Emergency Care Textbook Professional Responders-part-2.pdf

2 Responding to the Call Key Content Preparing for the Emergency. Response.............................. 28 Equipment............................ 28 Plan of Action...................... 28 Communications.................. 29 Training................................. 29 Psychological Preparation... 2...

2 Responding to the Call Key Content Preparing for the Emergency. Response.............................. 28 Equipment............................ 28 Plan of Action...................... 28 Communications.................. 29 Training................................. 29 Psychological Preparation... 29 Managing Hazards at the Emergency Scene................. 29 Personal Safety..................... 30 Safety of Others................... 30 Special Emergency Scenes... 30 Specific Scene Hazards......... 32 Introduction This chapter describes the responsibilities for preparing for an emergency response and for identifying and managing hazards at an emergency scene. RESPONDING TO THE CALL As a professional responder, you have a duty to respond to an emergency when called upon, but you also have a responsibility to prepare yourself and your equipment so that you can deliver prompt, effective care. You must also take all reasonable steps to protect yourself and others from harm once you reach the scene. 27 PREPARING FOR THE EMERGENCY RESPONSE Equipment The emergency response is supported by careful preparation of the vehicle and equipment before an emergency occurs. The three most common types of equipment used by the professional responder are a trauma response kit, an automated external defibrillator (AED), and a portable oxygen unit. A trauma response kit may also be called a trauma kit, jump bag, first aid kit, or responder kit. It should be checked on a regular schedule to ensure that it is properly stocked at all times. You should be familiar with the location of all equipment within the kit. Emergency equipment must always be clean and in good condition. Dressings, bandages, and other supplies kept in kits should be restocked as soon as possible following their use. The quantity of specific items should be determined by individual needs, local protocols, and legislation/regulations. AEDs must be properly maintained as per their manufacturers’ guidelines, and their batteries should always be charged. Oxygen cylinders should be kept full. Plan of Action RESPONDING TO THE CALL Having a plan of action allows you to respond more effectively and facilitates coordination between responders in an emergency. Emergencies generally happen suddenly, so there is often not time to discuss logistics and determine the best plan of action in the moment. Creating a plan lets these decisions take place before the emergency occurs, when there is time to weigh all of the factors involved. 28 Any emergency plan should be established based on the anticipated needs and available resources in a given situation. As a professional responder, you should engage in a preplanning process regarding the real or potential hazards in your area and familiarize yourself with existing emergency response plans. Ensure that you are aware of the resources in your community for Figure 2–1: Posted evacuation routes may be a part of an emergency plan. handling situations that require specially trained personnel and special equipment (e.g., hazardous materials spills). As a responder, you may encounter several different types of plans: Workplace emergency response plans are developed for specific workplaces. They typically identify trained personnel on site, the locations of emergency supplies and equipment, the communication system that is used in emergencies (including how to call for external emergency assistance, such as an ambulance), and the evacuation routes for the building (Figure 2–1). All personnel in a workplace with a response plan must familiarize themselves with it so that they will know what to do in an emergency. Emergency response plans are developed to respond to an emergency in a specific building. They may be created by EMS personnel (often Disaster response plans are developed to respond to specific large-scale emergencies, such as natural disasters, plane crashes, or mass-exposure incidents. These plans often involve multiple agencies and should be practised regularly with all personnel involved. Communications Emergency response depends on a reliable and efficient communication system. Ensure that you are always able to contact any specialized or more advanced personnel that may be required. Communication devices used by professional responders include pagers, computers, two-way radios, mobile phones, satellite phones, and CB radios. You should always have a backup communication system in place. Check communications equipment often to ensure that it is working. Become familiar with your communication networks and develop alternative plans in case regular communications fail. Training As a professional responder, your training is based on scientific evidence and best practices. This means that the guidelines for care will continue to evolve as new research is conducted and new evidence becomes available. It is crucial that you make every effort to remain aware of developments in your field and to keep your training current. In many jurisdictions, legislation and regulations require responders to engage in ongoing education in order to maintain their registration or licences. Practise all of your skills, including the ones you use infrequently. Pursue activities that will help you continue to improve in your professional role, including reading industry articles and publications and participating in workshops, emergency response exercises, and seminars. Professional responders have the opportunity and potential to advance their career qualifications through continuing medical education. Setting goals for career advancement and the acquisition of new skills can help you to practise ongoing professional development. Psychological Preparation Just as it is important to keep equipment