Operations, ICS, Hazmat, Terrorism Flashcards
(121 cards)
1
Q
What organization helps develop regulations with infection control practices, including PPE, Sharps containers, and disinfection equipment?
A
OSHA
2
Q
Discuss the importance of performing regular vehicle inspections and list the specific parts of an emergency vehicle that should be inspected daily. (pp 2655–2657)
A
To make sure all of your needed equipment is present, in date, and working properly. It is a safety hazard when you ambulance is not running properly.
3
Q
Provide examples of some high-risk situations and hazards that may affect the safety of the emergency vehicle and its passengers during both pretransport and transport.
A
Fatigue, distractions, hydroplaning, water on roadway, low visibility, ice, wrecks- all incidents are hazardous, up to and including death.
4
Q
Discuss specific considerations required to ensure scene safety including personal safety (pp 2660–2661)
A
Safety Hazards, Additional resources, MOI/NOI, specialized equipment, PPE.
Be aware of the potential need for traffic control on MVA’s.
5
Q
What is the process of removing dirt, dust, blood, or other visible contaminants from a surface?
A
Cleaning
6
Q
Give examples of the specific limited privileges provided to emergency vehicle drivers by most state laws and regulations. (Pp 2669-2671)
A
Park in otherwise considered illegal areas, drive faster than posted speed limit, drive against flow of traffic, travel left of center. You are not allowed to pass school buses.
7
Q
Explain why using police escorts and crossing intersections pose additional risks to EMS personnel during transport and discuss special considerations related to each. (pp 2670–2671)
A
Many drivers will only see the first set of lights and assume that the emergency vehicle has cleared prior to the ambulance passing
8
Q
How do you approach a helicopter?
A
Do nothing near the helicopter only walk whee pilot or crew direct you to. DO NOT WALK TOWARDS THE ROTATING TAIL (hot) OF THE HELICOPTER!!! Always approach from the front, and move to the side as directed.
9
Q
Explain the federal requirements for the minimum entry-level certifications of paramedics and other emergency personnel in incident command system (ICS) training. (p 2688)
A
The federal government requires ICS training
10
Q
Describe the National Incident Management System (NIMS) and its major components. (pp 2686–2688)
A
Fundamentals and Concepts of NIMS, Resource management, command and coordination, communications and Information Management
11
Q
Describe the purpose of the ICS and its organizational structure and the role of emergency medical services (EMS) response within it. (pp 2688–2695)
A
Providing a clear chain of command, use of common terminology, safety for responders, achievement of response objectives, efficient use of resources. EMS is used in pt care areas and for triage/ transport services
12
Q
What are the components of the ICS?
A
Command, Operations, Logistics, Planning, Command Staff
13
Q
Describe the role of the paramedic in establishing command under the ICS. (pp 2693–2695)
A
EMS systems fall under the operations division of the ICS
14
Q
Explain the purpose of EMS operations within incident management. (pp 2695–2697)
A
EMS is responsible to providing Triage, treatment, and transport, to pt injured in the MCI.
15
Q
Describe the specific conditions that would define a situation as a mass-casualty incident (MCI), including some examples. (Pp2699-2700)
A
An Incident that is characterized as a situation that can place great demand on the equipment or personnel, of the Ems system, or that has the possibility to overwhelm available resources
16
Q
what occurs during primary and secondary triage?
A
Primary triage- pt sorting used to rapidly categorize patient conditions
Secondary triage- type of sorting within the treatment group that involves retriage of pt’s
17
Q
Explain the need for retriaging of patients during MCIs. (p 2701)
A
Patient conditions may change with little warning. What may be triaged as delayed could change to immediate.
18
Q
Discuss guidelines for assisting special rescue teams in the context of NFPA 1670, Standard on Operations and Training for Technical Search and Rescue Incidents. (pp 2720–2721)
A
Stand there and look pretty ;)
Awareness- know what you are looking at, knowing the difference between rescuing a pt and recovering a body, protecting self and others
OPs- provide emergency response
Techs- emergency response and provide advanced technical rescue response
19
Q
how is the START triage method performed?
A
START
1st step- call out to walking wounded and bring to a designated landmark.
2nd step- move to non-ambulatory pt’s and assess respiratory status.
Not breathing- open airway, still not breathing- black tag
Breathing more than 30/bpm- red. Less than 30 move to next step
3rd- Hemodynamic status- assess radial pulse
Absent radial pulse- red. Strong radial pulse move to next step.
4th step- mental status- ask the pt to follow a basic command.
Unable to preform triage as red, able to follow command triage as yellow.
20
Q
Discuss specific hazards that may be encountered during the arrival and scene size-up of a technical rescue incident. (Pp 2722, 2724-2725)
A
Electrical hazardous- downed power lines,
Metals or conductive materials.
Natural gas and liquefied petroleum.
21
Q
Describe the purpose of critical incident stress management. (p 2708)
A
Debriefing after stressful/traumatic events with others who also went through the same thing may be beneficial. Can help to decrease the number of suicides in the first responder communities.
22
Q
how to ensure safety at the scene of a rescue incident including scene size-up?
A
Using the UCAN method for scene size up and size up communications
23
Q
Explain the three levels of training in technical rescue incidents in the context of NFPA 1006 Standard for Technical Rescue Personnel Professional Qualifications. (p 2720)
A
Awareness
Operations
Technician
24
Q
Explain the importance of the incident management system during technical rescue incidents. (p 2723)
A
Many TRI’s can become complex and require many assisting units. Without an ICS it can become difficult if not impossible to ensure rescuers safety.
25
Explain the simple methods used to access a patient during an incident that requires extrication. (pp 2726, 2733–2736)
Using hand held tools, such as sledgehammers, center punches, glass saw, halligan bar, or pry bar. Using power tools such as rams, spreaders, cutters.
Opening doors, breaking glass.
26
Discuss disentanglement methods including airbag safety
Airbags that have deployed present no safety hazard to rescuers
Disconnect battery and allow the airbag capacitor to discharge on non-deployed airbags
Do not place a hard object between the patient and a undeployed airbag
Do not cut steering column if airbag was not deployed
Maintain at least a 5in clearance around side airbags that have not deployed
Maintain 10in clearance around driver side airbags that did not deploy
Maintain 20in clearance around passenger side airbags that did not deploy.
27
Outline the standard terminology used to describe the anatomy of a vehicle. (pp 2728–2729
Front- portion that travels down the road first.
Rear- contains the trunk
Left- driver side
Right-passenger side
A post- front of vehicle near windshield
B post- between front and rear doors
C post- behind the rear doors
D post- found on SUV’s, vans that have windows behind the rear doors.
28
Identify the hazards posed by specific types of hazardous materials. (p 2731)
Fire hazards, electrical hazards, fuel sources, and liquid run off.
29
Identify various types of cribbing used for vehicle stabilization. (pp 2732–2733)
Step chock- wood, plastic, or composite material
Wedge- tapered piece of wood or other material used to snug loose cribbing.
