Preparing for Emergency Situations. Overview of the EMS System. New CPR/First Aid Guidelines

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Harry Gabriel Cross
5 years ago
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2 The Big Emergencies Preparing for Emergency Situations Emergency Care Training Overview of the EMS System New CPR/First Aid Guidelines

$Main Entry: emer gen cy Pronunciation: \i-`mər-jənt-sē\ Function: noun Inflected Form(s): plural emer gen cies Usage: often attributive Date: circa 1631 1 : an unforeseen$

3 Main Entry: emer gen cy Pronunciation: \i-`mər-jənt-sē\ Function: noun Inflected Form(s): plural emer gen cies Usage: often attributive Date: circa : an unforeseen combination of circumstances or the resulting state that calls for immediate action 2 : an urgent need for assistance or relief <the governor declared a state of emergency after the flood>

6 CAB S x 3: Circulation Airway Breathing Severe Bleeding Shock Spinal Injury

7 Sudden Death Sudden Cardiac Arrest Hypotropic Cardiomyopathy (HCM) Commotio Cordis Complications from Heat Stroke

8 Sudden Cardiac Arrest Hypertrophic Cardiomyopathy Leading cause of sudden cardiac death in young athletes Undetectable in basic physical examination without echocardiogram

9 Commotio Cordis Heart Concussion Caused by direct blow to chest during repolarization (15 to 30 milliseconds prior to T-Wave) Often unresponsive to cardiac treatment (defibrillation, ACLS) Young athletes at risk due to pliability of chest wall.

10 Complications from Heat Stroke Often occurs during initial days of practice Dehydration combined with intense exercise High temperature and humidity True medical emergency

11 Airway Compromise Lack of a patent airway is the number one cause of death in pediatric trauma patients

12 Types of Airway Compromise: Mechanical Asthma Soft tissue blockage Foreign bodies (Choking) Bleeding Aspiration Laryngeal Trauma

13 Respiratory Arrest Can have many causes If untreated, leads to cardiac arrest

14 Pneumothorax and Hemothorax Can occur in contact and collision sports Most common in football and rugby

15 Chest/Abdominal Trauma Head injury (intercranial, subdural, or epidural bleed Hemothorax Ruptured Spleen Liver Lacerations Kidney, Liver Contusions Fractures (Emergencies)

16 Subdural Hematoma Epidural Hematoma Intracranial Bleed

17 Kidney, Liver Contusions Ruptured Spleen Kehr s Sign: left shoulder pain Medical Emergency

18 Hypovolemic Hemorrhagic Cardiogenic Neurogenic Psychogenic Hypoglycemic (Insulin) Septic Anaphylaxis

19 C-spine Injury Initial care of spine-injured athletes has a significant impact on outcome

21 Personnel Rules Equipment Planning Arena Rehearsal Evaluation

22 PERSONNEL Who makes up your Sports Emergency Care Team? Athletic Trainers EMS Personnel Physicians Hospital Staff Coaching Staff Athletic Training Students Athletics Staff Athletes Parents? Others?

23 RULES Are your protocols consistent with those of the responding EMS units? The time to find out your protocols differ should never be during an emergency

24 EQUIPMENT Have the right equipment Airway Adjuncts Backboards Splints Communications Equipment Transportation Devices Resuscitation Equipment Facemask Removal Tools Diagnostic Tools Lifesaving Medications

25 Airway Adjuncts

28 Manual Mechanical

29 YES!

30 Therapeutic Oxygen and Emergency Oxygen

31 Both supplied in a container holding medical grade oxygen. Both have a pressure reducing system. Both have a contents indicator. Both have a mask or other means of delivering oxygen.

32 Emergency Oxygen System flow rate of at least 15 liters per minute (lpm) can operate for at least 15 minutes. Therapeutic Oxygen System flow rate of less than 6 lpm may last less than 15 minutes delivers oxygen via an adjustable flow regulator.

33 Therapeutic Is considered a drug and may only be distributed to persons holding a written Rx from a licensed physician. Emergency Is not considered a drug, is available as an Over the Counter (OTC) product with no Rx required.

35 Backboards

36 Splints

37 Communications Equipment

38 Transportation Devices

39 Resuscitation Equipment

40 Why should ATCs be trained in the use of AEDs? Can t we just wait for EMS? NO!

41 A SCA victim s chances survival decrease by seven to 10% for each minute a shock from a defibrillator is delayed.

42 Fact: CPR alone yields a survival rate of below 10%. Fact: National average EMS response time is 10 to 12 minutes. Fact: Studies have shown that CPR followed by rapid defibrillation within 3-4 minutes can yield a success rate of 70% or higher.

