Special Operations

ChapterChapter

Special Special OperationsOperations

Twenty-EightTwenty-Eight

Components of an incident management system as they apply to EMS Roles of triage, treatment, and transport sector officers How to use triage tags and prioritize patients at an MCI EMS personnel role at a hazmat incident

CORE CONCEPTSCORE CONCEPTS

(Continued)(Continued)

ChapterChapter

Twenty-EightTwenty-Eight

Levels of training specified by OSHA for responders to hazardous materials incidents Substance identification at a hazardous materials incident Differences between the NFPA 704 and DOT U.N. classifications for placarding hazardous materials at fixed locations and in transit

CORE CONCEPTSCORE CONCEPTSChapterChapter

Twenty-EightTwenty-Eight

Provides orderly communicationProvides orderly communicationand decision making.and decision making.

Interaction between agencies isInteraction between agencies iseasier with unified command.easier with unified command.

Incident ManagementIncident ManagementSystemSystem

ExtricationExtrication

TriageTriage

StagingStaging

TreatmentTreatment

TransportationTransportation

SupplySupply

CommandCommand

EMS Sectors inEMS Sectors inIncident CommandIncident Command

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.

PPRECEPTOR RECEPTOR PPEARLEARL

Follow command structure.Follow command structure.

Report to command or Report to command or sector officer.sector officer.

Follow through on assigned task.Follow through on assigned task. Upon completion, report backUpon completion, report back

to officer.to officer.

Role of EMT-B in EMSRole of EMT-B in EMS

Multiple-CasualtyMultiple-Casualty Incident (MCI)Incident (MCI)

An incident that places a great demand on An incident that places a great demand on EMS equipment and personnelEMS equipment and personnel

Sorting multiple casualties into priorities Sorting multiple casualties into priorities (3 levels) for care or transportation(3 levels) for care or transportation

TriageTriage

KKEY TERMSEY TERMS

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.

PPRECEPTOR RECEPTOR PPEARLEARL

Airway and breathing difficultiesAirway and breathing difficulties

Uncontrolled or severe bleedingUncontrolled or severe bleeding

Decreased mental statusDecreased mental status

MCI TriageMCI TriagePriority 1Priority 1

(Continued)(Continued)

Patients with severe medicalPatients with severe medicalproblemsproblems

ShockShock

Severe burnsSevere burns

MCI TriageMCI TriagePriority 1Priority 1

(Continued)(Continued)

Burns without airway problemsBurns without airway problems Major or multiple bone orMajor or multiple bone or

joint injuriesjoint injuries

Back injuriesBack injuries

MCI TriageMCI TriagePriority 2Priority 2

(Continued)(Continued)

Minor injuries to extremitiesMinor injuries to extremities

Minor soft-tissue injuriesMinor soft-tissue injuries

Death Death (Priority 0)(Priority 0)

MCI TriageMCI TriagePriority 3Priority 3

(Continued)(Continued)

MCI Triage TagMCI Triage Tag

Request additional help.Request additional help.

Designate command and Designate command and

triage officers.triage officers.

Perform initial assessment ofPerform initial assessment ofall patients first.all patients first.

(Continued)(Continued)

MCI ProceduresMCI Procedures

Assign available personnel andAssign available personnel andequipment to P-1 patients first.equipment to P-1 patients first.

Base transport decisions on:Base transport decisions on:• PriorityPriority• ResourcesResources• DestinationDestination

MCI ProceduresMCI Procedures

STARTSTARTSSimple imple TTriage riage AAnd nd RRapid apid TTreatmentreatment

30 seconds per patient

Utilizes the parameters of:

•Respiration

•Pulse

•Mental Status

Only 3 treatments during triage:

Open an airway and insert an OPA.

Apply pressure to bleeding.

Elevate an extremity.

STARTSTARTSSimple imple TTriage riage AAnd nd RRapid apid TTreatmentreatment

STARTSTARTBefore beginning assessment:Before beginning assessment:

Ask all patients who can walk (considered priority 3) to move to designated area.

This leaves priority 1, 2, and 4.

If patient is not breathing, and opening airway does not cause patient to start, he is priority 4.

STARTSTARTStep #1: Assess respirations.Step #1: Assess respirations.

STARTStep #1: Assess respirations.

If patient is breathing, and the rate is:

Less than 30 per minute, she is priority 2.

More than 30 per minute, he is priority 1.

If the patient has no pulse, is unresponsive, and is not breathing, he is priority 4.

STARTStep #2: Assess radial pulse.

If the patient has a pulse, and is not breathing, he is priority 1.

If the patient has a pulse, and is breathing, she is priority 2.

STARTStep #2: Assess radial pulse.

If the patient is alert, he is priority 2.

If the patient has an altered mental status, she is priority 1.

STARTStep #3: Assess mental status.

Assess all the patients who walked to the designated area using the same 3 steps.

STARTRe-triage the walking wounded.

Hazardous MaterialsHazardous Materials Found virtually everywhere.Found virtually everywhere. Safety is primary concern:Safety is primary concern:

• EMT-B and crewEMT-B and crew• Patient and bystandersPatient and bystanders

Occupants/driverOccupants/driver

ContainersContainers

Shipping papersShipping papers

SensesSenses

HazmatHazmatIdentificationIdentification

(Continued)(Continued)

Identify substances from a distance.Identify substances from a distance.

Hazmat PlacardHazmat Placard

Vehicle with PlacardsVehicle with Placards

Approach to SceneApproach to Scene

ProceduresProcedures• Park upwind, uphill.Park upwind, uphill.• Keep a safe distance away.Keep a safe distance away.• Keep people away from area.Keep people away from area.• Avoid contact with material.Avoid contact with material.

HazmatHazmatIncidentIncident

(Continued)(Continued)

Approach to SceneApproach to Scene

Procedures• Do not enter hazmat sceneDo not enter hazmat scene unless trained and equipped. unless trained and equipped.

• Remove patients to safe zoneRemove patients to safe zone if they do not pose risk if they do not pose risk to EMT-B. to EMT-B.

HazmatHazmatIncidentIncident

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.

PPRECEPTOR RECEPTOR PPEARLEARL

HazmatHazmatResourcesResources

Local hazmat resourcesLocal hazmat resources

CHEMTREC (800-424-9300)CHEMTREC (800-424-9300) Emergency Response GuidebookEmergency Response Guidebook

(Continued)(Continued)

Emergency Response GuidebookEmergency Response Guidebook

NFPA 472 and 473NFPA 472 and 473 OSHA 1910.120OSHA 1910.120

HazmatHazmatTrainingTraining

First Responder Awareness (4 First Responder Awareness (4 – – 6 hours) 6 hours)

First Responder Operations (8 hours)First Responder Operations (8 hours)

Hazardous Materials Technician (24 hours)Hazardous Materials Technician (24 hours)

Hazardous Materials Specialist (24 hours)Hazardous Materials Specialist (24 hours)

On-Scene Incident CommanderOn-Scene Incident Commander

OSHA 1910.120OSHA 1910.120

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.

PPRECEPTOR RECEPTOR PPEARLEARL

1. What should an EMT-B do when first1. What should an EMT-B do when first

to arrive at a hazmat scene?to arrive at a hazmat scene?

2. What resources are available to 2. What resources are available to

identify hazardous substances?identify hazardous substances?

3. What are the responsibilities of the EMS3. What are the responsibilities of the EMS sector officers at an MCI? sector officers at an MCI?4. What is the difference between the NFPA 4. What is the difference between the NFPA 704 and DOT UN placards systems? 704 and DOT UN placards systems?

RREVIEW QUESTIONSEVIEW QUESTIONS