Box crib- pallet like that can placed beneath a heavy load
Shim- similar to wedge but smaller
30
Outline the ways in which a patient can be accessed during a vehicle extrication from simple to complex. (pp 2726, 2733-2736)
Opening the door, breaking glass, once access to the pt is gained provided immediate care by managing life threats and ABC’s
31
Recognize the hazards to providers’ and patients’ safety during disentanglement including undeployed airbags. (pp 2736–2737)
K
32
Summarize the special hazards and challenges posed by entrapment in and rescue from a confined space. (pp 2739–2741)
Low ventilation areas, less O2, and may lead to trapping of poisonous gasses and fire hazards
33
Describe why collapse is a key safety concern in trench rescue and how this threat can be managed. (pp 2741–2742)
Can cause suffocation and asphyxiation. Stabilize properly.
34
Differentiate the equipment and techniques used in high- and low-angle rope rescue. (p 2746)
Low angle 35- 60 degree angle
High angle greater than 60 degree angle
35
Define and contrast wilderness search and rescue with lost person search and rescue. (pp 2746–2747)
Wilderness SAR: are conducted by a limited number of departments. Wilderness can cover many different environments like- forests, mountains, deserts, parks, animal refuges, rain forests. Even with short access time, the scene could require and extensive evacuation an qualify as wilderness incident. Terrain hazards include- cliffs, steep slopes, caves, wells, mines, avalanches, rivers, streams, valleys, beaches and rockslides. Don't exceed your physical limitations, and don't become involved in a situation beyond your ability to handle.
Lost person SAR: role is to stand by at the search base until the lost person have been found. You should isolate and prepare the equipment you will need to carry to the patient's location so that no time is lost when the person is found or if a member of the SAR team becomes injured during the search. You will be given a portable radio tuned to the search frequency so that you can monitor the progress of the search and communicate with and be contacted by those in charge of the operation. You must be sure that your radio is set to a discreet volume if staying at the scene with relatives of the lost person (the relatives will get information from IC not you).
36
Describe the steps in making a safe approach to a structure fire. (p 2748)
-Determine whether any special route will be necessary because of the fire.
-Park your ambulance far enough away to be safe from the fire itself and from collapsing building, if building collapse should occur.
-Ensure the ambulance will not impede other arriving equipment or become hemmed in by fire apparatus, equipment or hose.
-the ambulance must be close enough to be visible to rescuers and accessible to arriving patients. IC will determine this location.
37
Cite the similarities between agricultural and industrial rescue. (pp 2748–2749)
-Crucial skill for rescue personnel is effective cribbing to stabilize a vehicle or other agricultural or industrial equipment.
-During such a rescue, because of uneven ground, large spaces, and the necessity of supporting heavy loads, using the proper technique is essential for everyone's safety.
-Once you are able to get close to the patient, carefully evaluate how the person is trapped.
38
Explain the special considerations applicable to tactical response scenarios. (pp 2749–2751)
-Many SWAT teams now include specially trained EMS providers who work in partnership with law enforcement.
-Tactical paramedic is trained to enter the hot zone with law enforcement personnel and the equipment involved is- body armor, ballistics helmet, eye protection at a minimum.
-turn off lights and sirens as you approach.
-As you exit the ambulance, stay low and remain near the side of the vehicle unless you are directed to another place of safety.
-Do not look around the sides or over the tip of any building or structure that my be shielding you.
-As you exit the scene, follow the specific route indicated by the IC or law enforcement officer assigned to guide you.
39
Sequence the metabolic cascade that occurs in a patient with crush syndrome. (p 2751)
-Occurs when the chest, abdomen, or a lower limb or other extremity is compressed for 4-6 hours, elevating pressure and thereby reducing blood flow.
-Resulting oxygen deprivation in the area necessitates anaerobic metabolism within these tissues.
-Lactic acid and other metabolic wastes build up, especially in muscle tissue. (compartment syndrome is considered a hypoperfusion injury).
-After prolonged period, pressure can also break down cell walls, allowing for leakage of metabolic wastes and intracellular fluid and electrolytes that would normally be contained within the cell.
-As long as the area is under pressure, bleeding is typically controlled and leakage of cellular materials remains localized.
-When pressure is released, not only does BP often plummet and bleeding resume, but toxic materials that had been contained within localized tissues are released into the blood stream. Myoglobulin from muscle tissue, can impair kidney function as can phosphorus and uric acid which are also released.
-Potassium, due to sodium-potassium pumps malfunctioning can affect heart rhythm and may produce prolonged peaked T waves on an ECG.
Treatment: PPV with administration of sodium bicarb, calcium chloride and fluid bolus, can help to reverse the effects of respiratory and metabolic acidosis.
40
Articulate the patient care considerations involved in providing prehospital pain management. (p 2751)
Both pharmacologic and nonpharmacologic methods to manage pain in injured patients.
-Nonpharmacologic methods include placing the patient in position of comfort, splinting and padding to improve stabilization, ensuring gentle handling during treatment and transport, and talking to patients to help keep their minds off of their discomfort. Keep patient's warm, shivering can heighten pain.
-Pharmacological treatment: May be the difference between a patient who endures a recue scenario relatively easily, with tolerable pain, and an uncooperative patient who is in substantially more metabolic distress because of significant pain. Pain control should be considered according to the medications indications, relative and absolute contraindications, and possible side effects.
42
Using a basket stretcher as an example explain the importance of proper equipment selection in patient packaging. (pp 2727, 2751–2753)
The wired stokes basket is more suitable for water rescue and helicopter hoists because the wire mesh lets water and moving air pass through it easily.
-Unfortunately a wire basket snags every bit of debris and becomes ensnared on almost any obstruction or obstacle.
For most other types of evacuation, a plastic or fiberglass basket is the superior choice. It slides more easily across heaps of debris, down ladders, and over snow and other surfaces.
Both types of baskets have a wheel device attached to the bottom to facilitate movement over trails and low level debris.
-Each packaging system relies on the same basic principle: securing the patient's pelvis, which is the fulcrum of the body, into the basket. Separate techniques are then deployed to secure the patient's legs and or chest, or to lash or lace the patient's entire body into the basket.
Remember to secure equipment and lines and oxygen when packaging patient as it may get caught on a piece of debris or inadvertently become entangled in the raising or lowering mechanism.
If there is falling debris place head and eye protection on the patient during packaging.
Basket stretchers may not fit in confined spaces. So they may require KED or KED-SKED combinations or SKED (flexible wrap around litter, essentially a drag sheet made of heavy duty polyethylene plastic that wraps around and cocoons the patient, with pre-rigged securing and attachment points.
53
Who developed the first standardized equipment list to be carried on Emergency vehicles?
American College of Surgeons (ACS)
54
Define the term hazardous material. (p 2762)
Any substance or material capable of posing an unreasonable risk to human health, safety, or the environment when transported in commerce, used incorrectly, or not correctly contained or stored.
55
What injuries are expected with Immediate (red) triaged pt’s
Problems with ABC’s, Uncontrolled or severe bleeding, severe medical conditions, decreased mental status, signs of shock, severe burns, open chest or abd injuries
56
What injuries are expected with Delayed (yellow) triaged pt’s
Burns without airway problems, major or multiple bones or joints injuries, back injuries with or without SCI.
