SCENE TECHNIQUESSCENE TECHNIQUESSCENE TECHNIQUESSCENE TECHNIQUES

SCENE TECHNIQUESSCENE TECHNIQUES

Lesson ObjectiveLesson Objective: Describe the : Describe the fundamental concepts required for rescue fundamental concepts required for rescue and extrication to include hazardous and extrication to include hazardous materials and multi-patient scenario.materials and multi-patient scenario.

SCENE TECHNIQUESSCENE TECHNIQUES

Overview:Overview: 1. Role of the EMT-B1. Role of the EMT-B 2. Fundamental of Extrication2. Fundamental of Extrication 3. Introduction to Hazardous Materials3. Introduction to Hazardous Materials 4. Incident Management System4. Incident Management System 5. Multiple-Casualty Situations5. Multiple-Casualty Situations

Role of the EMT-BRole of the EMT-B

Nonrescue EMSNonrescue EMS Administer care to the patient before Administer care to the patient before

extrication extrication Patient care precedes extrication Patient care precedes extrication Work together with the providers of rescue.Work together with the providers of rescue. Cooperate the activities of the rescuers.Cooperate the activities of the rescuers.

ROLE OF THE EMT-BROLE OF THE EMT-B

Rescue EMSRescue EMS EMS providers can also be the rescue EMS providers can also be the rescue

providers.providers. A chain of command should be establish to A chain of command should be establish to

ensure patient care priorities.ensure patient care priorities. Administer care to the patient Administer care to the patient

Role of the EMT-BRole of the EMT-B

Patient care precedes extrication unless Patient care precedes extrication unless delayed movement would endanger the delayed movement would endanger the life of the patient or rescuer.life of the patient or rescuer.

Fundamentals of Extrication Fundamentals of Extrication

Definition : An aspect of rescue, a method Definition : An aspect of rescue, a method of freeing patients from that which binds or of freeing patients from that which binds or restrains by means of force, ingenuity or restrains by means of force, ingenuity or both.both.

ExtricationExtrication

EquipmentEquipment Personal safetyPersonal safety

Rescue & Extrication - requires mental and Rescue & Extrication - requires mental and physical preparation of selfphysical preparation of self

Safety begins with proper mind set and Safety begins with proper mind set and protective equipmentprotective equipment

ExtricationExtrication

Protective clothing Protective clothing Sturdy shoes or work bootsSturdy shoes or work boots Long underwear, hat, etc...Long underwear, hat, etc... Leather gloves, hard hat with protective shieldLeather gloves, hard hat with protective shield

ExtricationExtrication

Patient SafetyPatient Safety

Inform the patientInform the patient

Protect the patient.Protect the patient.

Lighting is of the utmost importanceLighting is of the utmost importance

Gaining AccessGaining Access

What type of accident?What type of accident? Is the patient in a vehicle? In some other Is the patient in a vehicle? In some other

structure?structure? Is the vehicle or structure severally damaged?Is the vehicle or structure severally damaged? In what position is the vehicle? On what In what position is the vehicle? On what

surface?surface? Is the patient injured?Is the patient injured? Is the environment hazardous or threatening?Is the environment hazardous or threatening?

Getting to the patientGetting to the patient

Simple accessSimple access

Complex accessComplex access

Specialized access techniquesSpecialized access techniques

Provide emergency medical careProvide emergency medical care

Evaluation and treatmentEvaluation and treatment Do not interrupt evaluation Do not interrupt evaluation Establish and maintain an open airway with Establish and maintain an open airway with

C-spine stabilization.C-spine stabilization. Artificial ventilationArtificial ventilation Control accessible bleedingControl accessible bleeding CPRCPR

Provide emergency medical careProvide emergency medical care

Complete initial assessmentComplete initial assessment Provide critical interventionProvide critical intervention Immobilize spine securelyImmobilize spine securely

