Thomas W.P. Slatin

In my dream I was driving a car that I borrowed from a family friend.  I was leaving the garbage dump in Harpersfield, New York, when I hit a patch of ice and loose gravel.  I was traveling at about 15 miles per hour attempted to stop at a stop sign.  A car pulled ahead in front of me, cutting me off.  The car spun out of control and tipped over onto the left side. I was trapped in the car until the fire department arrived and helped me out.

I refused medical treatment and the fire department paramedics gave me a very difficult time and they tried to force me into the ambulance. I resisted verbally and then physically. One of the paramedics stood in front of me with an IV needle.

Then the alarm sounded and I woke.

Posted under Everything Else

I had a dream where I fixed up my parents 2-car garage and it became a popular hang-out for me and my friends. It quickly became the talk of the neighborhood and soon, lots of people were coming over to hang-out there.  I made lots of friends until it was discovered that there was asbestos insulation in the ceiling.

In the dream, I decide to remove the asbestos insulation myself and in doing so, contaminate the entire 2-car garage with dust. People were afraid of the white dust and stopped coming over.  I lapsed into a feeling of helplessness and failure, as the friends I had stopped coming over since the hang-out was out of commission.

Posted under Everything Else

I had a dream that I was in the World Trade Center before it was demolished on September 11, 2001.  I remember walking into the front lobby doors and heading for an elevator.  The elevator had a red floor, possibly carpet, and bronze colored walls. It must have been back in the 1960’s because the elevator operator had a uniform that resembled a hotel bellhop. It was complete with the short rounded hat with the tassel.

Once the elevator reached the top floor, I proceeded to the next elevator in hopes of reaching the observation deck of the World Trade Center.  Unfortunately, I was awoken by the fire siren across the street.

Posted under Everything Else

Crime Scene Response For EMS Providers
Given By: Investigator / Paramedic Emanuel Shylman, Guilderland, NY Police Department

Good communication between the Police Department, Fire Department, and EMS services are crucial to the success of public safety as a whole.

Evidence is any object that has value in solving a crime.  Types of evidence include physical, forensic, latent, microscopic, etc. Preservation of evidence, no matter how small, is crucial to the police investigation.

Examples of crime scenes that EMS responders deal with include unattended deaths, motor vehicle accidents (MVA), drug overdose calls, potential injuries at nursing homes, and potential unexplained child injuries.

EMS responders in New York are mandated child abuse reporters.

Is this a crime scene?

• When in doubt, request police response.
• Consider type of call and history of the address.
• If the injury inconsistent with mechanism or history?
  • The injury does not match the story.
• Apprehension by 3rd party to allow access.
  • A 3rd party denies access to the patient and/or they state that everything is okay.
• Was there a delayed call for help?
• Unusual odors? Conifers of alcohol?
  • EMT’s are not mandated to report drug or alcohol use.  It is ultimately your decision to report your observations to the police.
• Weapons? Ask if there are guns in the house.

Types of Evidence at EMS Scenes

• Your Written Notes
  • PCR is confidential; on-scene non-PCR notes are not.
• Polaroid Photos
• Blood & Body Fluids
  • Some EMS agencies draw bloods for drug and alcohol screening.
• Foot & Hand Prints
  • If you see these, stay away from them! They are very important to scene investigation!
• Debris Fields
  • These show the exact point of impact of vehicles and their direction before and after impact.
• Computer
• Garbage Pails
  • People put all kinds of strange things in the garbage.
  • Once things are thrown in the trash and deposited on the sidewalk, they are no longer property of the individual.
• Tire Tracks
• Points of Impact
• Clothing
  • If possible, cut around gunshot holes, knife holes, etc.
  • If possible, cut only up the seams of clothing.
• Medications
  • Prescription
  • Non-Prescription
• Weapons
  • Leave weapons in place.
  • Report any weapons you find to the police.
• Urine / Feces in Toilet
  • Home invasions typically involve nervous intruders.  Therefore, they will sometimes use the bathroom and not flush afterwards.
• Telephone
  • *58 Will Trace The Last Call

Potential Evidence

If you see something you think might be important or useful, notify a police officer immediately.  These include cellular telephones, old lottery tickets, or almost any item found around the victim.

