have After a traumatic event, a patient will have the best outcome if rapid stabilization and the best outcome if rapid stabilization and surgical intervention is made within an hour surgical intervention is made within an hour of sustaining the injuryof sustaining the injury
Transport must be expedientTransport must be expedient Transport to an Transport to an appropriateappropriate facility facility
What EMS support is available in your jurisdiction?
Is this your Is this your ambulance?ambulance?
Will EMS need Will EMS need additional additional resources?resources?
What type of Fire Dept. support is available in your jurisdiction?
Is this the local fire Is this the local fire engine?engine?
Will the fire service Will the fire service need additional need additional resources?resources?
Levels of Emergency Medical Care
Basic life support Basic life support Advanced life supportAdvanced life support Hospital emergency roomHospital emergency room Trauma centerTrauma center Burn centerBurn center
Basic Life Support
BandagingBandaging SplintingSplinting Spinal precautionsSpinal precautions Oxygen therapyOxygen therapy Cardiopulmonary resuscitationCardiopulmonary resuscitation Automatic external defibrillatorAutomatic external defibrillator TransportationTransportation
Advanced Life Support
Basic life supportBasic life support Intravenous accessIntravenous access Advanced cardiac life supportAdvanced cardiac life support Advanced trauma life supportAdvanced trauma life support Pharmacological interventionPharmacological intervention EKG interpretationEKG interpretation Advanced airway placementAdvanced airway placement
Endotracheal IntubationEndotracheal Intubation
Advanced Life Support
Advanced invasive proceduresAdvanced invasive procedures Surgical cricothyrotomySurgical cricothyrotomy Chest tube placementChest tube placement Central line insertionCentral line insertion Intraosseous infusionIntraosseous infusion External jugular vein cannulationExternal jugular vein cannulation Nasogastric tube placementNasogastric tube placement
Trauma Centers
A designation made for a hospital that A designation made for a hospital that meets stringent requirements for providing meets stringent requirements for providing care to trauma patientscare to trauma patients
Board certified emergency physiciansBoard certified emergency physicians In-house neurosurgeonIn-house neurosurgeon In-house surgical staffIn-house surgical staff In-house radiology staffIn-house radiology staff
Burn Centers
Positive pressure isolationPositive pressure isolation HydrotherapyHydrotherapy Hyperbaric therapyHyperbaric therapy Surgical staffSurgical staff
DebridementDebridement Skin harvestingSkin harvesting Skin graftingSkin grafting
Incident Command System
A standardized system used by emergency A standardized system used by emergency services to manage incidents, regardless of services to manage incidents, regardless of sizesize
Initiated by first arriving assets and Initiated by first arriving assets and branches out based on primary dutiesbranches out based on primary duties
Required by OSHARequired by OSHA
Staging
Where should the command post, EMS and Where should the command post, EMS and fire assets stage?fire assets stage? UphillUphill UpwindUpwind Cold zoneCold zone
Hazards to EMS/Fire personnel
What are the potential hazards that EMS What are the potential hazards that EMS and fire personnel may face at the incident?and fire personnel may face at the incident? Secondary devicesSecondary devices FragmentationFragmentation Chemical, biological, radiological Chemical, biological, radiological
exposureexposure Exposure to residuesExposure to residues Blast pressureBlast pressure
Pre-arrival considerations
Prior to arrival at the scenePrior to arrival at the scene Notify medical controlNotify medical control Notify trauma centerNotify trauma center Use standing ordersUse standing orders Consider staging a medical helicopterConsider staging a medical helicopter
Pre-arrival considerations
Advise EMS/fire personnel what types of Advise EMS/fire personnel what types of hazards the technician may encounter so hazards the technician may encounter so they can prepare…they can prepare… R.F.I. HazardsR.F.I. Hazards
Turn off radiosTurn off radiosTurn off cellular phonesTurn off cellular phonesTurn off pagersTurn off pagers
Medical history data
Each technician should have information on Each technician should have information on scene for EMS providersscene for EMS providers Medical historyMedical history MedicationsMedications Allergies to medicationsAllergies to medications Blood typeBlood type Normal vital signsNormal vital signs
Bomb Technician Hazards
Blast pressureBlast pressure Ear injuryEar injury Lung damageLung damage Traumatic Traumatic
amputationamputation Internal Internal
hemorrhaginghemorrhaging
Bomb Technician Hazards
FragmentationFragmentation Possibility of Possibility of
fragments traveling fragments traveling in excess of in excess of 8900fps8900fps
Size Does Not Matter
Never underestimate Never underestimate the power of an the power of an explosive device by explosive device by it’s size. it’s size.
