L3 Extrication and Light Rescue v1 October 2020.pdf

Extrication and light rescue in the emergency and urgent care setting Component 15  Extrication and Light Rescue- Component 15 Light Rescue Objective Understand the current guidelines for extrication...

Extrication and light rescue in the emergency and urgent care setting Component 15  Extrication and Light Rescue- Component 15 Light Rescue Objective Understand the current guidelines for extrication and light rescue Identify Situations that may require Light Rescue Procedures ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Rescue might be required if: Casualty trapped in vehicle needs rapid release and treatment Casualty trapped in collapsed or damaged building is at risk of further injury or danger Need to gain rapid access to a casualty for treatment. ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 L.A.S. Equipment for Light Rescue Orthopaedic Stretcher & Rescue Board Kendrick Extrication Device (HART only) Fire extinguishers (2) – foam filled Safety Helmets, Debris Gloves/P.P.E. Hard Collar Vacuum Matress ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Scene Assessment S – Safety - Dynamic Risk Assessment – Continually assess throughout the incident C – Cause/MOI – Establish events leading up to the incident E – Environment – Weather conditions/time of day, entering and exiting N – Number of Patients – How many patients during initial assessment E – Extra resources – Is there anyone else required to help ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Dynamic Risk Assessment You will need to make an assessment of the risks you are faced with. Analyse the situation or task The assessment will change Select a safe Review as the information system of work available or situation evolves. Yes Dynamically Carry out assess the task system of Are the control work measures employed adequate to No manage the Reassess safe identified risks ? systems of work ©Department of Clinical Education & Standards  Extrication and Light LightRescue Rescue- Component 15 Information Required When Requesting Help Early Identification of the incident M/S (Major or Significant Incident if appropriate) E Exact Location i.e. map reference, T Type of incident, H Hazards present and potential A Access to scene, and egress route N Number and severity of casualties E Emergency services, present and required ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Your Role and Responsibility Do not attempt to rescue if HART or the Fire Service is available Never ‘have-a-go’ to negate calling HART or the Fire Service A patient’s condition is your responsibility The senior clinician must decide which form of management and handling is correct before, during and after the rescue attempt. ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Fire Service Provide Fire and Rescue Services throughout London Floods, CBRN incidents, USAR, Major incident Control Remember scene safety Ensure you wear PPE, high vis, helmet Remember good communication. Liase with the Incident Control Point. ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Metropolitan Police Maintain public order, secure scenes, provide entry to premises Able to detain and section under 136 Provide safety and support where required Maintain continuity at crime scenes Remember good communication Record Unit call sign on paperwork ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 HART HART are the specialist unit of the ambulance service providing: – Advanced Extra PPE and Other Vehicles. – Advanced clinical interventions in Hazardous Environments. – Improved initial response to “Conventional” Major Incidents. – Early Command and Control. – Triage and clinical interventions. – Early equipment support for mass casualties. ©Department of Clinical Education & Standards  Extrication and Light LightRescue Rescue- Component 15 HART These staff work alongside the other emergency services and other specialist agencies, having had training to work at height, in collapsed buildings and in confined space. The Urban Search and Rescue Paramedic provides a response to confirmed patients at incidents involving: Collapsed structures Unsafe structures ©Department of Clinical Education & Standards  Extrication and Light LightRescue Rescue- Component 15 HART HAZMAT / CBRN(e) Incidents ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 HART Swiftwater & Flood Remote Extrications ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Approaching a light rescue: Only attempt light rescue when there is no alternative If a rescue is attempted, never take chances with the patients life or your own Provide as much information as possible to other Services Work as a team The sole aim of any rescue operation is the safety and survival of patients: continuous treatment is essential ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Factors which Affect Speed of Extrication Safety Environment Number of patients Extra resources Equipment available Time Critical features ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Remember always wear P.P.E. in Light Rescue Situations YOUR SAFETY IS PARAMOUNT ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Crash Helmet Removal ©Department of Clinical Education & Standards  Extrication and Light Rescue - Component 15 Crash Helmet Removal Crash Helmet should be removed to allow for assessment and management of the airway Allows for identification of hidden bleeding at the back of the head Allows the head to moved into position of neutral alignment Remember – Some amount of spinal movement will occur during this procedure ©Department of Clinical Education & Standards  Crash Helmet Removal ©Department of Clinical Education & Standards ©Department of Clinical Education & Standards ©Department of Clinical Education & Standards ©Department of Clinical Education & Standards  Drowning & Suspension DROWNING: Introduction Drowning is defined as; “…the process resulting in primary respiratory impairment from submersion/immersion in a liquid.” Thus the person is prevented from breathing air due to liquid medium at the entrance of the airway Drowning does not infer that the patient has died 24 © Department of Clinical Education & Standards  Drowning & Suspension DROWNING Immersion - Being covered in a liquid medium. The main problems will be hypothermia and cardiovascular collapse from hydrostatic pressure on lower limbs Submersion - The entire body, including the airway being under the liquid medium Main problems asphyxia and hypoxia Exacerbating factors Intoxication of alcohol or drugs May be precipitated by a medical condition e.g. convulsion 25 © Department of Clinical Education & Standards  Drowning & Suspension DROWNING: Hypoxia If rescue is not made…..the patient will aspirate water in to the lungs leading to hypoxia Laryngospasm may occur preventing liquid entering the lungs (so-called dry drowning) However, this is rapidly terminated by cerebral hypoxia and active breathing attempts resume Aspiration of liquid into the airways and lungs results preventing gaseous exchange 26 © Department of Clinical Education & Standards  Drowning & Suspension DROWNING: Hypoxia If rescue is not made… (continued) Once gaseous exchange is prevented hypoxaemia results. Unless hypoxaemia addressed the patient will develop cardiac arrhythmias. This is followed by….. CARDIAC ARREST 27 © Department of Clinical Education & Standards  Drowning & Suspension SECONDARY DROWNING Should a drowning victim be successfully rescued and resuscitated they may appear to have fully recovered However, water in the stomach will continue to be absorbed into the bloodstream causing a distortion in the blood’s pH Death may occur up to 72 hours after rescue ALWAYS TRANSFER POST-DROWNING CASUALTIES TO HOSPITAL AS TIME CRITICAL 28 © Department of Clinical Education & Standards  Drowning & Suspension RESCUE REMEMBER; NEVER PUT YOURSELF AT RISK Carry out a dynamic risk assessment Establish number of patients involved GET HELP > EOC > HART If neck or back trauma is suspected wait until patient has been rescued before applying immobilisation, but.. Limit neck extension and flexion 29 © Department of Clinical Education & Standards  Drowning & Suspension Management Assess ABCDE If any of the following TIME CRITICAL features are presented  Major ABCDE problems  Pulseless and apnoeic  Major life threatening trauma  Neck and back injuries Start correcting ABCD problems and transfer as TIME CRITICAL Administer High % oxygen Prevent further heat loss Airway  Clear airway  There is a high risk of regurgitation of stomach contents Ventilation Adequate ventilation and oxygenation may restore cardiac activity. Consider assisted ventilations if:  SpO2 is