Legal Obligations

Your safety and then the patients safety comes first!

Do not knowingly destroy evidence. Until the police arrive, you are in charge of the scene. Your authority is derived from Article 35 of the Penal Law to protect a 3rd party (The Patient).  Don’t put yourself at risk.  You still have a duty to retreat. If you have the opportunity to get away, you are obligated to do so; in your own home, you are not obligated to retreat.

Moral Obligations

You have to decide your level of involvement.  Issues of family and personal history will effect your judgement.

Involvement can be accomplished on many levels, such as:

• You as the complainant.
• You as a witness for the victim or accused.
• You as an anonymous source.
  • Telephone
  • Tele-Cop
  • Internet
  • Etc.

DON’T RISK YOUR SAFETY!

Natural or Murder?

Let the police decide the circumstances behind the death.  Once you determine that resuscitative efforts will be ceased, withdraw from the scene. Be sure to leave everything as you found it, and do not remove any medical waste from the scene, except for sharps.

Traffic Accidents

• Crimes?
  • DWI
  • Fleeing Fugitive
  • AUO
• Evidence?
  • Odors
  • Cans and Bottles
  • Debris Fields
  • Who really drove?
    • Seatbelt Injuries
    • Spidered Windshield

The Crime Scene

• The EMS providers safety is first!
• Call the Police.
• Do nothing that puts you in danger.
• Treat the injured.
• Remove the injured from the scene if possible.
  • Move patient and ambulance to a different location.
• Remove non-essential personal, including family members.
• Keep a log of who is there.
  • Name(s)
  • Department(s)
  • Time In
  • Time Out
• Setup a wide perimeter.
  • The Fire Department and  EMS can close a street until the Police Department arrives.
• Do NOT remove items unless they are necessary to treat the injured.
• A pistol or knife can be secured by placing a bucket over it.  If you need to move anything, mark where it was with tape.
• Don’t clean up the scene.
  • Collect your needles and sharps only!
• Don’t use the telephone.
• Don’t use the toilet.
• Document who goes in and out of the house, then turn this log over to the police.
• If there is obvious death (i.e. gunshot to the head), secure the scene and then remove yourself and your equipment from the scene.
• A crime scene is NOT the responsibility of EMS.
• A balance between treatment and scene preservation can be achieved with good communication.

Are You a Witness?

• Did you witness an event?
• Situations where this might occur…
  • On the highway.
  • Domestic violence.
  • Anywhere.

Court

• You received a subpoena, now what?
  • Who sent the subpoena?
    • Meeting with the district attorney
    • Only the PCR is the patient’s record, your notes fall under, “discovery”.
    • You may be called to give a deposition (more common in civil cases).
    • The DA will call you in a witness in criminal cases.
    • A private attorney will “depose” you for civil action.
    • This can occur months or even years after the event.

Grand Jury

• In felony level criminal cases there may be a grand jury.
• This proceeding is a tool of the District Attorney.
• If you are called to testify before the grand jury, you receive automatic immunity.

Notes you took may look foreign to you by the time the case reaches the court.

Why do we do this job?

• We are here to help people.
• When you provide EMS at a crime scene:
  • Take factual notes.
  • Cooperate and communicate with the law enforcement personal.
  • Aid the injured.
  • Do no harm.
• Establish a good working relationship with the police.

Posted under Everything Else

The Role of the Paramedic in Rescue
Roles and Responsibilities for Rescue, and Fire Rehabilitation

• Scene Control
  • Defined and Described

Rescue efforts must be flexable. There is no cookie-cutter approach.  Likewise, you must always have a back-up plan. Redundancy is the key.

Most MVA’s are organized chaos.

• Qualities
  • Master
    • Experience (NOT Based on Years of Experience)
    • Ability to Multi-Task
  • Apprentice
    • Drive To Learn
    • One Task At A Time

Power is the ability to get people to do the things that you want.

