Special Operations


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Special Operations

  1. 1. Chapter Special Operations Twenty-Eight
  2. 2. <ul><li>Components of an incident management system as they apply to EMS </li></ul><ul><li>Roles of triage, treatment, and transport sector officers </li></ul><ul><li>How to use triage tags and prioritize patients at an MCI </li></ul><ul><li>EMS personnel role at a hazmat incident </li></ul>CORE CONCEPTS Chapter Twenty-Eight (Continued)
  3. 3. <ul><li>Levels of training specified by OSHA for responders to hazardous materials incidents </li></ul><ul><li>Substance identification at a hazardous materials incident </li></ul><ul><li>Differences between the NFPA 704 and DOT U.N. classifications for placarding hazardous materials at fixed locations and in transit </li></ul>CORE CONCEPTS Chapter Twenty-Eight
  4. 4. <ul><li>Provides orderly communication </li></ul>and decision making. <ul><li>Interaction between agencies is </li></ul>easier with unified command. Incident Management System
  5. 5. <ul><li>Extrication </li></ul><ul><li>Triage </li></ul><ul><li>Staging </li></ul><ul><li>Treatment </li></ul><ul><li>Transportation </li></ul><ul><li>Supply </li></ul><ul><li>Command </li></ul>EMS Sectors in Incident Command
  6. 6. Point out to new EMT-Bs that the EMS commander who doesn’t delegate, but instead attempts to wear all the vests, cannot possibly get the overall picture of the incident, because he or she has taken on too much responsibility. P RECEPTOR P EARL
  7. 7. <ul><li>Follow command structure. </li></ul><ul><li>Report to command or </li></ul>sector officer. <ul><li>Follow through on assigned task. </li></ul><ul><li>Upon completion, report back </li></ul>to officer. Role of EMT-B in EMS
  8. 8. Multiple-Casualty Incident (MCI) An incident that places a great demand on EMS equipment and personnel Sorting multiple casualties into priorities (3 levels) for care or transportation Triage K EY TERMS
  9. 9. Encourage new EMT-Bs to practice declaring EMS Command, establishing a triage sector, donning sector vests, giving an arrival report to dispatch, and applying triage tags at all incidents involving three or more ambulances. In this way, the procedures will be second nature to them at larger incidents. P RECEPTOR P EARL
  10. 10. <ul><li>Airway and breathing difficulties </li></ul><ul><li>Uncontrolled or severe bleeding </li></ul><ul><li>Decreased mental status </li></ul>MCI Triage Priority 1 (Continued)
  11. 11. <ul><li>Patients with severe medical </li></ul>problems <ul><li>Shock </li></ul><ul><li>Severe burns </li></ul>MCI Triage Priority 1 (Continued)
  12. 12. <ul><li>Burns without airway problems </li></ul><ul><li>Major or multiple bone or </li></ul>joint injuries <ul><li>Back injuries </li></ul>MCI Triage Priority 2 (Continued)
  13. 13. <ul><li>Minor injuries to extremities </li></ul><ul><li>Minor soft-tissue injuries </li></ul><ul><li>Death (Priority 0) </li></ul>MCI Triage Priority 3 (Continued)
  14. 14. MCI Triage Tag
  15. 15. <ul><li>Request additional help. </li></ul><ul><li>Designate command and </li></ul>triage officers. <ul><li>Perform initial assessment of </li></ul>all patients first. (Continued) MCI Procedures
  16. 16. <ul><li>Assign available personnel and </li></ul>equipment to P-1 patients first. <ul><li>Base transport decisions on: </li></ul><ul><li>Priority </li></ul><ul><li>Resources </li></ul><ul><li>Destination </li></ul>MCI Procedures
  17. 17. START S imple T riage A nd R apid T reatment <ul><li>30 seconds per patient </li></ul><ul><li>Utilizes the parameters of: </li></ul><ul><ul><li>Respiration </li></ul></ul><ul><ul><li>Pulse </li></ul></ul><ul><ul><li>Mental Status </li></ul></ul>
  18. 18. <ul><li>Only 3 treatments during triage: </li></ul><ul><li>Open an airway and insert an OPA. </li></ul><ul><li>Apply pressure to bleeding. </li></ul><ul><li>Elevate an extremity. </li></ul>START S imple T riage A nd R apid T reatment
  19. 19. START Before beginning assessment: <ul><li>Ask all patients who can walk (considered priority 3) to move to designated area. </li></ul><ul><li>This leaves priority 1, 2, and 4. </li></ul>
  20. 20. If patient is not breathing, and opening airway does not cause patient to start, he is priority 4. START Step #1: Assess respirations.