57
What injures are expected with Minimal (green) triaged pt’s
Minor fx’s and minor soft tissue injuries
58
What injuries are expected with Expectant (black) triaged pt’s
Obvious death, non-survivable injuries (major open brain trauma), respiratory arrest, caridac arrest
59
how are destination decisions regarding triaged patients made?
Red and yellow pt’s transported first, ground or air.
Red- transport one to two at a time
Transport to a hospital that is capable of treating injuries, if unable to, closest facility for stabilization.
Green pt’s preferably to be transported by bus to hospital away from the MCI. If bus is not available, transport two to three pt’s at a time.
60
Describe the OSHA HAZWOPER regulation and the entry-level training or experience requirements identified by the HAZWOPER regulation for a paramedic to respond to a hazmat incident. (pp 2763–2764)
Based on the HAZWOPER regulation, first responders at the AWARENESS level should have sufficient training or experience to objectively demonstrate competency in:
-understanding of what hazardous materials are and risks associated with them.
-Understanding potential outcomes of an incident.
-Ability to recognize the presence of hazardous substances, if possible.
-Understanding of the role of the first responder at the awareness level in the emergency response plan.
-Ability to determine the need for additional resources and notify the communication center.
HAZWOPER standard provides for the safety of personnel who work on hazardous waste cleanup sites or hazardous waste treatment storage and disposal sites or who respond to hazmat emergencies.
EMS personnel should receive appropriate hazmat response training, based on the needs and requirements of the authority having jurisdiction and the local EMS agency. Most cases, AHJ may decide that the awareness level of training is appropriate.
-It is up to the AHJ to decide how much hazmat response training will be required of EMS responders.
Awareness:
Operations: respond to protect nearby people, property, and the environment from the effects of a hazmat incident are trained to operate in a defensive manner and not make direct, intentional contact with the hazardous substance. May also support responders trained at the technician level.
Technician: directly involved in a contaminated atmosphere or be part of the hazmat response operation itself. Usually members of a hazmat team and make direct, intentional contact with a spilled material to mitigate the problem using appropriate protection and precautions. Use of specialized equipment, care of patient's during the rescue, management of the incident and of all personnel at the scene.
Specialist: work with and are trained at the technician level, but have specialization in handling specific hazardous substances and containers and are prepared to provide technical assistance to the IC in their area of expertise.
61
Explain the hazard classification system used by the National Fire Protection Association (NFPA). (pp 2769–2770)
NFPA 704: Standard for the identification of the hazards of materials for emergency response, outlines a marking system characterized by a set of diamonds that are found on the outside of buildings, doorways to chemical storage areas and on fixed storage tanks.
-This marking system is designed for fixed facility use.
-Uses a diamond shaped symbol of any size, which is itself broken into 4 smaller diamonds, each representing a particular property or characteristics. Colored and indicate specific hazards.
Red= fire
Blue= heath hazards
Yellow= reactivity hazards
White= special information.
Rated on a scale of 0 (no hazard) to 4 (severe risk).
White diamond contains special information (whether the chemical reacts with water, simple asphyxiant gas, or is an oxidizer.)
62
Who created the Traffic Incident Management System, and what is it?
The National Highway and Traffic Safety Administration. I program that reduces the risks for roadway incidents.
63
What are the four triage categories?
IDME
I-Immediate (red)
D-Delayed (yellow)
M-minimal (green) (walking wounded)
E- Expectant (black)
64
5. Discuss the specific types of information and reference resources a paramedic can use to recognize a hazmat incident. (Pp 2766-2770
-S/S of victims, labels, placards, shipping papers, SDS paperwork.
-ERG (emergency response guide) is a guidebook for first responders during the initial phase of a dangerous goods or hazmat transportation incident. Provides information on specific properties and hazards of substances.
DOT chemical families.
Placards: diamond shaped indicator that identifies the broad hazard class wo which the hazmat belongs. Most commonly used placards show 4 digit numbers that are part of the UN/North american coding system for identification of hazmat. this number identifies the specific material being transported and corresponds with information in the ERG.
Label: smaller version of a placard placed on the four sides of individual boxes and smaller packages being transported. Label on a box inside a delivery truck relates only to the potential hazard inside that particular package.
Bill of lading: or freight bill, should be carried by the truck driver in the cab.
Waybill: or "consist" which is carried by the conductor of the train.
Dangerous cargo manifest: located in the ships wheelhouse.
Air bill: documents for material being transported by air and are located in the cockpit with the pilot.
CHEMTREC: operates a telephone line (1-800-262-8200), has an extensive database to assist emergency responders. Can provide responders with technical information via phone, fax, or other electronic media. Translated into more than 200 languages.
Canadian (CHEMTREC) is CANUTEC.
Mexican equivalent is SETIQ.
65
Explain the role of paramedics during a hazmat incident both before and after the hazmat team arrives, including precautions required to ensure the safety of civilians and public service personnel. (pp 2763–2764)
-understanding of what hazardous materials are and risks associated with them.
-Understanding potential outcomes of an incident.
-Ability to recognize the presence of hazardous substances, if possible.
-Understanding of the role of the first responder at the awareness level in the emergency response plan.
-Ability to determine the need for additional resources and notify the communication center.
Know how a hazmat scene is organized from a command and control perspective including how you fit into the command structure and operational plan.
Be familiar with the different types of PPE use, how the hazmat or other responders will decontaminate patients, and how to assess and treat exposures.
You may be called on to support hazmat teams through on scene medical monitoring and or to provide treatment if responders are exposed.
66
What is the JumpSTART triage method
Used for pediatrics
Start by assessing walking wounded. Infants, children who cannot walk and children with special needs triaged as red.
Assess respiratory status. Not breathing- check a pulse- no pulse triage as black.
Not breathing and have a pulse- open airway, if still note breathing, administer 5 rescue breaths. Still no breathing triage as black.
Assess respiratory rate. Breathing fewer than 15 and more than 45, triaged as immediate. In between 15 and 45 move to next step.
Hemodynamic status- check distal pulse- absent triage as red. Has a pulse move to next step
Neurological status- modified AVPU- unresponsive/ responds to pain by posturing triage as red. Responds to pain by localizing or withdrawal is considered alert and triaged as yellow.
67
Describe some of the containers and vehicles used to transport hazardous materials on the roadway. (pp 2770, 2772–2778)
Container: is any vessel or receptacle that holds a material. Type, size and material of construction provide important clues about the nature of the substance inside.
Bulk storage vessels: containers include fixed tanks, highway cargo tanks, rail tank cars, totes, and intermodal tanks. A supplementary containment system often surrounds these bulk storage containers to help control an accidental release.
-Secondary containment: is an engineered method to control spilled or released product if the main containment vessel fails.
-totes: referred to as an intermediate bulk container. Capacities up to- 119 to 703 gallons.
-Intermodal tank: both a shipping and a storage vessel. Holds 5000 to 6000 gallons of product. Can be pressurized and non pressurized. Can also be used to store gaseous substances that have been chilled until they liquify (liquid nitrogen). Can be shipped by all methods of transport- air, sea and land.
