1. #1
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    Default Rural High Angle- EMS question

    Hello all,

    Every year my department runs anywhere from 1-3 high angle rescues in a state park known for its 50-80 feet deep gorges. We are constantly evaluating our equipment and tactics to continually streamline our operations. My question today is what EMS supplies do other departments take on a high angle rescue (both to the top and down the hole) that's inaccessible for an ambulance? The area where the majority of the rescues occur is approx. 1/4-1/2 mile off of the paved road and only accessible by 4x4's. Currently we send the stokes down with full c-spine immob. equipment as well as a basic bag equipped to control any bleeding as well as take V/S. Just looking for any tips, advice, or ideas on what others do.

    Thanks,
    Kevin

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    Good approach and topic. A rope rescue is normally a medical call with a vertical problem, and needs to be approached as such. Far to often in training you see a class or team "simulate" assessment and interventions. On the other hand, a team that splints arms, controls bleeding, takes a full set of vitals and such is usually better at knowing what to take.

    Having the gear in a bag that works for hiking into the rough is a plus. There are EMS backpacks that work well. Ours even has an O2 cylinder that can attach to a stokes basket rail.

    A big wheel for the stokes is another simple device that makes all this easier.

    Our med bag carries all our basic meds (oral glucose, epi, nitro tabs, baby aspirin, albuterol) in a small hard case. C-collar, cardboard head blocks save room compaired to the traditional foam ones, cravats, 4x4 gauze and roller gauze, saline water, splinting boards, non-rebreathers and nebulizers. Full set of oral nasal airways. B/p cuff, stethoscope, pulse ox, glucometer, pen lights, thermometer and a automatic wrist B/p cuff that is put on after a manual B/p is established to monitor patient. Duct tape. An emergency blanket and a tarp.

    Packaging the patient; a Stokes/Ferno is handy, but a SKED w/ OSS works well also. Sure you are familiar with packaging, but other techniques are available.

    Using a webbing loop with a trucker's hitch to pull traction on a femur once the patient is packaged in the Stokes works spectacularly. You don't have a traction splint hanging over the edge of a Stokes and you can put the patient still packaged in the Stokes onto the ambulance stretcher for transport. EMS does not have to take the person out of the Stokes and re-establish traction (ouch).

    In cool or inclimate weather we also teach a lot on taco'ing the patient in a blanket and tarp to keep the patient warm and dry.

    Any other thoughts?
    ~Drew
    Firefighter/EMT/Technical Rescue
    USAR TF Rescue Specialist

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    I haven't done a class in high angle rescue in a couple of years and we don't have much to worry about it around my fire district so we only train on this every once in awhile. Keep it simple is my approach. Stuff gets heavy when being carried. One thing that always scares me as an ALS provider is seeing IV bags on patients when they are being rescued. I know they are important and a lot of times hard to get in those conditions but just seeing the IV line dangling and just waiting to get caught in something frightens me to no end.

    These are calls that need to be critiqued when they are done. It's important to know what worked best and what made it worse. Including how equipment and techniques preformed is a key to this. I know these events take several hours to sometimes days and everyone just wants to go home afterwards but it's important to have a debriefing as soon as possible while it's still fresh on everyone's mind.
    NREMT-P\ Reserve Volunteer Firefighter\Reserve Police Officer
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    Experts built the Titanic, amateurs built the Ark.

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    Quote Originally Posted by FiremanLyman View Post
    Good approach and topic. A rope rescue is normally a medical call with a vertical problem, and needs to be approached as such. Far to often in training you see a class or team "simulate" assessment and interventions. On the other hand, a team that splints arms, controls bleeding, takes a full set of vitals and such is usually better at knowing what to take.

    Having the gear in a bag that works for hiking into the rough is a plus. There are EMS backpacks that work well. Ours even has an O2 cylinder that can attach to a stokes basket rail.

    A big wheel for the stokes is another simple device that makes all this easier.