  21. 21. START Step #1: Assess respirations. <ul><li>If patient is breathing, and the rate is: </li></ul><ul><li>Less than 30 per minute, she is priority 2. </li></ul><ul><li>More than 30 per minute, he is priority 1. </li></ul>
  22. 22. If the patient has no pulse, is unresponsive, and is not breathing, he is priority 4. START Step #2: Assess radial pulse .
  23. 23. <ul><li>If the patient has a pulse, and is not breathing, he is priority 1. </li></ul><ul><li>If the patient has a pulse, and is breathing, she is priority 2. </li></ul>START Step #2: Assess radial pulse.
  24. 24. <ul><li>If the patient is alert, he is priority 2. </li></ul><ul><li>If the patient has an altered mental status, she is priority 1. </li></ul>START Step #3: Assess mental status.
  25. 25. Assess all the patients who walked to the designated area using the same 3 steps. START Re-triage the walking wounded.
  26. 26. Hazardous Materials <ul><li>Found virtually everywhere. </li></ul><ul><li>Safety is primary concern: </li></ul><ul><li>EMT-B and crew </li></ul><ul><li>Patient and bystanders </li></ul>
  27. 27. <ul><li>Occupants/driver </li></ul><ul><li>Containers </li></ul><ul><li>Shipping papers </li></ul><ul><li>Senses </li></ul>Hazmat Identification (Continued)
  28. 28. Identify substances from a distance.
  29. 29. Hazmat Placard
  30. 30. Vehicle with Placards
  31. 31. Approach to Scene <ul><li>Procedures </li></ul><ul><li>Park upwind, uphill. </li></ul><ul><li>Keep a safe distance away. </li></ul><ul><li>Keep people away from area. </li></ul><ul><li>Avoid contact with material. </li></ul>Hazmat Incident (Continued)
  32. 32. Approach to Scene <ul><li>Procedures </li></ul><ul><li>Do not enter hazmat scene unless trained and equipped. </li></ul><ul><li>Remove patients to safe zone if they do not pose risk to EMT-B. </li></ul>Hazmat Incident
  33. 33. Emphasize to new EMT-Bs that they must not rescue people from the hot zone unless they have been trained to the proper level and are dressed with the appropriate protection for the chemical involved. P RECEPTOR P EARL
  34. 34. Hazmat Resources <ul><li>Local hazmat resources </li></ul><ul><li>CHEMTREC (800-424-9300) </li></ul><ul><li>Emergency Response Guidebook </li></ul>(Continued)
  35. 35. Emergency Response Guidebook
  36. 36. <ul><li>NFPA 472 and 473 </li></ul><ul><li>OSHA 1910.120 </li></ul>Hazmat Training
  37. 37. <ul><li>First Responder Awareness (4 – 6 hours) </li></ul><ul><li>First Responder Operations (8 hours) </li></ul><ul><li>Hazardous Materials Technician (24 hours) </li></ul><ul><li>Hazardous Materials Specialist (24 hours) </li></ul><ul><li>On-Scene Incident Commander </li></ul>OSHA 1910.120
  38. 38. Point out to new EMT-Bs that it is important to ask if patients have been properly decontaminated and exactly how this was done before patients are loaded into their ambulance. The last thing anyone wants to do is transport contaminated patients to the hospital. This could lead to a shutdown of the entire ED in order to decontaminate the department’s personnel. P RECEPTOR P EARL
  39. 39. 1. What should an EMT-B do when first to arrive at a hazmat scene? 2. What resources are available to identify hazardous substances? 3. What are the responsibilities of the EMS sector officers at an MCI? 4. What is the difference between the NFPA 704 and DOT UN placards systems? R EVIEW QUESTIONS