1. #1
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    Default Patient care during tech rescue events

    I'm working on developing a training class for our special ops team regarding patient care during these events. We are a regional haz-mat/tech rescue team, so it will address several disciplines- rope/high angle, trench, confined space, structural collapse, etc.

    Does anyone have any resources or anything that takes a look at patient care beyond packaging? Or any thoughts/experiences?

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    Rigging for Rescue (RFR) out of Ouray Co has a good class on patient care.

    Also check with Rick Lipke, at Conterra Equipment, WA state. He's a super knowledgeable resource and has probably been to RFR's class also.

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    Without a medical director, what can you do beyond first aid? With medical direction, EMTB can't do much beyond their scope which is bleeding control and O2 admin etc. In my state EMTB can't even do a BGL. Medics are the only ones that have the scope to really do much.
    Last edited by MichaelXYZ; 08-08-2013 at 07:46 AM.

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    In cased where the victim is trapped and it will be a while we often do routine trauma care, IV, monitor, O2 (be careful if in a CS) immobilization, etc.
    It all depends on the situation and access

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    Quote Originally Posted by MichaelXYZ View Post
    Without a medical director, what can you do beyond first aid? With medical direction, EMTB can't do much beyond their scope which is bleeding control and O2 admin etc. In my state EMTB can't even do a BGL. Medics are the only ones that have the scope to really do much.
    We have medics on our team, so we can go to the ALS level.

    Some of the things I'm looking at is what is appropriate to be looking at as far as treatment in various situations (confined space, trapped by debris, etc.), what kinds of things to be looking for (compression syndrome, complications from long durations in harnesses, etc.), to what degree we take packaging (KED vs LSB vs Sked vs Stokes...), and you could go on and on.

    I know a lot of it's going to be a decision-making process determined by the situation, but there has to be some resources out there that address some of these.

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    In the Agricultural rescue classes that we teach, we put the emphasis on patient care. If you aren't there to make sure that the patient is cared for to the absolute best of your abilities, why are you there? Everything done should be done with patient care in mind. Do you have time to have everything absolutely secured in duplicate so that nothing could possibly happen, or is it a rapid extrication due to deteriorating patient condition?

    There are no hard and fast rules that work in all situations, and that is what we teach. Rescuers need to be constantly monitoring the patient, environment, and everything else to make sure that the approach taken is the best for all involved. We are there for a rescue, not necessarily a recovery (although we teach that a recovery should be handled the exact same way other than to use the absolute safest way possible for the sake of the family and the responders).

    The non-medical people need to train as much on the medical side of things (not necessarily what treatments when, but what the medical people will need) to know what types of clearances, access, and other needs that the medical personnel will need. one of the things we routinely see is struts or cribbing placed where it restricts patient access. Medical personnel need to be the ones relaying this information to those doing the extrication. Nothing should get done without the knowledge and ok of those treating the patient. Otherwise you could see a patient removed from a hazardous situation only to be in worse shape because the proper treatment was not administered before the extrication.

    Conversely, the medical personnel need to know realistic time frames. It is not always possible to rapidly extricate. They need to have an idea of how long they will be in the current situation to know if additional medical assistance (field surgeon, etc.) is warranted.

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    Quote Originally Posted by HuntPA View Post
    In the Agricultural rescue classes that we teach, we put the emphasis on patient care. If you ...
    We're talking about the same concept here. What brought it to light, so to speak, was a trench rescue training where I was in the pit. As a guy that's taught various levels of EMS, fire, and rescue courses I brought up a number of different things during the scenario. Treating for crush syndrome, having the bag and equipment at the top with another medic pushing the buttons/meds, and things like that. The nice thing was I'm a trench tech, so I could also coordinate everything regarding patient removal.

    The idea is to take that ability and refine it, hopefully to a level where any of our special ops team medics can function to a similar degree.

    While we can't teach decision-making, I'm hoping we can find a way to teach the parameters to make those decisions. That's why I'm looking for input.

    I'm glad you brought up the ag rescue stuff (I teach it, as well). Being a city-limits department, we don't mess with that much. However, we are the rescue team for the area and will likely be called. Another facet we'll need to look at in both training and in this EMS concept.

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    Duplicate post.
    Last edited by Catch22; 08-13-2013 at 11:29 PM.

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    A new trend is to use some of the treatment cues from Tactical Emergency Casulty Care. This focuses on controlling massive bleeding, airway, breating, fluids, and hypothermia (in that order). Due to long extraction times, don't be afraid to get carried away with your bleeding interventions (tourniquet, wound packing with pressure dressing, hemmoriage control dressings such as quick clot). A lot of good data is coming out of the military and use of tourniquets. When I became an EMT in 1990 it was a no no. Now we no that you can wear a tourniquet for a few hours and not lose a limb. Our company is a subcontractor with a group who delivers a lot of this training along with advanced wilderness medicine. We deliver a lot of combined rescue and medical conisderations training to the DoD. Go to www.outcomes-basedtraining.com, www.c-tecc.org for more information.

    If traumatic injury is involved hypotermia can become a real issue; plan accordingly.

    My main teaching point is the injury guides our packaging method (as best as possible); this may affect internal lashing methods, and wound/injury access. I prefer a basic stokes, but SKED and MEDSLED VLR are great options. (I prefer the MEDSLED as it is virtually prerigged) Someone with a chest injury may like being in a SKED as it will give some splinting action to the upper torso; an arm or shoulder injury will most likely not tolerate a SKED too well due to the compression.

    KED and LSP are great temporary devices. I wouldn't use it beyond confined space/trench and would will always give my first consideration to a stokes.

    We also like to focus on a PACE methodology. That is have 4 options that you are comfortable with and use those options like a decision tree. Pace stands for - Primary, Auxillary, Contingent, Emergency. My primary may be a stokes; auxillary a MEDSLED; contingent an LSP; and the emergency method may be to use pike poles and tarp.

    I have an old government study on harness compartment syndrome. Hit me with an email address and I'll try to get it to you. I'm out of town next week, but if you get it to me today I'll do my best to get the file to you before I leave. email: info@technicalrc.net

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