Nonbulk storage vessels: is any type of container other than a bulk container. Can hold up to 119 gallons of product. Includes: drums, bags, compressed gas cylinders, cryogenic containers and more.
-Drums: is an easily recognizable, barrellike container. Used to store various substances like food grade materials, corrosives, flammable liquids and grease. constructed of low carbon steel, polyethylene, cardboard, stainless steel, nickel, or other materials.
-Bags: commonly used to store solids, powders like cement powder, sand, pesticides, soda ash, slaked lime.
-Pesticides must be labeled with: name, active ingredients, hazard statement, total amount of product, manufacturer's name and address, EPA registration number, EPA establishment number, signal words (danger-poison, danger, warning, caution), practical first aid treatment, directions for use, agricultural use, precautionary statements, storage and disposal, classification statement on who may use the product.
-Carboys: glass, plastic , or steel containers that holds 5-15 gallons of product. Often placed in a protective wood, foam, fiberglass, or steel box to help prevent breakage.
-Cylinders: used to hold liquids and gases. Uninsulated compressed gas cylinders store substances such as nitrogen, argon, helium, and oxygen. Come in a range of sizes.
Roadway transport of hazmat:
Cargo tank: is bulk packaging that is permanently attached to or forms a part of a motor vehicle or is not permanently attached to any motor vehicle and that because of its size, construction, or attachment to a motor vehicle, is loaded or unloaded without being removed from the motor vehicle.
The most common and reliable transportation vessel is the: MC-306/DOT 406 flammable liquid tanker.
-these tanks frequently carry liquid food grade products, gasoline and other flammable and combustible liquids. Oval shaped tank is pulled by a diesel tractor and can carry between 6000 and 10000 gallons. Non pressurized (working pressure is between 2.65 and 4 lbs/PSI). Made of aluminum or stainless steel.
MC-307/DOT 407 chemical hauler: Round or horseshoe shaped tank and is capable of holding 6000 to 7000 gallons of liquid. Also a tractor drawn tank, is used to transport flammable liquids, mild corrosives, and poisons. May be insulated (horseshoe) or uninsulated (round) and may have an higher internal working pressure than the 306/406, up to 35 psi.
MC-331 pressure cargo tanker: carries materials such as ammonia, propane, freon, and butane. Liquid volume inside the tank varies, ranging from the 1000 gallon delivery truck to full size 11,000 gallon cargo tank. It has rounded ends, typical of a pressurized vessel and is commonly constructed of steel or stainless steel with a single tank compartment. Operates at approx. 300 psi, typical internal working pressure working pressure being in the vicinity of 250 psi.
-Equipped with spring loaded relief valves that traditionally operate at 110% of the designated maximum working pressure. A threat of explosion exists when the relief valve is unable to keep up with rapidly building internal pressure under such conditions.
MC-338 cryogenic tanker: low pressure tanker that relies on tank insulation to maintain the low pressures required for the cryogens it carries. A boxlike structure containing the tank control valves is typically attached to the rear of the tanker. Special training is required to operate the valves on this and any other tanker.
-Have a relief valve near the valve control box. Small puffs of white vapor will be vented from this valve.
-This is normal occurrence; valve is working to maintain the proper internal pressure.
-Problems can occur in hot weather if these trucks crash an the freezer unit is damaged.
Tube trailer: carries compressed gases such as hydrogen, oxygen, helium, and methane. These high volume transport vehicles are composed of several individual cylinder banded together and affixed to a trailer. Individual cylinders on the tube trailer are much like the smaller compressed gas cylinders discussed earlier.
-Large volume cylinders operate at working pressures of 3000 to 5000 psi. One trailer can carry several different gases in individual tubes. These trailers can frequently be seen at construction sites or at facilities that use large quantities of compressed gases.
Dry bulk cargo tank: carries dry bulk goods such as powders, pellets, fertilizers, or grain. Tanks are not pressurized but may use pressure to offload the product. Commonly seen on the road; they are generally V-shaped with rounded sides that funnel the contents to the bottom-mounted valves.
68
Describe how the route of the exposure the dose and concentration of the hazard, and the length of time the hazard is in contact with the body affect the body. (p 2782)
Four primary methods: ingestion, inhalation, injection and absorption.
Other factors that influence: air temperature, concentration of the hazard, and the amount of time that the patient was exposed.
Local effect: may be described as reddening of the skin, localized pain, formation of blisters.
May also have a systemic effect on patients.
Effect may be seen right away or may be delayed for hours or even years, eventually presenting in the form of cancer.
The greater the length of time or the greater the concentration of the material, the greater the effect on the human body will probably be.
The cycle of poison action includes absorption into the body, delivery to target organs, and binding to organs. the cycle continues with biotransformation and elimination of the toxin through the gastrointestinal, kidney or respiratory systems.
69
Provide examples of how understanding the chemical and physical properties of a substance may give some valuable insight into providing care. (pp 2782–2784)
Propane is heavier than air, and does collect in low lying areas, so you might have to consider additional issue to deal with from a patient are perspective.
Vapor pressure: applies to liquids held inside any type of closed container. Amount of pressure will develop in the inner space above the liquid. All liquids even water will develop a certain amount of pressure in the airspace between the top of the liquid and the container.
-the vapors released from the surface of any liquid must be contained for them to exert pressure.
-Vapor pressure will cause the liquid to evaporate into the atmosphere.
-High vapor pressures will evaporate much more quickly than liquids with low vapor pressures.
-Vapor pressure directly correlates to the speed at which a material will evaporate once it's released from its container.
Vapor density: compares the hazmat gas to air. (air has a vapor density of 1). If gas is heavier than air, the gas will sink into little valleys and ditches. Propane, butane, carbon dioxide are heavier than air. Gases like anhydrous ammonia, acetylene, methane and hydrogen are lighter than air and will drift into the atmosphere. This is why you are taught to approach a scene from upwind and uphill!
Flash point: is the temperature at which a liquid fuel gives off sufficient vapors that when an ignition source is present, will result in a flash fire. Flash fire involves only the vapor phase of the liquid and will go out once the vapor fuel is consumed.
-Gasoline: -45 degrees F.
-Diesel: approx. 100 to 160 degrees F depending on the fuel grade.
-Liquids with low flash point typically have high vapor pressures.
Ignition temperature: is the next important combustion landmark, after flash point. When a liquid fuel is heated beyond its ignition temperature, it will ignite without an external ignition source.
Flammable range: Expression of fuel-air mixture defined by upper and lower flammable limits. Reflects the amount of flammable vapor mixed with given volume of air.
-Gasoline has LFL of 1.4% and UFL of 7.6%. If a gasoline air mixture is between the LFL and UFL, and the mixture encounters an ignition source, there will be a fire or explosion.
Hazmat team will make crucial decisions about whether the material will be Water reactive or water soluble. If they use water, they will also need to determine the hazmat's specific gravity: whether the hazmat will sink or float in water.
-runoff potential with water use should also be considered and addressed as well.
