Hazardous Terrains

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Information about Hazardous Terrains
Education

Published on October 15, 2008

Author: aSGuest1058

Source: authorstream.com

Hazardous Terrain : Hazardous Terrain EMS Skills : EMS Skills Rescue awareness Types of specialized teams Effective coordination with specialists Hazardous terrain litter evacuations Hazardous Terrain Types : Hazardous Terrain Types High angle Low angle Flat terrain with obstructions High Angle : High Angle Surfaces inclined >40o Gorges Cliffs Buildings Very smooth surfaces <40o Require use of hands in climbing Ropes, aerial apparatus required for access, removal Errors can cause life-threatening injury, death Low Angle : Low Angle Surfaces inclined <40o Accessed by walking, scrambling Difficulty can be affected by presence of: Water Ice Boulders Brush, down trees Ropes used to counteract gravity, act as hand lines Errors can result in falls, tumbles Presence of obstructions can result in serious injury Flat Terrain with Obstructions : Flat Terrain with Obstructions Examples: Trails Paths Creek beds Difficulty may be increased by: Downed trees Rocks Slippery leaves Scree (rock debris) Patients can be moved by carrying Least hazardous form of rugged terrain Slips, falls can result in injury Patient Access : Patient Access High Angle : High Angle Access/removal usually carried out by technical teams Additional resources needed to balance technical/medical aspects of rescue High Angle : High Angle Rescuer skills Knot tying Ascending, descending skills Rigging of hauling systems Packaging of patients for evacuation High Angle : High Angle Specialized Terms “Aided”—using means other than hands, feet, body “Anchor”—technique for securing rescuers to vertical face “Belay”—safeguarding climber by use of a rope secured to an anchor “Rappel”—descend by sliding down a fixed double rope Low Angle : Low Angle Access/removal conducted by EMS personnel in many systems Still requires appropriate training/equipment Low Angle : Low Angle Skills Assembly/use of harnesses Setting up hasty rope slides Rappelling, ascending by rope Patient packaging Rigging simple hauling systems Patient Packaging : Patient Packaging Stokes Basket Stretcher : Stokes Basket Stretcher Standard litter for rough terrain evacuations Provides rigid frame for patient protection Easy to carry Stokes Basket Stretcher : Stokes Basket Stretcher Come in plastic and wire/tubular (military) styles Wire/tubular style will NOT accept long spine boards Plastic styles weaker, but provide better shielding to patients All require additional strapping, use of plastic litter shields Stokes Basket Stretcher : Stokes Basket Stretcher Apply harness to patient Apply leg stirrups to patient Secure patient to litter Tie tail of one litter line to harness Use helmet, litter shield Give fluids Allow accessibility for assessment, management Ensure adequate padding Consider heating/cooling system use Provide gravity “tip line” to clear airway if necessary During high/low angle evacuations: Patient Removal : Patient Removal Flat Terrain : Flat Terrain When possible, walk patient out! Carrying over flat ground is strenuous under ideal conditions Flat Terrain : Flat Terrain Two to three teams of 6 litter-bearers All approximately same height “Leapfrog” ahead to save time Webbing straps tied to stretcher frame and pulled across rescuer shoulders to free hand can lessen load Litter wheel may help on flat ground Low/High Angle : Low/High Angle Anchors, personnel safety equipment, patient packaging, and hauling systems must be checked multiple times for safety Hauling systems may require multiple personnel to move weight of patient, basket, and ropes Low/High Angle : Low/High Angle Fire department snorkels can be used for patient evacuation Stokes stretcher must be properly belayed to snorkel basket Aerial apparatus is NEVER used as a crane to move a litter Helicopters : Helicopters Capabilities, policies vary widely Understand policies regarding: Loading and unloading practices Restrictions on carrying non-crew Use of winches for rescues Weight restrictions Restrictions on hovering rescues Use, practice of one-skids and toe-ins Use of short hauls and rappel rescues Extended Care Issues : Extended Care Issues Protocols : Protocols Long-term hydration Dislocation repositioning Wound cleaning/care Impaled object removal Non-pharmacologic pain management Pharmacologic pain management Assessment/care of head/spinal injuries Hypothermia/ hyperthermia management CPR termination Crush/compartment syndrome management Environmental Considerations : Environmental Considerations Weather/Temperature Extremes Risk of hypo/hyperthermia Difficulty in exposing patient for assessment Use of specialized packaging Environmental Considerations : Environmental Considerations Limited Patient Access Inaccessible parts of patient Cramped space Low lighting conditions Environmental Considerations : Environmental Considerations Difficulty Moving Equipment Identify minimum essential equipment Carry in backpack Environmental Considerations : Environmental Considerations Cumbersome PPE Restricted rescuer mobility Temporary removal of PPE to perform procedures Environmental Considerations : Environmental Considerations Patient Exposure Covering for thermal protection Hard protection from sharp objects, debris Environmental Considerations : Environmental Considerations ALS Skills Wires, tubing complicate extrication Limit to absolute necessities Oxygen may have to be given at slower flow rates to prolong cylinder life Environmental Considerations : Environmental Considerations Patient Monitoring Modification of procedures (palpated BP) Modification of equipment (compact pulse oximeters) Non-use of equipment (ECG monitors) Environmental Considerations : Environmental Considerations Improvisation Splinting using patient’s uninjured body parts Light-weight splints Downsized or improvised medical gear

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