ready for emergencies, it is also important to keep yourself prepared psychologically. Even experienced responders can have emotional reactions to disturbing injuries or situations, and it can be difficult to predict what will or will not have an effect. Thinking about your own mental health before you respond can help you prepare for whatever you might encounter. Recognize your own limitations, and make plans to address them so that they don’t become barriers to action in an emergency. You may never get used to some of the things that responders encounter on a regular basis. However, with preparation and experience, you can learn to control your reactions. MANAGING HAZARDS AT THE EMERGENCY SCENE Some emergency scenes are inherently dangerous, while others may become dangerous while you are providing care. Sometimes the dangers may be obvious (e.g., fire, hostile patients or bystanders). Other dangers may be less obvious (e.g., hazardous materials, confined spaces). Table 2–1 lists a number of hazards you may find at an emergency scene. RESPONDING TO THE CALL fire departments) or by private companies that administer the building in question, usually in collaboration with EMS personnel. Emergency response plans are typically created in cases where a building has unique challenges for responders or requires special resources. For example, a hotel may require a key card to access each floor, or a factory may contain large quantities of hazardous materials. Developing the plan involves inspecting the site, noting potential hazards, and identifying the types of equipment and personnel that could be required to respond effectively in that particular environment. Emergency response plans must be practised, evaluated, and updated periodically. 29 TABLE 2–1: POTENTIAL HAZARDS AT AN EMERGENCY SCENE People (aggressive patients, hostile bystanders) Debris Water Animals (domestic or wild) Confined spaces Uneven terrain Weapons Low lighting Hazardous materials Pathogens Unstable/unsafe structures Downed electrical lines Sharp glass or metal Obstructed exits Oxygen-deficiency Loud noise Extreme temperature Traffic Ice Personal Safety Among the seven primary responsibilities of the responder, your personal safety is always your first concern. You cannot overlook the importance of ensuring your own safety. If you are injured, you become a patient yourself. It may only require simple steps to make an emergency scene safe. Approach all emergency scenes cautiously until you can assess the situation. Pay particular attention to the: Environment (e.g., residence, construction site, highway). Extent of the emergency. Potential hazards. Behaviour of the patient(s) and any bystanders. RESPONDING TO THE CALL Dispatch may tell you to stage near the scene in the case of a scene with known or potential hazards (e.g., an assault). Be ready to respond immediately when police or other specialized personnel notify you that the scene is safe. 30 At any time, if the scene appears or becomes unsafe, retreat to a safe distance. Never enter a dangerous scene unless you have the training and equipment to do so safely. Responders have been injured or killed because they forgot to look for scene hazards. If your training has not prepared you for a specific emergency, such as a fire or an incident involving hazardous materials, request appropriately trained personnel. When arriving on an emergency scene, always follow these four guidelines to ensure your personal safety and that of others: 1. Take time to assess (size up) the scene. This will enable you to recognize existing and potential dangers. 2. Wear appropriate personal protective equipment (PPE). 3. Perform only the skills that you are trained in. 4. Get any assistance you need by requesting additional personnel. Be ready to describe the scene and the type of additional help required. Safety of Others You have a responsibility for the safety of others at the scene, as well as your own personal safety. Discourage bystanders and family members from entering any area that appears unsafe. You can ask these individuals to help you keep people away from unsafe areas or to call for additional help that might be required, such as police officers. Some dangers may require you to take special measures to protect people at the scene, such as placing physical barriers to prevent bystanders from getting too close. You may also encounter situations that require you to free a patient who is trapped or physically move a patient away from a hazard. So long as you do not put yourself at risk, you should do everything possible to protect everyone at the scene from harm. Special Emergency Scenes Some emergency situations, such as crime scenes, drug labs, and scenes with multiple patients, present a special set of problems and considerations. CRIME SCENE If you arrive at the scene of a crime, your own safety is paramount. If a crime scene is suspected, retreat and wait until police arrive and indicate it is safe to enter the area. If police have not been dispatched, notify them immediately. Once the scene is safe, your priority is patient care. A victim of an assault may have severe injuries, but there is very little that you can do to provide care until the scene is safe. Yield to the primary investigative agency on the scene and follow any instructions they give. DRUG LABS Police usually gather evidence at a crime scene. You must be careful not to compromise the continuity of evidence. Do not touch anything except what you must to give care. Use one path to enter and exit. Once you enter a crime scene to give care, make sure that police are aware of your presence and actions. Document anything that you interact with (e.g., if you must move something to access a patient). As always, remember that your notes could become legal evidence in a courtroom: They must be complete, accurate, and objective. Specific hazards in illegal drug labs include: Booby traps. Electrical hazards. Fire and explosion hazards. Poor air quality due to mould or chemical reactions. Biohazards. Hazardous chemicals. To avoid interfering with