• Power Trips and Ego Bangers
• Types of Power
  • Expert
    • Paramedics who are in school are at this level.
  • Informational
    • They have the knowledge that others may not.
      • Mechanism of injury.
      • Predictable injury pattern.
  • Legitimate
    • One gets Legitimate Power by practicing Informational Power
  • Sanctioned
    • Person with a Title such as Crew Chief, Lieutennant, Etc.

Just because somebody has been given a rank or a title does not automatically mean that they are competent.

• The X Theory / Y Theory
  • The X Theory
    • “The man at the top is in charge.  No matter how crazy the order we are given from the man at the top is, we will follow it.”
  • The Y Theory
    • “Real change and real leadership has to come from the bottom, not from the top.  My job is to help you along.”
• “The whole world is a stage and we are but actors upon it.” - William Shakespeare

Deming (…)

Some of the poersonal qualities of a good leader is remaining calm under fire, good decision making, knowledgeable, and tactful.

• Attention
• Tact and Diplomacy
  • “Praise in public, criticise in private.”
  • Do your bullshit at the station, not in the public eye.
  • Professionalism on the job is manditory!
• Reliability
  • 99% of the job is just showing up.
• Compassion
• Reputation
  • There is no question about one’s patient care. It is deeper than a personal front.

Principles of Vehicle Extrication
Trauma Junkies Anonymous 12 Step Program

• Preparation
• Response
• Arrival
• Hazard Control
• Access
  • “Try before you pry.”
• Assessment & Care
• Disentanglement
• Packaging / Removal
• Immobilization
• Transfer / Transport
• Termination

Rescue comes in two types; high priority and low priority.

Rescue Company Organization

• Incident Command
• Fire Command
• EMS Command
• Unified Command

Scene Assessment Management

• Outer Circle Team
  • Staging area for Fire & EMS.
  • Rescue Equipment & EMS Equipment.
  • Full turnout gear is a good idea, though not manditory.
• Inner Circle Team
  • Full turnout gear required!  No exceptions!
• Sectorize!

Vehicle Design

• Forces for Change
  • Protection
    • Active
    • Passive

Posted under Everything Else

Search & Rescue Management
A Prelude To Rescue Day

LAST

• Locate Patient
• Access Patient
• Stabilize The Patient
• Transport The Patient

SAR

• Search
• And
• Rescue

Components of SAR:

• Preplanning
  • Who needs to go?
  • Gear needed?
    • Establish cache(s) of equipment in strategic locations.
    • Medical Bags / Backpacks
    • Radio(s) / Communication Devices
    • GPS
    • Personal Survival Kits (24 Hours or Better)
    • All equipment must be prepackaged in gear bags or vehicles.
  • Procedures
  • Resources
  • Etc.
• Notification
• Initial Reports
  • Sources
    • Public Safety Officers
    • Emergency Locator Transmitters From Downed Aircraft
    • Citizens
• LKP - “Last Known Point”
• Strategy
  • Form a plan to find patient(s) within a set area or area(s).
• Operations
• Suspension
  • Once patient is located, search is suspended.
  • After a given amount of time, search may also be suspended.
  • Documentation!
• Critique
  • Discuss what happened, what went well, what needs improvement, etc.

Note:
In 80% of situations, local public safety teams will locate patients before professional rescue teams arrive on scene.

Incident Command System

• Advantages
  • Common terminology
  • Modular
    • Designed to accommodate between 20 to 250 rescue people.
    • Span of Control
      • One person can effectively control a large number of people.
  • Command
    • EMS, Fire, Police, or Incident Command
    • Public Information Officer
    • Safety Officer
    • Logistics
      • Long-term Operation
  • Declare a state of emergency?
    • Call in additional resources?

Resource Management

A strike team is a group of people each with the same objective. A task force is a group of strike teams.

