by dat1gi


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Underlying prinicples to operating an emergency vehicles
(the rules)
-Safetly is first priority
-Can exceed speed limit if not endangering lives or poperty
-Can drive wrong way
-Can turn in any direction
-Can park anywhere
-Can leave ambulance in middle of street or intersection
-Can cautiously go though red light
-Can pass in no-passing zone
-Need valid driver's license
-Must be responding to emergency
-Must use warning devices
Definition of multiple casualty incidents (MCI)
Any event that places excessive demands on personnel and equipment, typically 3 or more patients.
***Most common cause of MCI
All steps of using STARTS triage including vital limits
Take no more than 30 seconds to categorize to red, yellow, green, or black.

Respiratory status
Perfusion status
Mental status

Ambulatory or walking wounded = green
Respiratory rater over 30 = red
No repsiratory then open airway, No breathing = dead = black. Else breathing over 30 = red.
If RR = less than 30 go to Perfusion.

If cap refil is less than 2 seconds and pulse present go to next section.
Cap refil over 2 seconds or no pulse = Red.

Mental status able to follow commands = Yellow
Altered mental status and can't follow command = red
What level of training for hazmat you recieved during EMT-B
Awareness

Recognize - Avoid - Isolate - Notify
Definition of disaster
A sudden catastrophic event that everwhelms natural order and causes great loss of property or life
How to park your vehicle during a hazardous situation
Uphil
Upwind
Upstream
and away from danger
Defnition of weapon of mass destruction
Weapons intended to cause widespread and indiscriminate death and destruction
Definition of hazardous material
Material that in any quantity poses a threat or unreasonable risk to life, health or property if not properly controlled during manufacture, processing, packaging, handling, storage, transportation, use and disposal
The appropriate actions to perform while driving an ambulance on wet roads
-keep mirros cleared of water
-avoid sudden breaking and sudden moves of wheel
-if about to go through puddle slow down and turn on wipers, as you leave water tap brake to dry it out. if ambulance pulls to one side, pump brake slowly to dry brake out
-if you hydroplane, hode wheel steady, take foot off gas, gently pump break. if you turn wheel side to side or slam break you may skid
Your safety responsibilites when operating an ambulance
Responsible for all safety

Personal, partner, patient,  and public
How to set up landing ones for different size helicopters
-area clear of obstructions and about 150 ft from collision vehicles.Small helicopter 60ft  sided square, or 100ft at night - Medium or large need about double.
-if on highway, stop traffic on both directions
-Consider wind direction
-mark each corner with highly visible device
-put 5th device for wind direction
-wet down if dusty
-spectators at least 200ft away. ems 100ft away
-assign one person to guide pilot
-give primary care to patient and follow pilot and crews instructions
-extremely caustion about rotor blades
-never approach helicopter until pilot says its safe
-secure loose items so nothing gets blown
-no smokeing within 50ft
-if lands on incline, only approach form downhil
-never point spotlight up at helicopter that is on its final approach at night
-helipad, site designed for optimal landing of the aircraft
Know the infection control procedures that are completed post run
-dispose of sharps
-wash hands
-clean, disinfect or sterilize contaminated equipment. 1 first clean up visible spill of blood, vomit, or fluid. 2 then disinfect reusable patient care equipment
-launder soiled clothing and linens
-dispose of infectious wastes
Know all the phases of an ambulance call
1 daily prerun vehicle and equipment preparation
2 dispatch
3 en route to scene
4 at the scene
5 en route to recieving facility
6 at the receiving facility
7 en route to the station
8 post run
Know about high visibility apparel on the schene of a MVC
Class 1 - Low moving traffic 25mph or less and in parking lots

Class 2 - 25mph or greater traffic and for personnel whose attention is diverted from traffik

Class 3 - work greatly diverts their attention from roadway and where they are at serious risk from harads created by moving vehicles
When considereing your safety know the most common hazards that must be dealt with at an accident
-moving traffic
-visibility impairment, inexperianced drivers, loud music, cell phone use, distraction from conversation, inclement weather, intoxicated, medical conditions that impair reflexes, high speed,night time
What is the most common rescue situation?
Motor vehicle crashes
Know the different ways and be able to describe the basic ways a rescuer gains access, simple and complex
-Simple access is where tools are not required
-Complex acces requres tools and specialez equipment

-Residential access
1 unlocked door or windows
2 if open window blocked by screen, but screen
3 break window
4 inform patient what you are going to do
5 wear protection
6 stand alongside window to be broken
7 use object like flashlight or iron to break
8 clear broken pieces of glass

Motor Vehicle: simple, just use door

complex
1 wear ppe
2 locate window furthest from patient
3 break glass
4 remove proken class
5 attempt to unlock door
***Know how to gain full force access

Know the purpose of extrication
To remove the patient as rapidly and safely as possible from the wreckage - most commonly from a vehicle collision - in which he is entrapped
Know about hazmat placards
BLUE-health hazard
RED-firehazard
YELLOW-reactivity
WHITE=specific or special hazard

Scaled 0-4 or normal to deadly
Know about equipment used to stabalize vehicles
Upright vehicle.
-plastec step chocks
-box crib with wedges

Vehicle on side.
-stabilizing pole
-pulling device, cable or chain

Vehicle on roof
-box crib
-wedges
Know the general rules of hazmat rescue
1 Protect safety of all rescuers and patients
2 Provide patient care
3 Decontaminate clothing, equipment, and the vehicle

Also avoid risking your life or health if the only threat is to the environment
Know the different zones on a hazmat scene
Hot - contaminated
Warm - control
Cold - safe
Know the major principles about radiation related accidents
1 Protect yourself and others from contamination as your first priority
2 No emt should ever attempt to decontaminate a radiation patient

