ems aspects of extrication : fundamentals and focus
DESCRIPTION
It is crucial for all firefighters, rescue technicians and fire officers to understand how to rapidly assess the condition, life-threats and needs of their patients in order to coordinate efficient and effective automotive extrication. With the rapid evolution of extrication tools and techniques necessary to keep up with the automotive industry, today’s vehicle extrication education is becoming more and more task-focused, often at the expense of core scene and patient assessment practices. This program discusses how patient assessment must be performed as part of incident size up, and how this can be accomplished by firefighters of all levels of EMS certification or experience even under difficult access conditions. The FDIC audience will be interested in attending this program to improve their ability to provide patient care (either directly or alongside fellow EMS responders), to improve their skills in commanding and coordinating an extrication and to learn best practices in assisting special categories of victims including pediatrics, geriatrics, bariatrics and pregnant patients.TRANSCRIPT
- 1. GET IN GET CARE GET OUT
2. ARRIVE ACCESS ACTIONATRICS AFTER 3. Responder SAFETY Patient OUTCOME Department PERFORMANCE 4. Incident Commander EMT Rescue Technician Liaison Paramedic Driver Firefighter 5. Roadway Safety Zones 6. Roadway Safety Zones 7. Conditions Actions Needs Dangers Orders 8. Command Triage Treatment Transport Staging 9. Check 720 / Mitigate Hazards Stabilize Suspension / Set Brake Initial Patient Contact Power Doors / Power Seats / Power Windows Kill Ignition / Remove Key Headlights off / Hazards On Disconnect Battery / HV / Pull Fuses 10. Makes Contact Communicates Protects Assesses Stays w/Patient WHO? 11. Paralysis Neck / Back Pain Severe Angulation Impalement Crush Injury Pain Management 12. Conditions One patient pinned under dash Severe back pain. Clear ABCs Slow & Careful Actions C-Spine Stabilize Maintain Airway Applied Pressure Bandage Needs Manpower ALS Trauma Center Notification C.A.N. Reports 13. Detect Direct Pressure Devices Dont Dilute 14. Tourniquet Combat Gauze Pressure Bandage Clamp 15. Clamp Gel Foam 16. OPA /NPA / Suction SGA (King,LMA,etc.) ET Special Techniques Cricothyrotomy 17. Ventalitory Assist Flail Chest Sucking Chest Wound Tension Pneumothorax 18. Vascular Access Permissive Hyptnsn Careful / Coordinated Movement 19. Pain/Anti Emetic/Sdtn TXA Vasopressin Transfusion 20. Reduce Heat Loss Warmed Humid O2 Warmed IV Fluids 21. Hypothermia Hypocoagulability H+ Acidosis 22. Selective Spinal! Self Extrication? Spine Board* Pelvis: Extremities; 23. Preparation Harden Egress Coordination Crush Injuries 24. Trauma Center Pre-Notify Air vs Ground Facilitate Hand-Off 25. Top heavy projectiles PAT (Appearance, Breathing Effort, Circulation to Skin) Better compensation, smaller reserves Specialty centers Safety equipment, leave it in place? 26. Fragility Comorbidities Medications Poor compensation & reserves 27. Difficult to extricate Cushion effect Difficult to assess Difficult airways Difficult vents (CPAP) Difficult IVs Special resources 28. Uterus has no compensatory mechanisms Trauma to uterus can begin premature labor Position! The fetus can be affected even in the compensating mother Fetus possibly viable at approx. 25 weeks. the 29. Decrease in residual capacity & gastroesophageal sphincter tone =- respiration, + aspiration Significant potential bleeding from placenta / uterus Physical exam tends to be unreliable due to physiological changes 30. Pictures Pain / Pathogens PTSD Preview Practice 31. Effort Time Money Comfort Commitment 32. ARRIVE ACCESS ACTIONATRICS AFTER 33. Responder SAFETY Patient OUTCOME Department PERFORMANCE