Search Tactics and Theory

A search is an emergency.  Time is the key regardless of what type of incident you are faced with.  The more time, the poorer the outcome of the incident and any patient(s) involved.

In a search and rescue, one does not search for the victim.  Instead, one searches for clues that lead them to the victims.

Containment of the scene is twofold. First, one must establish containment by surrounding the area and keeping unnecessary people from entering the contained area for any reason.  The key is to confine and contain the area.

There are two natural barriers to an area. There are either natural barriers, such as fast-moving streams, cliffs, or dense foliage, or man-made barriers such as roads, and pathways.

The command post should be setup behind the perimeter. This is where the press and the news media will show up. They too must be kept out of the perimeter.

Search Tactics

• Passive
• Fact-finding
• Confinement
• Attraction
• Hasty Search
  • Areas where a lost person is most likely to go.
    • Openings & Clearings
    • Roads / Trails
    • High Points
    • Water Sources
    • Caves
    • Buildings / Cabins / Campsites
    • Culverts
    • This is NOT a woodland search.
• Type 1

Note:
Line searches highly contaminate the area and will often make dog teams ineffective.

Bastard Search

Searches are usually done following school bus accidents.  In this case, every single kid must be accounted for.  If a kid is missing, they must be found.

Most of the time, parents will get word of the accident and arrive at the scene. Look for missing kids in locations where the parents might have taken them or where the kid may have wandered to.

Any homes inside the perimeter must be investigated. Send the police to these locations to search the premises.

Active Search

An Open Grid (Type 2) search involves two rescuers that are purposely sent out on compass lines. They are sent out following the natural contours of the land.

A Closed Grid (Type 3) search is usually reserved for searching for bodies.  This is only done during daylight hours and no obstacle gets in your way. Every rescuer goes in a straight line.

General Guidelines

Stay alert, and do not chatter about anything. In the woods, sounds travel quite a distance and talking may confuse other rescuers.

Try calling out the name of the person you are looking for.  Stop every 10 yards, call out the name, and listen for 30 seconds before moving on. This gives time for the patient to hear their name and reply.

Look side to side as well as forward, and if working at night, keep your light out of the eyes of others.

If you come across hikers or other people in the woods, ask them if they have seen any clues, people, etc. Interview anybody you come across in detail.

If you come across family members or friends of the patient, the best solution is to give them something to do that will involve them in the team.  Having a friend or family member will assist you greatly in finding your patient.

If you find something, consider it evidence and a clue.  Record and report the evidence, and protect and preserve the evidence.  Everything you find should be considered both a clue and evidence. All of the things found will be sorted through later on and it will be decided at that point whether or not it is actually part of the search.

To protect the clue or evidence, place flagging tape around it and make a note of it’s location.  Photograph the evidence if you are able to.  Do not touch it, pick it up, or move it in any way for any reason.

If during your search you discover a dead body, report it to your command. If you have 3 person teams, send 2 back and leave 1 person at the scene.

Lost Person Behavior LPB

• Fear
  • Fear of the dark.
  • Fear of weather conditions.
  • “Woods” Shock
    • State of Panic
    • State of Chloristophoba
• General Behavior
  •  
    • Following Water
    • Disrobe
    • Leave Necessary Equipment Behind
    • Fail to Make Shelter
    • Fail to Make Fire
• General Characteristics
  • Usually between the age of 8 and 60.
  • 50% of people will follow a trail or drainage.
  • 1/3 are within 1/2 mile of the Place Last Seen.
  • 40% of people are still on the move at night.
  • PLS (Place Last Seen)

Note:
Being lost in the woods can be a very traumatic event for people.