Threshold limit Value (TLV): maximum concentration of a toxin that someone can be exposed to for a 40 hour workweek over a typical 30 year career.
Permissible exposure limit (PEL): the concentration of toxin to which a person can be exposed for a 40 hour workweek.
Short-term exposure limit (STEL): the concentration of toxin to which a person can be briefly exposed for a maximum of 15 min, 4 times a day.
Lethal dose (LD): the single dose of toxin that is likely to be fatal. (of a specified number of the group of test animals exposed by any route other than inhalation).
Lethal concentration (LC): the concentration of toxin that is likely to be fatal. (expected to kill a specified number of the group of test animals when administered over a specified period).
Immediately dangerous to life and health: atmospheric concentration of toxin posing an immediate danger, irreversible or delayed adverse effects, or serious interference with a team members attempt to escape from the dangerous atmosphere.
Toxic is defined as:
-LD50 (dose that would be lethal to 50% of the test population) of more than 50 mg/kg but not more than 500 mg per/kg of body weight when administered orally to albino rats weighing between 200 and 300 g each.
-LD50 of more than 200 mg/kg but not more than 1000 mg/kg of body weight when administered by continuous contact for 24 hours (or less if death occurs in 24 hours) with the bare skin of albino rabbits weighing between 2 and 3 kg each.
-LC50 in air of more than 200 ppm but not more than 2000 ppm by volume of gas or vapor, or more than 2 mg per liter bur not more than 20 mg per liter of mist, fume, dust, when administered by continuous inhalation for 1 hour ( or less if death occurs within 1 hour) to albino rats weighing between 200 and 300 g each.
Highly toxic:
-LD50 of 50 mg or less/kg of body weight when administered orally to albino rats weighing between 200 and 300 g each.
-LD50 of 200 mg or less/kg of body weight when administered by continuous contact for 24 hours (or less if death occurs within 24 hours) with the bare skin of albino rabbits weighing between 2 and 3 kg each.
-LC50 in air of 200 ppm by volume or less of gas and vapor, or 2 mg/L or less of mist, fume or dust, when administered by continuous inhalation for 1 hour (or less if death occurs within 1 hour) to albino rats weighing between 200 and 300 g each.
70
Describe decontamination techniques including emergency decontamination, mass decontamination, and technical decontamination. (pp 2786–2789)
4 types: Dilution, absorption, neutralization, disposal.
-Dilution is the most commonly used method and typically the easiest to perform. Relies on the use of copious amounts of fluid, usually water, flush the containment from the skin and eyes. This action decreases the dose effect of the hazmat on the patient.
Sometimes vegetable or mineral oil is sometimes used if the contaminant is a water reactive substance. Be cautious when using brushes.
Absorption: accomplished with large pads that the hazmat team carries to soak up liquid and remove it from the patient. Is not always the most effective way to remove contamination from the skin as a rule, but it is a method.
Neutralization: involves the use of a chemical to change the hazmat into less harmful substances. Neutralization on the skin is almost never used when a person has been in contact with hazardous substances because of the dangers of uncontrolled exothermic reactions.
Disposal: is not so much of a decontamination strategy as it is a result of the process. Be mindful of removing a much of the patient's clothing as possible to reduce the amount of contamination that contacts the body. Simply removing the clothing of a person exposed to chemicals can reduce the level of contamination by as much as 80 to 90%.
Emergency decontamination in "fast-breaking" situations: is the process of removing the bulk of contaminants from a person as quickly and completely as possible. Once you are properly protected, instruct the exposed person to remove all potentially contaminated clothing and belongings. Give the person bags, if available, in which they may place personal belongings and clothing. If the hazmat is a powder, use an object or a gloved hand to brush away as much of it as possible, then immediately secure this now contaminated object in an appropriate bag or container. The goal is to get the victim clean enough that you may render care, this is the point at which the victim becomes a patient.
Mass decontamination: Firefighters can set up hose streams to souse a large number of patients with copious amounts of water, thereby effecting mass decontamination. Do your best possible for the most people in the shortest amount of time possible.
-Decontamination corridor: is controlled area within the warm zone where decontamination takes place. considered a "normal course of business" decontamination that responders do as part of their mitigation efforts. Decontamination corridor may be formed by parking two fire engines parallel to each other and approximately 10-20 ft. Nozzles can be attached to the side discharge ports of the engines and set to create a find particle fog stream decontamination shower. Patient's should disrobe on one end and enter the shower single file. Hypothermia is potential problem for some patient populations such as young children and older adults. At the end of this corridor that you will make initial contact with the patients and begin triage.
Technical decontamination: is the process used by the responders to clean PPE, tools and equipment. It is a thorough cleaning process, often involving cleaning solutions and scrub brushes and a decontamination corridor. No single right way to do it.
72
Describe patient care at a hazmat incident and explain special requirements for specific exposures. (pp 2789–2790)
Corrosives: Are chemicals that include both acids and bases. Acids have a low pH (0-7) where as bases have a high pH (7-14). Substances with high or low pH can cause severe burns to the skin, eyes and mucous membranes.
S/S: skin irritation, reddening or other discoloration, blistering. Exposure of the mucous membranes to fumes can also cause burns, including severe life-threatening airway and lung burns.
Treatment: once decontaminated the treatment is generally supportive. Patent airway, oxygenation of the patient, treat for pain if indicated, and treat burns appropriately. Patient showing signs of Pulmonary Edema secondary to inhalation exposure may need treated with diuretics, you should always consult medical control to determine the proper course of action.
Solvents: (water is the universal solvent) may be liquids, solids or gases. Commonly encountered are paint thinner and nail polish remover. Solvent is substance that can dissolve another substance. Give off potent vapors that can be inhaled and can also be absorbed through the skin. Respiratory exposure can cause immediate pulmonary symptoms such as pulmonary edema. Prolonged dermal exposure also can include cardiac dysrhythmias and seizures. Some solvents can be metabolized into other toxic substances once absorbed in the body. Acetonitrile can be metabolized into a form of cyanide.
Treatment: may require extensive decontamination, almost to the point that this process may be considered a form of treatment. Require much of the same basic patient care as with any other exposure.
S/S: watch for vomiting if it has been ingested. This may further complicate or compromise the patient's airway and be a cause for chemical pneumonitis.
Pesticides: Exposure to organophosphate and carbamate pesticides as well as nerve agent chemical weapons can produce severe signs and symptoms by interfering with the enzyme acetylcholinesterase, which promotes uptake of the neurotransmitter acetylcholine.
Chemical Asphyxiants: any gas that displaces oxygen from the atmosphere is termed an asphyxiant. A chemical asphyxiant interferes with the use of oxygen at the cellular level, cyanide is an example of such an agent.
-Hydrogen cyanide is used in many industrial processes.
-Cyanide poisoning can also occur during exposure to the by products of combustion at structure fires, which is the most common exposure scenario for hydrogen cyanide.
-Treatment for cyanide poisoning: begins with use of amyl nitrite ampules, which should be inhaled for 15 seconds of every minute. This step should be followed by IV administration of 300 mg of sodium nitrite, followed by 12.5 g of sodium thiosulfate.
