Chapter 18: EMS Operations

Cognitive Objectives

7-1.1 Discuss the medical and nonmedical equipment needed to respond to a call.

7-1.2 List the phases of an out-of-hospital call.

7-1.3 Discuss the role of the First Responder in extrication.

7-1.4 List various methods of gaining access to the patient.

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Cognitive Objectives

7-1.5 Distinguish between simple and complex access.

7-1.6 Describe what the First Responder should do if there is reason to believe that there is a hazard at the scene.

7-1.7 State the role the First Responder should perform until appropriately trained personnel arrive at the scene of a hazardous materials situation.

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Cognitive Objectives

7-1.8 Describe the criteria for a multiple-casualty situation.

7-1.9 Discuss the role of the First Responder in the multiple-casualty situation.

7-1.10 Summarize the components of basic triage.

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Affective Objective

7-1.11 Explain the rationale for having the unit prepared

to respond.

Psychomotor Objective

7-1.12 Given a scenario of a mass-casualty incident, perform triage.

Knowledge and Attitude Objectives

1. Explain the medical and nonmedical equipment needed to respond to a call.

2. List the five phases of an emergency call for a first responder.

3. Discuss the role of a first responder in extrication.

4. List the seven steps in the extrication process.

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Knowledge and Attitude Objectives

5. List the various methods of gaining access to a patient.

6. Describe the simple extrication procedures that a first responder can perform.

7. List the complex extrication procedures that require specially trained personnel.

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Knowledge and Attitude Objectives

8. State the responsibilities of the first responder in incidents where hazardous materials are present.

9. Describe the actions that a first responder should take in hazardous materials incidents before the arrival of specially trained personnel.

10. Define a multiple-casualty incident.

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Knowledge and Attitude Objectives

11. Describe the role of a first responder in a multiple-casualty incident.

12. Describe the purpose of the National Incident Management System.

13. Describe the steps in the START triage system.

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Skill Objectives

1. Perform simple procedures for gaining access to a wrecked vehicle.

2. Triage a simulated multiple-casualty incident using the START triage system.

EMS Operations

• Be prepared to respond with the proper equipment. • Know simple extrication procedures and the basics of air

medical response. • Understand the purpose of the incident management

system and NIMS. • Understand basic triage and the START system.

Preparing for a Call

• Be prepared to respond promptly.• Use the most direct route.• Have the proper equipment to perform your job.

– Equipment must be stocked and maintained on a regular basis.

First Responder Life Support Kit

• Patient examination equipment• Personal safety equipment• Resuscitation equipment• Bandaging and dressing equipment• Patient immobilization equipment• Extrication equipment• Miscellaneous equipment

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First Responder Life Support Kit

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Five Phases of Response

• Dispatch• Response to scene• Arrival at scene• Transferring patient care to other EMS

personnel• Postrun activities

Dispatch

• Dispatch facility – The center that citizens call to request emergency

medical care• Most centers are part of a 9-1-1 system that dispatches

for fire, police, and EMS.

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Dispatch

• Information from dispatch should include:– Nature of the call– Name and location of patient– Number of patients– Any special problems– Call-back number from the caller

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Response to the Scene

• Get there quickly and safely.• Follow safety procedures

– Use seatbelts. – Proper use of vehicle warning devices– Drive so you are not involved in an accident.

Arrival at the Scene

• Place your vehicle in a safe location. • Use your vehicle warning lights. • Consider scene safety. • Determine if additional help is needed. • Follow the patient assessment sequence.

Transferring Patient Care

• Transfer care to more highly trained personnel.• Give brief report. • Offer assistance.

Postrun Activities

• Complete necessary paperwork. • Clean equipment. • Replace supplies. • Notify dispatch when you are ready for another call.

Helicopter Operations

• Helicopters are used to reach patients in inaccessible areas.

• Obtain a copy of the ground operations procedure.

• Schedule an orientationsession.

Helicopter Safety Guidelines

• Main rotor may be just 4 feet from the ground. • Tail rotor may be invisible. • Rotors can generate a “wash” equivalent to winds

of 60–80 mph.

Setting Up Landing Zones

• Landing zone should be flat and free of debris. • Check carefully for nearby wires.• Zone should be at least 100 feet x 100 feet.

Loading Patients into Helicopters

• Secure all loose clothing, sheets, and instruments. • Use eye protection. • Approach from the front. • Follow the helicopter crew’s instructions.

Approaching Helicopters

Extrication

• Simple techniques to access, treat, and extricate patients who are trapped in vehicles

• Primary goals for first responders:– Obtain safe access to patients. – Ensure patient stabilization.

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Extrication

• Know your limitations.• Identify hazards.• Control hazards if trained.• Gain access to patients.• Provide patient care and stabilization.• Move patients only if necessary.