forensic evidencegathering, follow these guidelines: When removing clothing following gunshot wounds, stabbings, or other assaults, if at all possible, do not cut clothing through or near the bullet or stab wound holes. Avoid allowing blood or debris to contaminate another area or other objects, such as clothing. Handle patient clothing as little and as carefully as possible. Minimize the introduction of foreign objects into the crime scene. Communicate with law enforcement concerning any items you leave behind (e.g., medical supplies). In situations where sexual assault is suspected, discourage the patient from washing, showering, or changing clothing. HOSTILE BYSTANDERS Illegal drug labs are unsafe environments. Do not enter the scene until trained personnel arrive. You may encounter hostile bystanders at any emergency scene. Hostile behaviour may result from the use of alcohol or other drugs, or from an underlying medical condition. If you encounter hostile bystanders at a scene, request law enforcement personnel and wait at a safe distance until they arrive. Approach the scene only after police officers have declared it safe and have asked you to help. HOSTAGE SITUATIONS If you encounter a hostage situation, your first priority is to not become a hostage yourself. Assess the scene, request law enforcement personnel, and wait at a safe distance. A police officer trained in hostage negotiations should take charge. Remain at a safe distance until you are summoned by law enforcement personnel. Try to get any information from bystanders that may help law enforcement personnel. Ask about the number of hostages, any weapons they have seen, and other possible hazards. Report any information to the first law enforcement official on the scene. NATURAL DISASTERS Natural disasters include tornadoes, hurricanes, earthquakes, forest fires, ice storms, and floods (Figure 2–2). The consequences of a natural disaster can be very complex. A large number of RESPONDING TO THE CALL If an unarmed person threatens suicide, try to reassure and calm the person. Ensure that appropriate personnel have been notified. You cannot physically restrain a suicidal person without medical or legal authorization. Listen to the patient and try to keep him or her talking until help arrives. Try to be understanding. Do not dare the person to act or trivialize his or her feelings. Unless your personal safety is threatened, never leave a suicidal person alone. Drug labs are places where people illegally manufacture or process drugs. Clues that may indicate the presence of a drug lab include chemical glassware, strange odours, and unusual chemicals. 31 Figure 2–2: A natural disaster. Figure 2–3: Hazardous material placard. injuries and deaths can result from electricity, hazardous materials, rising water, and other dangers that accompany or follow the disaster itself. When responding to a natural disaster, be sure to carefully assess the scene, avoid obvious hazards, and use caution when operating rescue equipment. In confined spaces, never use gasoline-powered equipment such as chainsaws, generators, or pumps. placard but suspect that a hazardous material is present, request that the appropriate agency respond to the scene (e.g., a fire department or hazmat response team). Specific Scene Hazards RESPONDING TO THE CALL HAZARDOUS MATERIALS 32 Hazardous materials pose a special risk for responding personnel. When you approach an emergency scene, look for clues that indicate the presence of hazardous materials, including: Signs (placards) on vehicles, storage facilities, or railroad cars. Clouds of vapour. Spilled liquids or solids. Unusual odours. Leaking containers, bottles, or gas cylinders. Chemical transport tanks or containers. Those who transport or store hazardous materials in specific quantities are required to post placards identifying the specific hazardous material, by name or by number, and the specific risks it poses (Figure 2–3). This information is available from various sources, such as shipping documents and Safety Data Sheets (SDSs). If you do not see a Safety Data Sheets (SDSs) Safety Data Sheets (SDSs) are documents containing important technical information for workers on a work site. An SDS must be available for every hazardous material at the work site. An SDS contains important information about the specific hazardous material, including: Toxicological properties: information on how a material enters the body and its short- and long-term health effects. Preventive measures: information on how to protect yourself when you’re working with the material, including ventilation, PPE, and work procedures. First aid measures: information on what to do if the material causes illness or injury. Each SDS contains large amounts of specific information for a given substance, broken down into 16 categories: 1. Identification 2. Hazard identification 3. Composition/Information of ingredients 4. First aid measures 5. Fire-fighting measures Accidental release measures Handling and storage Exposure controls/Personal protection Physical and chemical properties Stability and reactivity Toxicological information Ecological information Disposal considerations Transport information Regulatory information Other information WATER AND ICE Water and ice can also be serious hazards. If a PFD or lifejacket is available, a responder should wear it in or around water. If you cannot reach a responsive person in the water, try to throw him or her something that floats and is nearby. Never enter a body of water to rescue someone unless you have been trained in water rescue. Even then, enter the water only as a last resort. To help a responsive person in the water, reach out to him or her with a branch, a pole, or even your hand, being careful not to be pulled into the water. When the person grasps the object, pull him or her to safety. Fast-moving water is extremely dangerous and often occurs in floods and hurricanes, and at lowhead dams. Ice is also treacherous. It can break under your weight, and the cold water beneath can quickly overcome even the strongest swimmer. Never