    Our med bag carries all our basic meds (oral glucose, epi, nitro tabs, baby aspirin, albuterol) in a small hard case. C-collar, cardboard head blocks save room compaired to the traditional foam ones, cravats, 4x4 gauze and roller gauze, saline water, splinting boards, non-rebreathers and nebulizers. Full set of oral nasal airways. B/p cuff, stethoscope, pulse ox, glucometer, pen lights, thermometer and a automatic wrist B/p cuff that is put on after a manual B/p is established to monitor patient. Duct tape. An emergency blanket and a tarp.

    Packaging the patient; a Stokes/Ferno is handy, but a SKED w/ OSS works well also. Sure you are familiar with packaging, but other techniques are available.

    Using a webbing loop with a trucker's hitch to pull traction on a femur once the patient is packaged in the Stokes works spectacularly. You don't have a traction splint hanging over the edge of a Stokes and you can put the patient still packaged in the Stokes onto the ambulance stretcher for transport. EMS does not have to take the person out of the Stokes and re-establish traction (ouch).

    In cool or inclimate weather we also teach a lot on taco'ing the patient in a blanket and tarp to keep the patient warm and dry.

    Any other thoughts?
    Great topic....and great response Lyman. Any chance you have a pic of the webbing /truckers hitch application I would love to see it.
    Thanks,
    Mike
    "Training Prepares You...For Moments That Define You

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    Honest-to-God true story... we mutual aided to another department a couple weeks ago with our rope rescue team. Mountain biker in a state forest, riding a path along a 30-foot cliff (not our first rescue of this type at this place), and off he goes. The ambulance had parked about 1/2 mile before the staging area, left all emergency lighting on, yet turned the engine off. One of our members stopped and shut off the lights. We get to staging and pile our rope equipment into the County EMA's Mule and off we go, back about a mile. When we get there, ambulance medics, who had to carry all their equipment, are with the patient. Their first request? "Did you guys bring an O2 unit?". No, they didn't bring theirs, but based on what they were seeing on their 75-pound Lifepack 15 12-lead EKG monitor/defibrillator boat anchor, they must have needed some. Probably NOT what I would have chosen to walk in 1 1/2 miles with.

    You can't get fancy when your patient is way back in the jing-weeds. Control bleeding, manage airway, immobilize. We had a lost dementia patient with severe hypothermia (ultimately passed away before we could get him out) about 300 yards up a very steep snow-covered hill this spring; an EMT free-climbed to the patient with a B/P cuff, steth, an oral airway, and a bag-valve mask.

    As far as IV lines... if a medic starts an IV and actually hangs a bag BEFORE the patient is extricated, and that line gets pulled out, too bad. They can get IV ACCESS and run fluids while you're getting set up, then disconnect the bag. Or at least shut off the bag and coil everything between the patient's legs in the basket where it has minimal chance of getting caught. But independent EMS needs to understand that this isn't a clean, sterile environment; we may have to be a little rough getting the patient out.

    The worse a patient is, the less you need ALS. 'Back to basics' should be the standard of care on critical patients that we don't have good access to.

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    Quote Originally Posted by ProgressiveRescue View Post
    Great topic....and great response Lyman. Any chance you have a pic of the webbing /truckers hitch application I would love to see it.
    Thanks,
    Mike
    I'll work on it.
    ~Drew
    Firefighter/EMT/Technical Rescue
    USAR TF Rescue Specialist

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    BTW, our walking in the woods EMS backpack is the Stat Pack G1; http://www.statpacks.com/products.php?grid=0&id=113

    Loaded with all I listed it weights in around 45 pounds. It wears comfortably, I've worn it on a 2 mile run with no problem.
    ~Drew
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    Lyman's run down of gear and approach is very similar to what my mountain SAR team does.

    Almost 100% of our rescue calls involve some element of foot (or helo) only based access. Routine pproaches are typically 1/2 mile to over 4 miles and may involve elevation gains of over 3,000 feet and/or travel in technical terrain. Rescue calls run right around 2/week.