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7 Steps of Extrication

1. Conduct overview of scene.

2. Stabilize scene; control hazards.

3. Gain access to patients.

4. Provide initial emergency care.

5. Help disentangle patients.

6. Help prepare patients for removal.

7. Help remove patients.

Overview of the Scene

• Anticipate and plan for what you might find. • Overview the scene before exiting your vehicle. • Determine

– Extent of incident– Number of patients– If any hazards exist

• Call for assistance.

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Overview of the Scene

As you approach an accident, look over the entire scene.

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Stabilize Scene and Hazards

• Infectious diseases• Traffic hazards• Bystanders • Spilled gasoline

• Automobile batteries• Downed electrical wires• Unstable vehicles • Vehicle fires

Hazards

A single accident scene may contain many hazards.

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Hazards

• Infectious diseases – Follow BSI precautions. – Wear heavy rescue gloves.

• Traffic hazards– Park vehicles so they protect the scene and

warn other motorists.

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Hazards

• Bystanders – Give specific directions about where

they should move to. • Spilled gasoline

– Call fire department. – Consider covering with dirt.

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Hazards

• Automobile batteries – Turn off vehicle’s ignition to reduce possibility

of electrical short circuit. • Downed electrical wires

– Locate wires but avoid contact. – Keep trapped persons inside vehicle and all

bystanders away from scene.

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Hazards

• Unstable vehicles – On their wheels– On their sides or upside-down

• Vehicle fires– Use dry chemical fire extinguisher. – Remove patients as quickly as possible.

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Gain Access to Patients

• Access through doors– Always try doors first!– Start with least

damaged door.

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Gain Access to Patients

• Access through windows– Break side windows rather than windshield.– Wear proper safety equipment.

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Provide Initial Emergency Care

• Conduct a patient assessment.– Monitor ABCs.– Control bleeding. – Treat for shock.– Stabilize cervical spine.

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Provide Initial Emergency Care

• Provide psychological reassurance.• Maintain patient’s body temperature.• Leave the patient in vehicle unless in immediate danger.• Keep patients stabilized and immobilized until properly

packaged and removed.

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Assist With Patient Removal

• Help disentangle patients. • Help prepare patients for removal.

– Access route may not be large enough for extrication. • Help remove patients.

The Golden Hour

• The less time spent on scene with a seriously injured patient, the better.

• Chance for survival increases if rescuers get the patient to a trauma center within 1 hour of injury.

Review of the Extrication Process

• Call for help. • Specify types of vehicles involved. • Identify and contain hazards. • Park your vehicle so headlights and warning

lights can be used to protect scene.

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Review of the Extrication Process

• Clear a working area around the accident.• Remember to try opening the doors first. • Once you gain access, assess and monitor patients. • Keep your cool!

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HazMat Incidents

• Your first priority is to protect yourself.• The most important step is to identify the substance.• Unless you have received training, you should keep

away from the hot zone.• Wait for the help of trained personnel.

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HazMat Incidents

• Patients with HazMat injuries – Very few specific antidotes or treatments– Emergency treatment usually aimed at supportive

care – Constantly evaluate patient’s vital signs.

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Multiple-Casualty Incidents

• Multiple-casualty incidents: Situations with more than one sick or injured individual – Provide the greatest medical benefit for the greatest

number of people. • Triage: Sorting of patients into groups according to their

need for treatment– Should be simple and fast

Visual Survey

• Prepare yourself mentally and force yourself to stay calm.

• Visually assess:– Number of patients – Severity of injuries– How much help is needed

Initial Radio Report

• Location of incident• Type of incident• Hazards• Approximate number of victims • Type of assistance needed• Be as specific as possible.

Sorting Patients

• Do not become involved in treating the first or second patient you see.

• Triage– Get to each patient quickly. – Conduct rapid assessment.

• Do not stop except to correct airway and severe bleeding problems.

START System

• SSimple TTriage AAnd RRapid TTreatment• Based on breathing, circulation, and mental

status (BCM)• Designed to help identify the most seriously

injured patients

Four Colors of Triage

• Priority One (Red tag):Priority One (Red tag): Immediate care/life threatening• Priority Two (Yellow tag):Priority Two (Yellow tag): Urgent care/can delay up

to 1 hour• Priority Three (Green tag):Priority Three (Green tag): Delayed care/can delay up

to 3 hours• Priority Four (Gray/Black tag): Priority Four (Gray/Black tag): Patient is dead/no care

required.

Triage Tags

START Steps

• Step 1: Get up and walk.• Step 2: Begin where you stand.

– Breathing: It all starts here.– Circulation: Is oxygen getting around?– Mental status: Open your eyes.

Working at Mass-Casualty Incidents

• Report to incident commander (IC). • IC will assign you an area. • Effective incident command system (ICS) depends on

integrated, agreed-upon protocols and procedures. – Learn the ICS used in your area.

National IncidentManagement System

• Developed by U.S. Department of Homeland Security• Provides a consistent and unified approach to handling

emergency incidents

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National IncidentManagement System

• Role of first responder falls into Command and Management area.

• Federal government requires many agencies to utilize NIMS. – You may be required to be trained.

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