• LPB of Young Children
  • Many children do not know to answer to whistles or people calling their name.
  • They will usually find shelter.
• LPB of School-Age Person
  • Typically get lost while traveling a short-cut.
  • Follow trails and look for clues.  Sometimes these people will leave behind signs intentionally.
  • 50% will be found within 1.3 miles.
  • They will respond to voice and whistle.
  • They travel quickly.
• LPB of Elderly
  • They typically wander aimlessly.
  • They are typically dressed inappropriately.
  • They are unpredictable.
  • Long term memory is a key.
    • Search places that they may be familiar with.
  • Often they will walk in a straight line.
  • Most of them will be found within 2/3 of a mile.
  • They will find shelter in cars, buildings, etc.
• LPB of Hikers
  • Trail oriented.
  • Usually they have a compass or GPS.
  • Check trails as they will usually hike back to the nearest trail.
  • 50% are found within 1.5 miles of the trail.
  • These people will follow trails, streams, etc.
  • These people will seek out shelter, especially man-made shelter.
• LPB of Hunters
  • Focused on tracking game.
  • Usually wear either bright clothing or cammo.
  • Usually they will carry survival kits such as matches, food, etc.
  • 50% are found within 1.5 miles of where they were last seen.
  • They will follow tree lines, and they will look for roads.
  • 39% of hunters will follow streams.
  • There is usually an issue with daylight savings time.
• LPB of Fishermen
  • Usually they get lost along a stream or injured.

•  
  • More Information on LPB (…)
    Search and Rescue Society of British Columbia

Note:
Dependent people typically do not travel very far. Usually they will wander a short distance and sit down.  They will likely have drugs or alcohol with them.  They may also leave behind a lot of clues, especially if they want help and want to be discovered.

Tracking and Clues

Clues are from the person, such as clothing, equipment, etc. Signs are the impact on the environment such as footprints, broken sticks, etc.

A good tracker can often see the sign after locating a clue.

Footprints, Clues, and Signs

Sign can be broken sticks, bent grass, footprints, compressed foliage, etc.

Bracketing is done by lining up clues in conjunction with a logical path of travel.

Note:
If you photograph evidence, tracks, or signs, use Black & White film of 100 speed.

Rescue: Is it our mission?

EMS is based on rescue.  Rescue is an integral part of EMS.  Rescue is where the EMS and the Fire Service cross. It requires cooperation on both the Fire Service and EMS.

One of the most dangerous rescues are high-angle rescues.  They are done mainly when time is an issue. When time is not an issue, the best thing may be to walk the victims out instead of hauling them vertically.

Slope Analysis

• Grade 1
  0 to 15 Degrees
• Grade 2
  15 to 40 Degrees
• Grade 3
  40 to 60 Degrees
• Grade 4
  60 Degrees or Greater

Equipment

Helmets are a must!  Fire helmets work great.  Also, lather gloves are necessary to protect hands from the elements and from rope burn.

Ropes can be natural or synthetic. They come in two types of construction; twisted or braided.  Most services use kermantle rope.

Kermantle rope is made up of inner filaments that is covered by a protective sheath. These ropes are rated according to a “fall factor” as one cannot see the damage to the inside kermantle.  These ropes will require a log of the rope and they can be quite expensive.  They must be destroyed and discarded after the set number of falls have been reached or if there is any question as to the quality of the rope.

Dynamic ropes are used by rock climbers and can stretch a little bit to absorb shock.

Static ropes are used for rescue and utility and do not stretch.

There is a 10 to 1 ratio for safety. Therefore, any safe working load is only 1/10 of the actual breaking strength.

After a rope is removed from service, they can be used for utility lines, knot practice, or for any application that does not involve personal safety.

5/8″ is the standard for fire service ropes.

Webbing is simply flat webbing.  Tubular webbing is stronger than flat webbing.  Although there is a color system, it is rarely followed.

NEVER STEP ON A ROPE!  THIS WILL GRIND DIRT INTO THE INSIDE OF THE ROPE AND WILL WEAR IT OUT FASTER, AND MAY JEOPARDIZE SAFETY.

Ropes should always be stored in rope bags, away from light and moisture.

Fuel and exhaust fumes will destroy rope on contact. Therefore, rope cannot be kept in engine compartments unless it is stored in an airtight container.

Knots will lower the working load of the rope by a certain percentage according to the knots and the number of knots in a length of rope.