enter fast-moving water or venture out onto ice unless you are specifically trained in this type of rescue. Water rescues require careful planning and proper equipment, so they must only be attempted by personnel with special training. DOWNED ELECTRICAL LINES Downed electrical lines also present a major hazard for responders. Look for downed wires at a scene and always assume that they are live and dangerous. Even if the line is not live initially, power could be restored without warning. Note that the outer covering on power lines does not provide insulation against the electrical current; it will not protect you from electrocution. Do not touch any vehicle that is in contact with downed wires, and do not let others touch it. Tell anyone in the vehicle to remain calm and stay inside the vehicle. Vehicle occupants should keep still and avoid touching one another. Never attempt to remove people from a vehicle with downed wires touching it, no matter how seriously injured they may seem. If you find downed wires, follow these guidelines: Electricity can travel through the ground, so stay at least 15 metres (50 feet) from downed power lines and ensure that bystanders do the same. Do not attempt to move downed wires. Notify the fire department immediately. Do not touch any metal fences, metal structures, or bodies of water in contact with a downed wire. Wait for the power company to shut off the power source. FIRE Any fire can be dangerous. Only firefighters should approach a fire, as they are highly trained and use equipment that protects against fire and smoke. Make sure that the local fire department has been dispatched and warn others not to approach the fire. If you arrive at the scene before any responding firefighters, gather any information you can from bystanders about people or hazards inside the building and provide this information to the fire department personnel when they arrive. TRAFFIC Traffic is the most common danger emergency personnel will encounter when responding to a motor vehicle collision (MVC). When you arrive, position the vehicle you are operating in a safe manner in accordance with the law and operational guidelines of your organization. Your vehicle placement should create a safe zone by preventing regular traffic from entering the scene, while allowing other incoming emergency vehicles direct routes to the incident. Applicable warning devices (such as reflectors or lights) must be activated and all applicable laws and organizational guidelines complied with. RESPONDING TO THE CALL 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 33 Professional responders have been killed by traffic at emergency scenes. If dangerous traffic makes the scene unsafe, do not put yourself at risk. Always ensure that the proper steps are taken to create a safe area for yourself and others before providing care. UNSAFE STRUCTURES Buildings and other structures such as mines, wells, and unreinforced trenches can become unsafe because of fire, explosions, natural disasters, deterioration, or other causes. An unsafe building or structure is one in which: The air may contain debris or hazardous gases. There is a possibility of being trapped or injured by collapsed walls, weakened floors, and other debris. Gather as much information as you can to determine the exact or probable location of anyone in the structure, call for appropriate help, and wait for the arrival of properly trained and equipped personnel. CONFINED SPACES Features of confined spaces (Figure 2–4) include: Restricted openings for entry and exit. Poor ventilation with possible air contaminants. Physical hazards related to engulfment or collapse (being surrounded and overwhelmed by a substance such as soil or grain). RESPONDING TO THE CALL Such spaces might include pits, tunnels, storage tanks, sewers, ventilation and exhaust ducts, underground utility vaults, and pipelines. 34 Confined spaces are particularly challenging because they are not designed or intended to have people in them. They can present a risk to the health and safety of anyone who enters (including responders) due to one or more of the following factors: Their design, construction, location, or atmosphere The materials or substances inside Work activities being carried out inside Figure 2–4: A confined space has restricted openings for entry and exit. There are specific processes for dealing with confined spaces (e.g., a grain silo, vat, or pipe). Without appropriate training, you are putting yourself at risk. If dealing with confined spaces is not within your training, request specialized personnel and manage the scene until they arrive. WRECKAGE The wreckage of automobiles, aircraft, or machinery may contain hazards such as sharp pieces of metal or glass, fuel, and moving parts. Do not try to rescue someone from wreckage unless you have the proper equipment and training and the wreckage has been stabilized. SUMMARY Elements of Preparing for an Emergency Response EQUIPMENT PLAN OF ACTION Ensure that all equipment is stocked, maintained, and inspected properly. Develop plans for responding in specific situations or locations. COMMUNICATIONS PSYCHOLOGICAL PREPARATION Ensure that you are able to contact specialized and advanced personnel, that communications systems are working properly, and that backup communications systems are in place. Prepare yourself mentally for the emergency scene so you will be able to remain professional and effective. TRAINING Ensure that your skills and knowledge remain up to date through skill practice and professional development activities. Scene Safety Guidelines Take time to assess (size up) the scene. Wear appropriate personal protective equipment (PPE). Perform only the skills that you are trained in. Get any assistance you need by requesting additional personnel. Crime scene Hostile bystanders Natural disasters Hostage situations Drug labs Specific scene hazards ◆ Hazardous materials ◆ Confined spaces ◆ Wreckage ◆ Downed electrical wires ◆ Unsafe structures ◆ Fire ◆ Traffic ◆ Water and ice RESPONDING TO THE CALL Special Emergency Scenes 35