-Treatment option for smoke inhaled cyanide poisoning is the antidote hydroxocobalamin, or cyanokit. This is a precursor to vitamin B12 and is safe to use in the field to treat the cyanide component of smoke exposure.
-Treatment for carbon monoxide poisoning: removal of patient from the source and administration of 100% supplemental oxygen. Consider transport to an ED with hyperbaric oxygen capability.
Toxic products of combustion: are the hazardous chemical compounds released when a material decomposes under heat. combustion process is a chemical reaction and will generate a given amount of by products. A burning piece of Douglas fir gives off more than 70 harmful chemical compounds. This includes carbon monoxide, carbon dioxide, formaldehyde, cyanide compounds, and may oxides of nitrogen.
73
Define the terms persistence, volatility, contact hazard, and vapor hazard. (pp 2813–2814, 2817)
Persistence and volatility: are terms used to describe how long the agent will stay on the surface before it evaporates.
-Persistent and nonvolatile agents can remain on a surface for long periods, usually longer than 24 hours.
-Nonpersistent or volatile agent evaporate relatively fast when left on a surface in an optimal temperature range.
-An agent that is considered highly persistent can remain in the environment for weeks to months, where as a agent that is highly volatile will turn from liquid to gas within minutes to seconds.
Vapor hazard: Primary route of exposure through the respiratory tract, makes things like choking or pulmonary agents a vapor hazard.
Contact hazard: Agent lets off very little vapor, easily absorbed through the skin and the oily residue that remains on the skins surface is extremely difficult to decontaminate.
74
Explain the signs, symptoms, and emergency medical treatment of a patient with pulmonary agent exposure. (pp 2814–2815)
S/S: initial production of upper airway irritation and choking sensation. Patient later experiences: SOB, burning or tightness in the chest, hoarseness and stridor due to upper airway constriction, gasping and coughing, water eyes and drooling. with serious exposure: may experience pulmonary edema, complete airway constriction, and death.
Treatment: Best initial treatment is to ensure the patient has been removed from the atmosphere and decontaminated if there is visible evidence of contamination on the skin or clothes. Aggressive management of ABC's, with attention to ventilation and oxygenation and suctioning if require. Do not allow the patient to be active, activity will worsen their condition much faster. There are no antidotes to counteract these agents. Management of ABC's, IV access, allow patient to rest in position of comfort with head elevated, initiate rapid transport are the primary prehospital goals. Pharmacotherapy may include: standard treatment for bronchospasms, pulmonary edema, potential corticosteroid use, and PPV with supplemental oxygen.
75
Explain the signs, symptoms, and emergency medical treatment of a patient with nerve agent exposure. (pp 2816–2817)
Nerve agents all produce similar symptoms but have varying routes of entry.
Once the agent has entered the body through skin contact or through respiratory system, the patient will begin to exhibit a pattern of predictable symptoms. Severity of symptoms will depend on the route of exposure and the amount of agent to which the patient was exposed.
D: diarrhea
U: urination
M: miosis, muscle weakness
B: bradycardia, bronchospasms, bronchorrhea
E: emesis
L: lacrimation
S: seizure, salivation and sweating.
Treatment: Wear appropriate PPE, decontaminate patient's prior to treatment. Follow management recommendations for organophosphate poisoning outlined in toxicology.
76
Explain the signs symptoms, and emergency medical treatment of a patient with cyanide agent exposure. (pp 2815–2816)
In low doses: S/S associated with dizziness, light headedness, headache, vomiting.
Higher doses: S/S SOB and gasping respirations, tachypnea, flushed skin color, tachycardia, AMS, seizures, coma, apnea, cardiac arrest.
-Symptoms associated with the inhalation of a large amount of cyanide will all appear within several minutes. Death is likely unless the patient is treated promptly.
Treatment: Wear proper PPE, remove patient from source of contamination, after there is no liquid contamination, the patient's clothes must be removed to prevent off gassing in the ambulance. Trained personnel must decontaminate the patient before you can initiate treatment. Cyanokit is the antidote for cyanide agent exposure.
77
Define the terms dissemination , disease vector, communicability, and incubation. (p 2819)
Dissemination: is the means by which a terrorist spreads the agent, such as poisoning the water supply or aerosolizing the agent into the air or ventilation system of a building.
Disease vector: an animal that spreads disease, once infected, to another animal.
Communicability: how easily the disease is able to spread from one human to another human.
incubation: describes the period between the persons exposure to the agent and the onset of symptoms. Especially important for you to understand. Although a patient may not exhibit S/S that person may still be contagious.
78
Explain the signs symptoms, and emergency medical treatment of a patient with smallpox. (pp 2820–2821)
S/S: illness with start with a high fever(101-104 degrees F), body aches and headaches. malaise. Later S/S include: rash and blisters, bleeding of the skin and mucous membranes. All lesions will be identical in development. Blisters will begin on the face and extremities and will slowly move towards the chest and abdomen. In its most contagious form when the blisters are starting to form (10-12 days). Duration of this illness is approx. 4 weeks.
Treatment: standard precautions must be taken to prevent cross contamination, wear examination gloves, HEPA filtered respirator and eye protection. There is no specific treatment for patient's with small pox they should be provided with supplemental supportive care (Management of ABC's).
79
Explain the signs symptoms, and emergency medical treatment of a patient with viral hemorrhagic fever. (p 2821)
S/S: sudden onset of fever, weakness, muscle pain, headache, sore throat. Followed by vomiting and as the virus runs its course symptoms such as internal and external hemorrhaging.
Treatment: Standard precautions must be taken when you are treating patient's with this illness. no specific treatment, although two monoclonal antibodies are approved to treat the Ebola Zaire variation. Should be provided supportive care (management of ABC's) and treatment for shock and hypotension if present.
80
Explain the signs symptoms, and emergency medical treatment of a patient with plague. (pp 2823–2824)
S/S fever, headache, muscle pain and tenderness, pneumonia, shortness of breath, extreme lymph node pain and enlargement (bubonic).
Treatment: standard precautions, management of ABC's, provide supplemental oxygen and transport.
81
Explain the signs symptoms, and emergency medical treatment of a patient with botulinum toxin exposure. (p 2824)
S/S: dry mouth, intestinal obstruction, urinary retention, constipation, nausea and vomiting, abnormal pupil dilation, blurred vision, double vision, drooping eyelids, difficulty swallowing, difficulty speaking, and respiratory failure due to paralysis.
Treatment: management of ABC's, provide supplemental oxygen, transport. Ventilatory support may be needed due to paralysis of the respiratory muscle. A vaccine is available.
82
Explain the signs, symptoms, and emergency medical treatment of a patient with ricin exposure. (pp 2824–2825)
S/S:
-inhaled: cough, difficulty breathing, chest tightness, nausea, muscle aches, pulmonary edema and hypoxia.
-Ingested: nausea and vomiting, internal bleeding and death.
-Injection: no signs except swelling at the injection site and death.
Treatment: management of ABC's, no treatment or vaccine exists.