Knots cannot pass through devices such as pulleys, brake bars, belay devices, etc.  Therefore, ALWAYS tie a knot at the end of any rope that will be used for belaying or rappelling.

Rope Commands

• Haul
  • 2 Whistle Blows
• Set
• Slack
• Stop
  • 1 Whistle Blow
• Down
  • 3 Whistle Blows

Rescue Medicine

Oxygen must be used sparingly unless you have runners available to provide an oxygen supply or you have stock piles of oxygen bottles available.

When using IV’s, apply a pressure bag to the IV bag and use a 3-way stopcock to aspirate the IV to check to see that it is still patent.

All IV bags, BP cuffs, etc., must be wrapped up inside the patient packaging. Nothing can be exposed or left hanging outside the patient packaging.

Any patient with a real potential of spinal injury should be a consideration for helicopter evacuation. The chance of patient movement is likely over the course of a long carry over various wilderness terrain.

If possible, carry the patient with the head slightly elevated.

Standing wilderness protocols will usually dictate 30 minutes of CPR and if no response, CPR is ceased.

Dislocations are commonly treated by wilderness EMT’s, with the exception of shoulders, knees, and hips. However, if evacuation is necessary using a basket, hip dislocations must be reduced to fit the patient into the basket.

Hypothermia is a concern in wilderness medicine. Use caution with IV’s.  Use caution when moving hypothermic patients.

Back injuries from carrying a patient will result in them being carried out as a patient.  Ask them if they can pass urine, if they have any numbness, tingling, or odd sensation in their lower extremities. If they do not have numbness or tingling, and they can still move their lower extremities, they most likely have had a muscle injury, not a spine injury.

Rules of Carries

Never walk backwards, only walk forward. If an obstacle is encountered, every team member stands in one spot and they pass the basket to other team members.

Shore Based Water Rescue

NOBODY IS ALLOWED NEAR THE WATER WITHOUT WEARING AN APPROVED PFD. FIRE HELMETS AND FIRE BOOTS CAN FILL WITH WATER AND DRAG YOU UNDER WATER.

NOBODY WALKS THE SHORE ALONE, EVERYBODY IS PAIRED UP WITH A PARTNER.

A snag line is never placed at a 90 degree angle.  Instead, it is placed at an angle, so if somebody catches on to it, they will easily move to the shore.

Never tie yourself into throw lines. If you do need to tie it to something, tie it to a stationary object, but never a person.

Report any victim sightings immediately!

Posted under Everything Else

Enviornmental Emergecies
A Primer in Wilderness Medicine

Diabetics, the elderly, asthma patients, and patients with extensive medical histories are more at risk for enviornmental emergencies.

Beta blockers do not slow the heart rate, they prevent the heart from racing.  Therefore, in a cold emergency, tachcardia is a fail-safe.  Therefore, patients taking beta blockers cannot warm themselves per a compensitory mechanism.  This will cause a decrease in the amount of time of exposure it will require to cause a heat or cold emergency.

Burn patients have no sweat glands on severely burned skin and they cannot perspire through the area(s) of skin that have been severely burned.

Stroke patients are pre-disposed to heat and cold emergencies due to the fact that in some extreme cases of stroke, they may be unable to leave the heat or cold. A patient with a history of epillepsy may have similar problems similar to stroke patients.

All in all, any patient who is fatigued will be more succeptable to heat and cold emergencies.

Body Reactions To Cold

The body shunts blood (sympathetic nervous system).  On a cold day, the body can have as little as 30 cc of blood in their skin.  This is why if a patient is found with a wound in the cold, they will bleed more when they are moved to a warm location, such as the bck of an ambulance.

The heart begins to go into tachycardia and thus will circulate blood through the body at a faster rate.

As the heart rate increases, the respritory rate increases and the lungs dilate.  This may cause a cold-induced asthma attack.

Cold diresis occurs due to the fact that the kidneys recieve an increased amount of blood and the kidneys produce more urine.

