1. SCENE TECHNIQUES

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

3. SCENE TECHNIQUES • Overview: • 1. Role of the EMT-B • 2. Fundamental of Extrication • 3. Introduction to Hazardous Materials • 4. Incident Management System • 5. Multiple-Casualty Situations

4. Role of the EMT-B • Nonrescue EMS • Administer care to the patient before extrication • Patient care precedes extrication • Work together with the providers of rescue. • Cooperate the activities of the rescuers.

5. ROLE OF THE EMT-B • Rescue EMS • EMS providers can also be the rescue providers. • A chain of command should be establish to ensure patient care priorities. • Administer care to the patient

6. Role of the EMT-B • Patient care precedes extrication unless delayed movement would endanger the life of the patient or rescuer.

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

9. Extrication • Equipment • Personal safety • Rescue & Extrication - requires mental and physical preparation of self • Safety begins with proper mind set and protective equipment

10. Extrication • Protective clothing • Sturdy shoes or work boots • Long underwear, hat, etc... • Leather gloves, hard hat with protective shield

12. Extrication • Patient Safety • Inform the patient • Protect the patient. • Lighting is of the utmost importance

13. Gaining Access • What type of accident? • Is the patient in a vehicle? In some other structure? • Is the vehicle or structure severally damaged? • In what position is the vehicle? On what surface? • Is the patient injured? • Is the environment hazardous or threatening?

14. Getting to the patient • Simple access • Complex access • Specialized access techniques

16. Provide emergency medical care • Evaluation and treatment • Do not interrupt evaluation • Establish and maintain an open airway with C-spine stabilization. • Artificial ventilation • Control accessible bleeding • CPR

17. Provide emergency medical care • Complete initial assessment • Provide critical intervention • Immobilize spine securely • Short spine board • Rapid extrication considerations • Move the patient not the immobilization device use sufficient personnel • choose path of least resistance

19. Provide emergency medical care • Disentanglement of patient • Treat injuries and correct life threatening problems • Do not forget toe re-evaluate the patient’s status • Disentanglement involves use of : • A great deal of common sense • Ingenuity in use of available tools and method

21. Preparation of the patient for transfer • Ensure all injury are treated • All fractures splinted • All wounds dressed • Cervical spine immobilized • Improvise if you have to

22. Prep of Pt’s for transfer • Package patient for removal • Best accomplished by use of spine board • Move patient as a unit • Use ingenuity, common sense and mechanical knowledge when the situation dictates

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

25. Hazardous Materials • Common problem - People are killed or injured before the danger is identified. • Primary concern - Safety • The EMT-B and crew • Patient • Public

27. Hazardous Materials • Identification - Different kind of hazards have different colors and shaped labels. • Law • Shipping papers or packing - will have same number • Drivers -must carry shipping paper with the same number

29. Hazardous Material • Pay attention - to your own senses. strange looking fumes, funny odor from a wrecked vehicle • Only trained - to handle this incidents should enter the area or hazards you as an EMT-B are not. • Consider the cargo of an overturn semitrailer truck.

31. Hazardous Material • General Procedures • Park upwind/uphill from the incident, safe distance • Keep unnecessary people away from area • Isolate the area • (1) Keep people out • (2) Do not enter unless fully protected with proper equipment and SCBA

32. Hazardous Material • Avoid contact with material • Remove patients to a safe zone, if no risk to EMT-B. • Resources • (1) Local hazardous material response team • (2) CHEMTREC 800- 424-9300 • (3) Hazardous Materials, The Emergency Response Handbook

34. Incident Management System • Has been developed to assist with control, direction , and coordination of emergency response resources.

35. Incident Management System • Structure - After an incident manager is determined, EMS sectors are established as needed: • Extrication sector • Triage sector. • Treatment sector

37. Incident Management System • Transportation sector • Staging sector • Supply sector • Mobile command center

38. Role • Individuals at the scene will be assigned to particular roles in one of the sectors. • Upon arrival, the EMT-B should report to the sector officer for specific duties. • Once assigned a specific task, the EMT-B should complete the task and report back to the sector officer.

39. Multiple Casualty Situations (MCS) • Definition - An event that places a great demand on resources, be it equipment or personnel. • Basic triage - sorting multiple-casualties into priorities for emergency care or transportation to definitive care. Priorities are given in four levels.

41. Triage • Highest priority (RED) • Airway and breathing difficulties • Uncontrolled or severe bleeding • Decreased mental status • Patients with severe medical problems • Shock (hypoperfusion) • Severe burns

42. Triage • Second priority (YELLOW) • Burns without airway problems • Major or multiple bone or joint injuries • Back injuries with or without spinal cord damage

43. Triage • Lowest priority (Green) • Minor painful, swollen, deformed extremities • Minor soft tissue injuries Lowest priority (BLACK) • Death • Obviously mortal wounds, open brain trauma, full cardiac arrest

45. Triage • The cardinal rule of triage is to do the greatest good for the greatest number. • Triage is on - going process, therefore triage priority may change.

46. Triage Procedures • Most knowledgeable EMS provider arriving on-scene first becomes triage officer • Additional help should be requested • Perform initial assessment on all patients first. • Assign available personnel and equipment to priority one patients.

47. Triage Procedures • Patients transport decisions are based on a variety of factors. • (1) Prioritization • (2) Destination facilities • (3) Transportation resources • Triage officer remains at scene to assign and coordinate personnel, supplies, and vehicles.

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49. Summary: • Role of the EMT-B • Non rescue • Rescue • Fundamental of extrication • Equipment • Getting to the patient • Providing emergency care

50. Summary • Hazardous Materials • Common Problem • Primary concerns • Identification • General Procedures • Incident Management System • Role • Structure