    Each rescue vehicle carries a master medical pack that is used to carry all the primary medical gear + a jumbo D 02 cylinder (aluminum or carbon fiber). The Conterra pack is pricey but is large and carries very well even on extended operations. With our typical approach, comfort is a key factor as well as having sufficient space for a rescuer to store "personal" gear (harness, headlamp, extra clothes, etc.) in the medical pack since they will not be carrying their regular rescue pack.

    We also have a # of smaller fanny pack sized medical kits that are easily attached to rescuer's packs. Additional O2 is available in the trucks and may be easily carried in a rescuer's pack (in a case similar to this).

    Rapidly access to the subject is key to stabilize the situation as much as possible. Adding

    Our reality is that incidents where extensive ALS interventions are needed and directly impact outcome are fairly rare. Time to get on scene can easily approach an hour and a ground based evac typically take much longer. If someone is very seriously injured their chances of survival are not great.

    When working with other responding agencies and transporting medical gear packaged for carrying by hand (i.e., from the rig to a house), we often place their gear into a stokes attached to a litter wheel since carrying gear by hand over long distances is not practical. This is particularly important when a rescuer needs to be free to use their hands when traversing difficult terrain.

    The look on a new (and it is always the newbie) medic's face is usually priceless when they find out it is a 2.5 mile approach to the victim when they've got the LifePak to carry...

    Good discussion!

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    [QUOTE=MtnRsq;1279897]Our reality is that incidents where extensive ALS interventions are needed and directly impact outcome are fairly rare. Time to get on scene can easily approach an hour and a ground based evac typically take much longer. If someone is very seriously injured their chances of survival are not great. QUOTE]

    Exactly! Back to basics. ABC, stop bleeding, immobilize. That Lifepak will tell you what type of cardiac problems the patient is having... now what to do about it? Medics get all antsy when all their IV sites get used up when tree branches keep pulling out their lines. So let's get the patient on some O2 and expedite extraction.

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    Quote Originally Posted by ProgressiveRescue View Post
    Great topic....and great response Lyman. Any chance you have a pic of the webbing /truckers hitch application I would love to see it.
    Thanks,
    Mike
    A little sloppy, we just got done with the yard.

    Put the patient in a harness to lock his position.


    Make a loop with webbing.


    Drop a bite into the loop so it makes a hitch on the loop.


    Loop goes around the ankle, the bite goes around the bottom of the foot. Tighten the loop to capture the ankle.


    Pull the webbing down through the bottom of the basket, take proximal webbing end and wrap a far point on the basket to give distance for trucker's hitch.


    Continued...
    Last edited by FiremanLyman; 07-01-2011 at 02:41 PM.
    ~Drew
    Firefighter/EMT/Technical Rescue
    USAR TF Rescue Specialist

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    ...

    Use trucker's hitch to pull traction.


    Tie off trucker's hitch, check for PMS (which is done better without a shoe, but you get the idea).


    Write me if you need further.

    Link to the set on flicker http://www.flickr.com/photos/6466052...7626967143285/
    Last edited by FiremanLyman; 07-01-2011 at 02:44 PM.
    ~Drew
    Firefighter/EMT/Technical Rescue
    USAR TF Rescue Specialist

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    Quote Originally Posted by FiremanLyman View Post
    <snip>...Far to often in training you see a class or team "simulate" assessment and interventions. On the other hand, a team that splints arms, controls bleeding, takes a full set of vitals and such is usually better at knowing what to take....<snip>
    This is a key point and reinforces the comment from xchief23.

    It is very important to include a realistic assessment and treatment aspect to any training. Incorporating this into the training will quickly give you a feel for what you can and should attempt in a high angle environment. Doing much beyond the basics (and even that can be very hard) is probably a waste of time. Stabilize and extract - KISS.

    If appropriate you can increase the level of intervention once the subject is in a more stable position.

    I really like the webbing traction splint. Something to try out in a bit more depth....

    Have a safe 4th of July weekend. With temps in our area targeted for the high 90s to 100 we are taking bets on how many calls we'll get to our local cliff-dive-into-the-pool spot. At least it is only 1.5 miles from the road! Only about 20 min. access time...

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