83
The killing of pathogenic agents by directly applying a chemical made for that purpose to a surface.
Disinfectant
84
Complete elimination of micro-organisms, with the exception of small bacterial spores.
High-level disinfection
85
A process, such as the application of heat, that removes all microbial contamination.
Sterilization
86
What is a vesicant?
A blister agent.
90
Describe how to park and position your emergency vehicle when responding to a call involving another motor vehicle. (Pp 2879-2880)
First on scene park 100 ft in front of the scene to protect the scene. If not first park after the scene, unless fire.
91
Discuss concerns related to specific human-made disasters including structural fires, construction failures, power failures, riots and stampedes, strikes, snipers and hostage situations, explosions, and technology disruptions. (pp 2863–2868)
Structural fires- falling or collapsing items, burns and respiratory problems, stay upwind, be prepared to evacuate, cardiac events (CO and cyanide poisoning can cause ECG abnormalities such as T wave aberrations.)
Construction failures and building collapse: building collapses, PPE considerations you may need. Lock out tag out review. May be called on to do a perimeter search, watch for portions of the structure that may not have collapsed initially (these areas may still be dangerous.
Power failures or disruptions: can be life threatening, especially if they persist for a prolonged time. Make a list of all patient is in your community who use electrically powered medical devices, such as ventilators. Identify locations that would be suitable for these patient’s and that have a sufficient emergency generator to power their equipment, such as local schools. Be ready to use radios and paper maps for navigation.
Riots, civil disputes, and stampedes: Dangers are multiplied when people are in a state of panic. Tear gas or pepper spray may cause eye irritation, you will need to protect yourself and will need water for eye irritation to treat large numbers of patient’s. Limited visibility in areas of fires or emergencies.
Strikes and labor disputes: can involve large groups of people, and may last a long time. Failure to cross a picket line to care for an ill patient simply because you support the cause of the strikers constitutes abandonment , gross negligence, and represents wounds for a lawsuit and for disciplinary action relative to your license or certification.
Sniper, shooter and hostage situations: EMS should be staged behind efficient cover and out of gun range (kill zone), Need to be out of the line of fire. Only enter an active shooter scene warm zone if warranted with police protection and proper PPE (ballistic vest and helmet). Members of press may praise and compliment you in an effort to win your trust and get you to say something “off the record”. This will come to haunt you and jeopardize the scene.
Explosions: Unintentional or intentional. The end result is the same: predictable injuries. Secondary and tertiary explosives may have been placed. IED’s and vehicle borne improvised explosive devices have been used in new waves of explosive attacks. Air particles are probably contaminated.
Cyber disruptions: a single disruption in an IT system can create a cascade of problems affecting large populations and areas.
92
What does the awareness level do in technical rescue incident
Maintain awareness and possessing fundamental knowledge, skills, and attitudes to preform scene-size ups.
Ability to identify general hazards, differentiating recovery of a patient from a recovery of a body, when an incident has unique hazards beyond their capabilities, summoning appropriate resources, preforming functions under direct supervision in existing level of training.
93
Explain the significance of potential violence that can occur on an emergency medical services call including the settings in which violence is more likely to occur. (pp 2876–2878)
-Anticipate an increased potential for violence when you are dispatched to a shooting or stabbing.
-Family members on scene’s have been known to become extremely emotional when they see a loved one that has been severely injured or killed. Your actions or lack of action (patient already deceased on arrival) may be enough to trigger a violent outburst from family or bystanders.
-There are times when there are almost no obvious signs of danger as responders approach the scene.
-Do your best to identify any potential indicators of violence (abnormal behavior, body positioning, harsh language, body language).
-Always remain vigilant and always do what you can to maintain the highest level of safety.
94
Discuss practical measures paramedics should take to reduce the likelihood of becoming a victim on the scene scene, including uniform style and body armor. (p 2877)
Maintain situational awareness. Proper awareness begins when you are dispatched. If you do not feel the scene is safe, request law enforcement personnel to secure the scene.
-Evaluate your services uniforms and advocate for easily identifiable characteristics such as unique colors or having them clearly marked EMS.
-Know which types of body armor to use for different levels of protection. It can help to absorb some of the impact and decrease the risk of a bulled penetrating the body. Ensure your body armor fits properly. It serves no purpose if not fitted properly and worm properly. Even if you are wearing body armor, you should not enter areas that you would not normally enter without law enforcement.
95
What does the operations level do in technical rescue incident
Provide emergency response, identify hazards, use equipment, and apply some limited technical rescue techniques to coordinate and preform, supervise technical search and rescue incidents.
96
3. Describe factors to assess during scene size-up that can help determine whether the scene is safe including specific indicators of violence. (pp 2877–2878)
Anticipate an increased potential for violence when you are dispatched to shooting or stabbing.
-patient’s or family may become a potential for violent outbursts from family or bystanders.
-Expect the unexpected and do your best to identify any potential indicators or violence.
-Don’t become so involved with patient care that you fail to see the possibility of physical harm. (Tunnel vision).
-If you expect there to be problems, contact law enforcement.
97
What does the technician do in a technical rescue incident
Provide emergency response to TRI’s, identify hazards, use equipment, and apply advanced technical rescue techniques to coordinate, preform, and supervise technical search and rescue incidents.
98
Discuss the role of standard operating procedures at a potentially violent incident. (pp 2878–2879)
SOP’s for responses to specific scenes, such as meth labs, civil disturbances , and hostage or barricade incidents, provide paramedics with specific steps to follow. May include information regarding which types of scenes require you to wear your body armor or how far away to stage for a barricaded subject.
-cannot cover every possible scenario, always use them as the basis for your approach to the scene or patient care, but be prepared to modify them if they interfere with the preservation of your or your partner’s life.
99
What DOT class includes explosives?
Class 1
100
What DOT class includes gases?
Class 2
101
What DOT class includes flammable & combustible liquids?
Class 3
102
What does the ICS Command in include?
Includes the Public Information Officer, Safety officer, and Liaison officer, designated incident command.
103
What does the Command do in the ICS management.
They establish strategic objectives, priorities, and a response plan to manage incident.
104
What PPE is needed for special rescues?
PPE must be bright
PPE must be flame or flash protective
Footweart must be highly visible, provide ankle support, traction, and chemical or thermal protection
Protective head gear
Safety googles
105
What does the operations section of the ICS do?
Manages tactical operations, including Standard triage, treatment and transport of Pt’s.
106
What additional equipment may be needed for special rescues?
Chalk or spray paint to mark already searched areas
Compass
First aid kits
Whistle
Handheld gps
Light sticks
Binoculars
107
Discuss disentanglement methods for displacing the seat,
In frontal or rear impact collisions the vehicle may be compressed. By displacing the seat, can relieve pressure on the driver and give rescuers more room for removal.
Move the seat backwards. That’s all the book says.
108
Discuss disentanglement methods by removing the windshield
Removing windshields, rear-windshields, and side windows can improve communication with rescuers and pt’s.
Glass saws may be used to remove windshields and rear-windshields. Sometimes you just need to roll down a window. If the roof needs to be removed, all glass must be removed from the vehicle.