Even small explosive Even small explosive devices can cause devices can cause death or serious injury.death or serious injury.
This injury was caused This injury was caused by a dry ice bomb.by a dry ice bomb.
Effects of a Dry Ice Bomb
Explosive Injuries
Blasting cap injury Blasting cap injury
Injuries Continued
Effects of improvised fireworksEffects of improvised fireworks
Explosive Force
Pressure and Fragmentation effects of high explosives Pressure and Fragmentation effects of high explosives
Russian Bomb Russian Bomb Technician Technician attempting to attempting to disarm a disarm a backpack device backpack device
Blast Over Pressure Injuries
Blast Over Pressure Injuries
The results The results of trying to of trying to
crimp a crimp a blasting blasting cap with cap with
your teethyour teeth
Blast Over Pressure Blast Injuries Blast Injuries
5 PSI over pressure 5 PSI over pressure Slight chance of eardrum rupture (without Slight chance of eardrum rupture (without
hearing protection) hearing protection) 15 PSI over pressure 15 PSI over pressure
50% chance of eardrum rupture 50% chance of eardrum rupture 30 to 40 PSI over pressure 30 to 40 PSI over pressure
Slight chance of lunge damage Slight chance of lunge damage
Blast Over Pressure Blast Injuries Blast Injuries continuedcontinued
80 PSI overpressure 80 PSI overpressure Severe Lung damageSevere Lung damage
100 to 120 PSI overpressure 100 to 120 PSI overpressure Slight chance of death Slight chance of death
130 to 180 PSI overpressure 130 to 180 PSI overpressure 50% chance of death 50% chance of death
200 to 250 PSI overpressure 200 to 250 PSI overpressure Nearly 100% chance of death Nearly 100% chance of death
Bomb Technician HazardsBlast Effects
Bomb Technician Hazards
Spinal injurySpinal injury EMS should know how the bomb suit EMS should know how the bomb suit
ensemble is donned/doffedensemble is donned/doffed When the bomb technician’s safety is at When the bomb technician’s safety is at
risk, the suit may need to be cutrisk, the suit may need to be cut
Bomb Technician Hazards BurnsBurns
Chemical or thermal burnsChemical or thermal burnsSecond or third degree burns greater Second or third degree burns greater
than 10% of body surface area will than 10% of body surface area will require transport to a burn centerrequire transport to a burn center
Circumferential burns, burns to hands, Circumferential burns, burns to hands, face, groin or respiratory tract will face, groin or respiratory tract will require transport to a burn centerrequire transport to a burn center
Bomb Technician Hazards
Heat stressHeat stress Monitor vitals signs Monitor vitals signs
HR >100, diastolic BP>110 should HR >100, diastolic BP>110 should rehab prior to donning PPErehab prior to donning PPE
Monitor core temperature, 105F Monitor core temperature, 105F degrees can be life threateningdegrees can be life threatening
Bomb Technician Hazards
Heat stress injuriesHeat stress injuries CrampsCramps Heat exhaustionHeat exhaustion Heat strokeHeat stroke
Heat stroke is life threateningHeat stroke is life threatening
Bomb Technician Hazards
Heat stress preventionHeat stress prevention HydrationHydration CoolingCooling
ShadeShadeAir conditioningAir conditioningCooling systemsCooling systems
Fire Department Concerns
Utility locationsUtility locations GasGas Power Power SewerSewer Water lines, hydrantsWater lines, hydrants
Fire Department Concerns
Hazardous chemicalsHazardous chemicals Combustible gasesCombustible gases Fire loadFire load WeatherWeather DecontaminationDecontamination
Fire Department Concerns
Staging location for a rapid intervention Staging location for a rapid intervention team (RIT)team (RIT) Protected locationProtected location Hose lines connectedHose lines connected Water supply readyWater supply ready PPE/SCBA donnedPPE/SCBA donned
Summary
Levels of EMSLevels of EMS Trauma centersTrauma centers Hazards for EMS/fire personnelHazards for EMS/fire personnel Hazards for the bomb technicianHazards for the bomb technician Importance of vital sign monitoringImportance of vital sign monitoring Donning/doffing of PPEDonning/doffing of PPE
Questions? Comments?
Sergeant/Paramedic Marty HietalaSergeant/Paramedic Marty Hietala
Davis County Sheriff’s OfficeDavis County Sheriff’s Office
800 West State Street800 West State Street
Farmington, Utah 84025Farmington, Utah 84025
801 451 4188 Office801 451 4188 Office
801 451 4167 Fax801 451 4167 Fax
801 510 4081 Cellular801 510 4081 Cellular
[email protected]@co.davis.ut.us