Short spine board Short spine board Rapid extrication considerationsRapid extrication considerations Move the patient not the immobilization Move the patient not the immobilization device device

use sufficient personneluse sufficient personnel choose path of least resistance choose path of least resistance

Provide emergency medical careProvide emergency medical care

Disentanglement of patientDisentanglement of patient Treat injuries and correct life threatening Treat injuries and correct life threatening

problemsproblems Do not forget toe re-evaluate the patient’s Do not forget toe re-evaluate the patient’s

statusstatus Disentanglement involves use of :Disentanglement involves use of :

A great deal of common senseA great deal of common sense Ingenuity in use of available tools and methodIngenuity in use of available tools and method

Preparation of the patient for transferPreparation of the patient for transfer

Ensure all injury are treatedEnsure all injury are treatedAll fractures splintedAll fractures splintedAll wounds dressedAll wounds dressedCervical spine immobilizedCervical spine immobilized Improvise if you have toImprovise if you have to

Prep of Pt’s for transferPrep of Pt’s for transfer

Package patient for removalPackage patient for removalBest accomplished by use of spine Best accomplished by use of spine

boardboardMove patient as a unitMove patient as a unit Use ingenuity, common sense and Use ingenuity, common sense and

mechanical knowledge when the mechanical knowledge when the situation dictatessituation dictates

Hazardous Materials Hazardous Materials

If you even suspect possible hazardous If you even suspect possible hazardous materials at the accident scene, you must materials at the accident scene, you must first step back and assess situation, then first step back and assess situation, then call for a trained HazMat team.call for a trained HazMat team.

Hazardous MaterialsHazardous Materials

Common problem - People are killed or Common problem - People are killed or injured before the danger is identified.injured before the danger is identified.

Primary concern - SafetyPrimary concern - Safety The EMT-B and crewThe EMT-B and crew PatientPatient PublicPublic

Hazardous MaterialsHazardous Materials

Identification - Different kind of Identification - Different kind of hazards have different colors and hazards have different colors and shaped labels.shaped labels. LawLaw Shipping papers or packing - will have Shipping papers or packing - will have

same numbersame number Drivers -must carry shipping paper with Drivers -must carry shipping paper with

the same numberthe same number

Hazardous MaterialHazardous Material

Pay attention - to your own senses. strange Pay attention - to your own senses. strange looking fumes, funny odor from a wrecked looking fumes, funny odor from a wrecked vehiclevehicle

Only trained - to handle this incidents Only trained - to handle this incidents should enter the area or hazards you as an should enter the area or hazards you as an EMT-B are not.EMT-B are not.

Consider the cargo of an overturn Consider the cargo of an overturn semitrailer truck.semitrailer truck.

Hazardous MaterialHazardous Material

General ProceduresGeneral Procedures Park upwind/uphill from the incident, safe Park upwind/uphill from the incident, safe

distancedistance Keep unnecessary people away from areaKeep unnecessary people away from area Isolate the areaIsolate the area

(1) Keep people out(1) Keep people out (2) Do not enter unless fully protected with proper (2) Do not enter unless fully protected with proper

equipment and SCBAequipment and SCBA

Hazardous MaterialHazardous Material

Avoid contact with materialAvoid contact with material Remove patients to a safe zone, if no risk to Remove patients to a safe zone, if no risk to

EMT-B.EMT-B. ResourcesResources

(1) Local hazardous material response team(1) Local hazardous material response team (2) CHEMTREC 800- 424-9300(2) CHEMTREC 800- 424-9300 (3) Hazardous Materials, The Emergency (3) Hazardous Materials, The Emergency

Response HandbookResponse Handbook

Incident Management System Incident Management System

Has been developed to assist with Has been developed to assist with control, direction , and coordination control, direction , and coordination of emergency response resources.of emergency response resources.