Time is critical factor in managing radiation emergencies
Know the problems that can be caused by radiation
Radiation sickness - lasts few days to 7 or 8 weeks. Nausea, vommiting, diarrhea, hemorrhage, weight loss, appetite loss, malaise, fever, sores in throat and mouth. Affects immune system lowering resistance

Radiation injury - exposed to large amounts of less penetrating particles such as beta particles. Hair loss, skin burns, generalized skin lesions

Radiation poisoning - exposed to dangerous amounts of internal radiation. Serious disease including cancer and anemia
Know all the designated sections of the Incident Command system
1 command
2 operations
3 planning
4 logistics
5 finance and admin
Know all about JUMP START
triage system for pediatric patients. child will typically go into repiratory arrest followed by circulator failure and cardiac arrest. opening airway and providing ventillation  to try to stimulate spontanious ventillation or a jumpstart to their breathing. take 15 seconds

walking = green

breathing exists go to repiratory rate
no breathing=open airway
if spontaneous breathing happens = red
if still no breathing check pulse
no pulse = black
if pulse ventilate for 15 seconds by mouth to mask if no breathing = black. If breathing restored or jumpstarted mark as RED

respiritory rate
under 15 and over 45 = red
between 15 and 45 asses pulse

palpable pulse
no pulse = red
pulse exists check avpu

avpu
if avp = yellow
if u = red
Know how patients get moved from triage to treatment unit
Patients should be moved from triage to treatment in order of their priority. immobilize all patients before moving them if necessary. place them in rows according to triage category

1st priority is red
2nd priority yellow
lowest priority green

Know all about effective disatster assistance
- families of patients need and deserve accurate information
-reunite families as soon as possible
-group patients with family and neighbors
-encourage patients to do necessary chores
-provide structure for emotionally injured and let them know your expectation, tell them whats happening
-help patients confron the reality of the disaster
-dont give false assurances
-a patient may refuse offers of help due to culure, threats to self image or inaccurate seriousness of situation
-identify high risk patiends
-identify people who are in a positino to help those in need
-arrange for those involved to get follow up care and support
Know about evacuation and warning messages and what they consist of
Contains
- the nature of the disaster and its estimated time of impact on an area. if possible expected severity
- safe routes to take out of the area
- appropriate distinations for those who evacuate, indicating where food and shelter will be available
What does CBRNE stand for?
CBRNE
chemical
biological
radiological
nuclear
explosive
Know what weapon of mass destructions causes the greatest damage
Conventional bombs, explosives, and incendiary devices
Know about volatility and persistence
Volatility - the tendency of a chemical agent to evaporate. A volatile liquid evaperates easily and creates a dangerous breathable vapor

Persistence - a characteristic of agents that do not evaporate quickly and tend to remain as a puddle for long periods of time
Know all the major types of chemical agents
1 Nerve agents
2 Vesicants
3 Cyanide
4 Pulmonary agents
5 Riot control agents
6 Toxic industrial chemicals
Know how to treat patients exposed to a vesicant
--Immediate Irrigation--

-treatment during first few minutes is crucial to preventing damage
-irrigate with water or chemical decontamination kit
-continue to irrigate the areas of exposure
-manage the blistering as a chemical burn
-apply a dry sterile dressing on are after being flushed
-patch eye injury after being flushed
Know the different pneumonia like agents (3)
1 Anthrax - Incubationt periad is 1-6 days. Fever, fatigue, nonproductive cough, mild chest discomfort with progressing dyspea, diaphoresis, stridor, cyanosis, shock, and death can occur within 24-36 hours.

2 Plague - Incubation period is 3-6 days. Headache, coughing blood, severe dyspnea, high fever, stridor, cyanosis, and death from repiratory failure, circulatory collapse and bleeding disorder

3 Tularemia - chest pain that worsens when breathing, headache, malaise, nonproductive cough and weight loss

Other 2 include Q fever and glanders
Know about alpha and beta radiation
Alpha - Heavy and slow moving particle that travels only inches in air and is stopped by clothing and skin. Very dangerous internal damage. Short range. Can be ingested or inhaled

Beta - Low speed, low energy particly stops after 6-10 ft of air. Serious threat if ingested from contiminated food or inhaled from airborne particles
Know about fall out
Fallout iws the second form of radiation exposure

It is radioactive dust and particles that may be life threatening to people far from the epicenter of the detonation. May scatter  a few miles or around the world. Most immediate danger in 48 hours and with close proximity.
Know about radiological dispersel devices
Device where the radiation doses are strong enough to cause illness or injury well beyond the blast radious
Know about thermal burns in nuclear detonation
Causes most deaths and injuries. Anything in close proximity is incinerated.  Travels through air. Can Sheild with opaque object. Eye injury can occur.
Know about carbon monoxide poisoning in older ambulances and how to prevent it
Any amout of carbon monoxide over 10 parts per million can be dangerous.

Can come from
- ambulance's exhaust gases
- supplemental equipment that is powered by gas or petroleum
- exhaust gases of vehicles parked next to or traveling by ambulance
- greater outside air pressure which forces CO into ambulance

S&S: yawning, dizzy, dimmed vision, headache, irregular heart rhythm, nausea, vomitting. Worse: seizures, coma and death

Prevent CO poisoning by
- frequent tune ups
- adequate exhaust system that discharges beyond side of vehicle
- keeping rear windows shut
- making sure doors shut tightly
- covering any openings to outside
- not using ventilation exhaust fans or static roof vents
- keeping heater or AC on
- not using supplemental gas or petroleam powered equipment inside ambulance
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