Increased urine output can lead to dehydration.  The more dehydrated a person is, the less amount of fluid is available to provide warmth or to allow for adequate blood circulation. Hypovolemia may eventually lead to heart failure in extreme cases.

The elderly are prone to heart failure in cold weather.  This is due to a back up of blood into the lungs (pulminary edema).

Water is lost in cold weather due to the fact that moisture in the lungs is lost upon exhallation.  The cold air contains almost no humidity.  This is an example of diffusion.

Cold emergencies may also involve hypoglycemia due to the fact that shivering takes energy in the form of glucose. A patient who has low blood sugar may have an altered mental status. Most hypothermic patients will show hypoglycemia in lab blood tests.

Pulse oxymeters are not reliable due to the fact that there is decreased blood flow to the extremeties. Therefore, every hypothermic patient is automatically administered 100% oxygen.

A hypothermic patient will likely show an Osborne wave on the EKG, and obtaining an EKG on a hypothermic patient may be problematic.

Cold Injuries

Minor Cold Injuries

• Frost Nip
• Chilbain’s (Trenchfoot)
• Frost Bite

Phases

• Pre-Freeze
• Freeze-Thaw
  • With proper warming, there is little or no injury.
  • A water bath of 86-90 degrees F. is acceptable.
  • Skin-To-Skin contact with a warm person is ideal.
  • Do not thaw body parts that will be re-frozen.
  • Do not administer Asprin (ASA).
• Vascular Statis
• Late Ischemic

Note:
Always take a pulse for a full minute on a hypothermic patient.  If the patient has a pulse of 30 or less, carefully transport the patient.

Cold causes muscular constriction. This will sometimes cause signs and symptoms similar to rigor mortis.  This may impair airway measures by preventing the traditional opening of the airway.

The only chance of survival for a deeply hypothermic patient is to be transported to a facility that is capable of performing open-heart surgery.

Alternatively, hypothermic patients can be transported to a facility that is capable of performing dialysis.

At the minimum, any local hospital can likely place tubes into the stomach, bladder, and into the rectum to inject warm water.  There has not been much success with these methods, but there still may be a chance of survival.

Note:
Warming a patient too quickly can cause death by cooling the core more quickly.

Establishment of an IV in the field can be extremely helpful.  As little as 100 cc of fluid can make a huge bit of difference.  However, administer fluid slowly.

Warmed bags of saline works also, but one should shake the warmed bag before administration to ensure that the entire bag is of uniform temperature. This should only be used with awake patients.

Drownings

85% of drownings involve water in the lungs, while 15% of drownings involve lyrangospasm and keep the lungs free from water.

Sea water contains more salt than human blood, and therefore it will drwa water out of the lungs. However, this will typically only draw out about 500 cc of water.

Ventillate and intubate the patient as soon as possible. Consider using a PEEP valve in conjunction with a BVM and ET tube.

Hypothermia and Drowning

Some patients survive due to cold. This is because the cold will sometimes slow down body functioning.  Unfortunately, the majority of hypothermic drowning patients experience hypoxia, which results in brain damage.

Drowning victims are also prone to death by infection. The water that is let in to the lungs is filled with bacteria and it is not unusual for the patient to die a week later from massive infection.

Co-Morbid Factors

• Age
  • Risk-Taking Activities
• Location
• Alcohol
• Boating

Heat Illness

Everybody who is prone to cold emergencies are also prone to heat emergencies.

People who are dehydrated are more prone to heat illness.  In New York State, all nursing homes are required by law to have central air conditioning installed.

The key to cooling is low humidity, wind, and lower air temperature.

Initially, a person will experience heat exhaustion. The signs and symptoms of such include heat syncope, orthostatic hypotension, and nausea and/or vomiting.

In the heat, up to 3,000 cc of blood can go to the skin. This is about 50% of a persons total blood volume.

Treatment of heat illness might include water misting, placing the patient in front of a fan, or administering a small cup of water about every 30 minutes.

Heat Stroke

50% of heat stroke patients still perspire.  Perspiration does not automatically indicate that somebody has or has not experienced heat stroke.