109
Discuss disentanglement methods removing the roof.
Cutting the roof gives more access to the patient and a larger exit route.
When cutting the roof, it must be supported to stop from caving in.
110
Discuss disentanglement methods displacing the dash.
In frontal collisions the dash can be pushed down or backwards trapping the occupant.
Using a dash roll or pushing or rolling the entire front of the vehicle.
111
What is the UCAN method
U-Unit- unit identification and role at the incident
C-Conditions- what do you see when you approach? The nature and scope of incident, hazards, routes of entry, and egress.
A-Actions- clarify next immediate actions
N-Needs- identify any additional resources that may be needed immediately
112
Hazmat Diamond
Top - 12 o’clock : Red/Flammable
3 o’clock : Yellow/Reactivity
6 o’clock : White/Special Considerations
9 o’clock : Blue/Health
112
What DOT class includes flammable solids, spontaneously combustible materials, & dangerous-when-wet materials or water reactive substances?
Class 4
113
What does the finance devision of the ICS do?
Responsible for documenting all expenses of an MCI’s for reimbursement.
114
What does the Logistics Devision of the ICS do?
Responsible for communications equipment, facilities, food, water, fuel, lighting, and medical equipment and supplies.
115
What does the planning devision of the ICS do?
Solves problems as the arise during the ICS, and works to develop an incident action plan(IAP)
116
What is/ What does the command staff doing in the ICS?
They are the 3 important positions that help the general staff. The safety officer, PIO, and liaison officer.
117
Safety officer
Monitors scene for conditions or operations that may present hazards to responders.
118
Treatment for a vesicant?
Decontamination, Airway maintenance, IV, and burn protocols/ centers.
119
Least harmful form of radiation, will not penetrate through objects.
Alpha Radiation
120
Radiation that is more harmful than alpha, requires a layer of clothes to stop it.
Beta Radiation
121
Radiation rays that can easily penetrate the body, requires several layers of concrete
Gamma Rays
122
Public information Officers(PIO)
Provides public and media with clear understandable information. Post is Far from the scene and IC.
123
Liaison Officer (LNO)
Relays information and concerns among command, to the general staff and other agencies.
125
Summarize the safest way to approach a van. (p 2881)
Move 10-15 feet away from the van’s passenger side, (do not belly in as someone might be able to grab you). Remain clear of the vans side door throughout the approach. Walk parallel to the van until you are at 45 degree angle forward of the A post. Gives you best visibility inside of the van but keeps you at a safe distance until you can determine the situation is secure.
126
Discuss concerns related to gang territories and the measures paramedics can take to work safely in these areas. (pp 2884–2885)
Always be mindful of situations. Gangs don’t want to see us rescuing someone they just tried to kill and may hurt you in the process.
Have situational awareness
127
Describe how to retreat from danger. (p 2882)
Safest means of retreat is to back away and call for law enforcement using cover and concealment as you move.
128
Describe how to approach a residence safely. (p 2882)
One person should approach the house while the other stays a short distance away. This would allow for one person to call for help if violence erupts. Listen for loud, threatening voices. Glance through window for anything suspicious. Look for visible weapons.
129
Discuss the procedures paramedics should follow at mass shootings and at scenes involving active shooters or snipers. (Pp 2886-2888)
Medics must take direction from law enforcement
Triage will be based on pt safety
Responding units stay in staging area until the scene is secured by law enforcement personnel.
Stage approximately 0.5-1 mile away from the actual scene
Line of sight and line of fire locations relative to windows must be avoided
130
Describe primary and secondary types of exits. (p 2883)
Primary exit: is the main means of escape if violence erupts, usually the door that was used to enter the building.
Secondary exit: is another means of egress, this might be a rear door or a window.
131
Define cover and concealment; include an example of each. (p 2889)
Cover- objects that are difficult or impossible for bullets to penetrate. (Trees, utility poles, mail collection boxes, etc.)
Concealment- obscures your position from the shooter. (Tall grass, shrubs, and dark shadows)
132
Discuss techniques to use when responding to a call involving potential domestic violence. (pp 2883–2884)
Wait for law enforcement before you enter.
-Use good communication in conjunction with eye contact and appropriate body language to help defuse the situation and keep tempers from flaring. Use proper pace, and pitch with speaking with the patient, family members, and bystanders.
-Maintain professional and respectful tone to help ease tensions and facilitate a safe environment in which you may treat the patient.
-Do not “return fire”
-Show the person respect, this will defuse the situation.
133
Explain the measures paramedics should take to increase safety in a hostage situation. (pp 2888–2889)
Don’t do anything to attract unwanted attention and do not stare at your captors.
-Your only chance for survival is to maintain your role as a bargaining chip.
-Develop a non-threatening image by removing badge, collar pins, and patches. Turn your uniform shirt inside out.
-Ask to treat any wounded patients, if possible for minor injuries. Will serve to help you gauge the intentions of your captors, as well as make you seem less threatening. Consider offering to treat the injuries of any captors, this may help your captors perceive you as less of a threat, making you more valuable.
134
Describe the role self-defense can play in the practice of paramedicine. (pp 2891–2892)
Defensive moves may allow you to resolve the situation or allow you enough time to retreat to a safe area.
Use physical force only as a defensive technique, not an aggressive motion.
-The amount of defensive force needed to protect yourself varies with each incident. But if you believe your life is in imminent danger, any actin that gets you out of the situation is a reasonable level of force.
-the idea is to not cause harm to the attacker, but rather to escape to a safer location.
135
Discuss the measures paramedics should take to preserve evidence at a crime scene while still providing optimal patient care. (Pp 2893-2896)
Avoid any bullet holes or knife marks ink the clothing. Cut along the seems of the clothing so the large surfaces remain intact. Do not shake the clothes because valuables, including trace evidence may fall from the pockets to the floor.
-Do your best to not leave any of your own equipment on scene.
If you must remove a piece of evidence (clothing), place each piece of evidence into a brown paper bag. If the item is saturated, place the paper bag holding it into a plastic bag for biohazard control.
-Limit your time and interaction with the crime scene and ALWAYS wear gloves when entering.
-Be mindful of bullet vainglorious, weapons, blood splatter, and puddles. Whenever possible, walk around such evidence.
-DOCUMENT, DOCUMENT, DOCUMENT. (What you saw, heard, told, smelled, or disturbed and the Chain of custody of any items that were presented to you, what you found on the patient or descendent. Description of the scene. How many patients or defendants were present, victim supine or prone? Any weapons? And characteristics of the scene that were noteworthy.
136
Identify signs of human trafficking. (p 2893)
Signs of: physical abuse or injury.
-accompanied everywhere by a person who speaks for the patient or will not allow the patient to speak when addressed directly.
-Appears fearful or under the control of another person.
-Ongoing health issues that have not been addressed.
-Unfamiliar with the neighborhood in which the patient is located.
-appears to be traveling with a minimal or inappropriate amount of luggage or belongings.
-Lack of identification documents or does not have control over personal identification documents.
-Patient is a juvenile engaged in commercial sex acts.