43 Facemask Removal Tools

44 14% of ATC s covering football games did not have a facemask removal tool. Mean time to produce tool in simulated emergency during practice and game situations was 46 seconds. (Rehberg, Kleiner & Almquist, 2000)

45 Diagnostic Tools

47 Life Saving Medications

48 PLANNING Emergency Action Plans- a detailed document that describes: Who will act What actions should be taken How those actions will be carried out Should be site-specific

49 Know the venue Access to Field Field Type Field Conditions Routes of Egress Location of EMS Location of Equipment Communication Issues ARENA

50 WATCH THE GAME!

51 REHEARSAL

52 EVALUATION Create an after action report What worked? What didn t? Learn from mistakes Fine tune emergency action plan

54 First Aid Emergency Medical Responder (formerly First Responder) Emergency Medical Technician Advanced Emergency Medical Technician Paramedic

55 Differences in philosophy have made programs inconsistent. Range in time commitment from 3 to 40 hrs. Most programs are diagnosis based. Available from many providers: American Red Cross National Safety Council Medic First Aid American Safety & Health Institute American Heart Association American Academy of Orthopedic Surgeons/ECSI

56 First Level of EMS training. State Certification in PA and NY (may be coming soon in NJ). Training available nationally from ARC, NSC, and AAOS/ECSI. All programs soon to follow National Educational Standards (2009). 40 to 50 hour program.

57 State credential or National Registry. 110 to 130 hour course. Follows National Standard Curriculum for the EMT-Basic (1994). Also known as EMT-Defibrillation (EMT-D) BOC awards 40 CEUs for completing initial EMT course

58 Anatomy & Physiology: 2.5 hours Vital Signs: 2 hours Lifting and Moving: 3 hours Airway: 6 hours Patient Assessment: 20 hours Bleeding and Shock: 2 hours Soft Tissue Injuries: 2 hours Musculoskeletal Care: 4 hours Injuries to the Head and Spine: 4 hours

59 General Medical: 30 hours General Pharmacology: 1 hour Respiratory Emergencies: 2.5 hours Cardiac Emergencies: 7 hours Diabetic/Altered Mental Status: 2 hours Allergies: 2 hours Poisoning/Overdose: 2 hours Environmental Emergencies: 2 hours Behavioral Emergencies: 1.5 hours Obstetrics: 2 hours Practical Lab time: 7 hours

State credential or National Registry Advanced level of training. 500+ hours.

60 State credential or National Registry Advanced level of training hours. Can administer specific medications. National movement to make paramedic training an A.S. degree programs. Some programs are CAAHEP accredited.

61 ATC s say: Fracture Dislocation Sprain Strain EMT s say: Painful, Swollen, Deformed Extremity

62 Prevent further injury. Perform a patient assessment. Correct life-threatening problems. Stabilize patient. Transport patient.

66 Many states have a two-tiered system Basic Life Support Advanced Life Support

67 Types of EMS Agencies Paid vs. Volunteer Municipal vs. Contract Services Ambulance Corps or First Aid Squads Fire based services Police based services

68 EMS Issues to consider: Oversight Level of training Operational requirements Lack of volunteers Training programs differ on protocols Respect

69 AC-6. When appropriate, obtain and monitor signs of basic body functions including pulse,blood pressure, respiration, pulse oximetry, pain, and core temperature. Relatechanges in vital signs to the patient s status. AC-7. Differentiate between normal and abnormal physical findings (eg, pulse, blood pressure, heart and lung sounds, oxygen saturation, pain, core temperature) and the associated pathophysiology. AC-9. Differentiate the types of airway adjuncts (oropharygneal airways [OPA], nasopharyngeal airways [NPA] and supraglottic airways [King LT-D or Combitube]) and their use in maintaining a patent airway in adult respiratory and/or cardiac arrest. AC-10. Establish and maintain an airway, including the use of oro- and nasopharygneal airways, and neutral spine alignment in an athlete with a suspected spine injury who may be wearing shoulder pads, a helmet with and without a face guard, or other protective equipment. AC-11. Determine when suction for airway maintenance is indicated and use according to accepted practice protocols.

AC-16. Explain the indications, application, and treatment parameters for supplemental oxygen administration for emergency situations. AC-17.

70 AC-16. Explain the indications, application, and treatment parameters for supplemental oxygen administration for emergency situations. AC-17. Administer supplemental oxygen with adjuncts (eg, nonrebreather mask, nasal cannula). AC-18. Assess oxygen saturation using a pulse oximeter and interpret the results to guide decision making. AC-29. Assess core body temperature using a rectal probe. AC-30. Explain the role of rapid full body cooling in the emergency management of exertional heat stroke. AC-31. Assist the patient in the use of a nebulizer treatment for an asthmatic attack.

Emphasis on high quality CPR Compression depth at least 2 Compression rate at least 100/min Change from ABC to CAB Elimination of Look, Listen and Feel Cricoid

71 Emphasis on high quality CPR Compression depth at least 2 Compression rate at least 100/min Change from ABC to CAB Elimination of Look, Listen and Feel Cricoid pressure no longer recommended Focus on team resuscitation AED use now includes infants Skill performance should be assessed during 2-year certification period

72 Hands Only CPR? Untrained and Lay rescuers only

73 Epinephrine Medical assistance (physician) suggested before second dose administered

74 Supplementary Oxygen Not recommended as a first aid measure for shortness of breath or chest discomfort Should be considered as first aid measure for divers with decompression injury

75 Aspirin administration for chest discomfort Advise patent to chew 1 adult or 2 baby aspirin

76 Hemostatic agents not recommended Tissue destruction Thermal injury

79 For more information contact: Robb S. Rehberg, PhD, ATC, CSCS, NREMT Coordinator of Athletic Training Clinical Education William Paterson University Wightman Gymnasium 300 Pompton Road Wayne, NJ Tel. (973)

Canadian Red Cross Summary First Aid Technical Changes for 2011 Implementation

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