When the temperature gets so high that they lose conciousness, they are likely experiencing heat stroke.

In less than 20 minutes of excessive temperatures, irreversible damage will occur to the brain.  The only chance of survival for these patients rests in the hands of Paramedics.

The key to relieving heat stroke is to finely mist the patient while they are in front of a running fan.  Alternatively, opening all the windows of the ambulance while misting the patient works almost as well as the mist and fan method.

Patients who take psychiatric medicines and some antibiotics will be extremely succeptable to heat stroke.

Posted under Everything Else

MCI Management
Public Safety Incident Management

What is an MCI?

An MCI is a situation in which the number of patients exceeds your ability to treat them per normal daily operation.  It outstrips all local resources, including financial.

In Colonie, New York, any time there are 3 or more patients found on scene, an MCI is declared.

Most MCI incidents involve Fire, EMS, Hospitals, Police, and sometimes Federal Agencies.

Triage is used for MCI incidents; it is used to save the greatest number of patients.

Levels of incidents are depended upon juristiction, weather conditions, time of day, and various other variables.

MCI occurances are not dependant upon cycles of the moon, time of day, weather conditions, season, population, etc.  However, the more transportation goes through your area, the higher the chance of an MCI.

The biggest problems with MCI situations are an overabundance of resources, a lack of an organized command structure, and a lack of adequate communication.

Most MCI plans fail when they are first used.  Therefore, your MCI plan must be flexable and reproducable.  They must also be simple and easy to understand such that anybody can be the incident command of an MCI.

MCI Management (EMS):

• Medical Command
• Triage Officer
• Treatment Officer
• Transportation
• Staging

The person in charge should be the person who has the most training and experience in MCI management.  It is not necessarilly the highest trained EMT.

The key to triage is not to think too much as a Paramedic. Think of the patients as when you were an EMT-Basic.

Sectors of MCI Management:

• Staging
• Supply
• Extrication
• Treatment
• Transportation

Medical Command:

• Scene Size-Up
  • Global Evaluation
  • Hazard Identification & Mitigation
• Request Additional Resources
• Delegate Responsibility
• Develop A Strategy
• Stay away from patient care!

Your safety comes first!

Guide 111 - Universal Unknown Cargo

The location of a paticular building and the building occupancy can sometimes determine the number of patients that may be present.  The certificate of occupancy designates how many people can be present inside the building. Dispatch centers usually have this information on file.

Triage is the sorting of patients by the severity of injury or illness so that resources can be more efficiently utalized to do the most good for the most people.

SEMO - State Emergency Management Office (…)

Triage is a dynamic process…

• Regardless of whether patients are moved from point of injury or illness to another location for treatment, or if they are treated in place.
• Triage is repeated before treatment begins.
• Triage is conducted at least four (4) times.

Methods:

• Implement the trige system and tag patients according to the severity of their injuries or illness.
• Report progress and needs to the EMS Command Officer.
• Treat only immediate threats to life such as blocked airways and severe arterial bleeding, but only if time permits.
• Move patients by priority to treatment sector.

Triage tags are used to document the patient condition and treatment recieved.  Tags come in a variety of different designs.  Different colors are used to represent priority of injury.

Red: Immediate Care Needed

Yellow: Delayed Care

Green: Walking Wounded, Minor Care

Black: Deceased

The best systems typically use surveyer’s tape to tag patients.  The same colors are used as mentioned.

START System:

• Simple
• Triage
• And
• Rapid
• Transport

RPM:

• Respirations?
  • Greater than 30, or less than 8 — Red Tag.
  • No Respirations — Black Tag.
• Perfusion?
  • No radial pulses — Red Tag.
• Mentation?
  • Unconscious, or cannot follow simple instructions — Red Tag.
  • Can follow instructions — Yellow Tag.

Staging is the most common mistake in MCI incidents. The key is not to storm the scene.  Instead, units should respond to an assigned area and await assignment.

155.715 Mhz - New York Statewide Disaster Frequency

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