Incident Management SystemIncident Management System

Structure - After an incident manager is Structure - After an incident manager is determined, EMS sectors are established as determined, EMS sectors are established as needed:needed:

Extrication sector Extrication sector Triage sector.Triage sector. Treatment sector Treatment sector

Incident Management SystemIncident Management System

Transportation sector Transportation sector Staging sectorStaging sectorSupply sector Supply sector Mobile command centerMobile command center

Role Role

Individuals at the scene will be assigned to Individuals at the scene will be assigned to particular roles in one of the sectors.particular roles in one of the sectors.

Upon arrival, the EMT-B should report to Upon arrival, the EMT-B should report to the sector officer for specific duties.the sector officer for specific duties.

Once assigned a specific task, the EMT-B Once assigned a specific task, the EMT-B should complete the task and report back to should complete the task and report back to the sector officer.the sector officer.

Multiple Casualty Situations (MCS)Multiple Casualty Situations (MCS)

Definition - An event that places a great Definition - An event that places a great demand on resources, be it equipment or demand on resources, be it equipment or personnel. personnel.

Basic triage - sorting multiple-casualties Basic triage - sorting multiple-casualties into priorities for emergency care or into priorities for emergency care or transportation to definitive care. Priorities transportation to definitive care. Priorities are given in four levels.are given in four levels.

TriageTriage

Highest priority Highest priority (RED)(RED) Airway and breathing difficultiesAirway and breathing difficulties Uncontrolled or severe bleedingUncontrolled or severe bleeding Decreased mental statusDecreased mental status Patients with severe medical problemsPatients with severe medical problems Shock (hypoperfusion)Shock (hypoperfusion) Severe burnsSevere burns

TriageTriage

Second priority Second priority (YELLOW)(YELLOW) Burns without airway problemsBurns without airway problems Major or multiple bone or joint injuriesMajor or multiple bone or joint injuries Back injuries with or without spinal cord Back injuries with or without spinal cord

damagedamage

TriageTriage

Lowest priority Lowest priority (Green)(Green) Minor painful, swollen, deformed extremitiesMinor painful, swollen, deformed extremities Minor soft tissue injuriesMinor soft tissue injuries

Lowest priority Lowest priority (BLACK)(BLACK) DeathDeath Obviously mortal wounds, open brain trauma, Obviously mortal wounds, open brain trauma,

full cardiac arrestfull cardiac arrest

TriageTriage

The cardinal rule of triage is to do the The cardinal rule of triage is to do the greatest good for the greatest number.greatest good for the greatest number.

Triage is on - going process, therefore Triage is on - going process, therefore triage priority may change.triage priority may change.

Triage ProceduresTriage Procedures

Most knowledgeable EMS provider arriving Most knowledgeable EMS provider arriving on-scene first becomes triage officeron-scene first becomes triage officer

Additional help should be requestedAdditional help should be requested Perform initial assessment on all patients Perform initial assessment on all patients

first.first. Assign available personnel and equipment Assign available personnel and equipment

to priority one patients.to priority one patients.

Triage ProceduresTriage Procedures

Patients transport decisions are based on a Patients transport decisions are based on a variety of factors.variety of factors. (1) Prioritization(1) Prioritization (2) Destination facilities(2) Destination facilities (3) Transportation resources(3) Transportation resources

Triage officer remains at scene to assign Triage officer remains at scene to assign and coordinate personnel, supplies, and and coordinate personnel, supplies, and vehicles.vehicles.

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Summary:Summary:

Role of the EMT-BRole of the EMT-B Non rescueNon rescue RescueRescue

Fundamental of extricationFundamental of extrication EquipmentEquipment Getting to the patientGetting to the patient Providing emergency careProviding emergency care

SummarySummary

Hazardous MaterialsHazardous Materials Common ProblemCommon Problem Primary concernsPrimary concerns IdentificationIdentification General ProceduresGeneral Procedures

Incident Management SystemIncident Management System RoleRole StructureStructure

SummarySummary

Multiple-Casualty SituationsMultiple-Casualty SituationsBasic triage categoriesBasic triage categoriesTriage proceduresTriage procedures