As an Emergency Medical Responder, you should have the appropriate equipment and supplies with which to assess a patient, provide emergency care, and assist other healthcare professionals:
Personal protective equipment (PPE)
Basic wound care supplies
Instruments to measure blood pressure
Additional items as needed
The six phases of a typical EMS response are the following:
Detection of the emergency
Reporting the emergency (the call made for assistance) and dispatch
Response (medical resources sent to the scene)
On-scene care
Care during transport
Transfer to definitive care
Air medical transport may be necessary when the condition of one or more patients is critical. As an Emergency Medical Responder, you must observe the following safety considerations:
If your unit is designated to land the helicopter, you will need to locate a secure landing zone. You must locate an area that is easily controlled for traffic and pedestrians.
You should allow at least 100 feet by 100 feet to land any helicopter.
The area should be free of overhead obstacles, such as wires, trees, and light poles. It should also be free of debris and should be relatively level. The ground should be clear of rocks and grooves and must be firm enough to support the aircraft.
Mark the corners of the landing area with light sticks or cones. Alternately, you can use emergency vehicles with headlights directed toward the landing area (but not at the approaching aircraft).
If the landing area is dirt, lightly moisten the area with water, if possible.
Under no circumstances should anyone be allowed to enter the landing zone after it has been secured.
If you are the ground contact, you may be responsible for relaying important information to the responding flight crew about the patient's condition.
Extrication is a means of freeing a trapped, or otherwise inaccessible patient, and getting him or her to a treatment area.
As an Emergency Medical Responder, you will be responsible for giving necessary care to the patient before extrication. You will also make sure that the patient is removed in a way that minimizes further injury. Some Emergency Medical Responders are also responsible for extrication procedures.
All persons involved in an extrication operation must wear proper protective clothing. At least one member of the team should be in full protective clothing, including fire gear.
The two types of gaining access to a patient are simple and complex:
Simple access does not require equipment. Opening a door, rolling down a window, and having the patient unlock a door are examples of simple access.
Complex access requires the use of tools, special equipment, and special training.
After the patient is extricated, move him or her away from the incident area to an appropriate treatment area.
Disentanglement is the moving or removal of material that is trapping a victim.
As defined by the National Fire Protection Association (NFPA), a hazardous material is a substance (solid, liquid, or gas) that, when released, is capable of creating harm to people, the environment and property. Hazardous materials may be biological agents, other disease-causing agents, a waste, or a combination of wastes. These materials may be found in vehicle crashes, on railroads, in pipelines, in storage containers and buildings, in chemical plants, and in acts of terrorism. Hazardous materials can also be found in the home.
A hazardous substance can be identified using a number of resources:
U.S. Department of Transportation (DOT) Emergency Response Guidebook
United Nations (UN) classification numbers
NFPA 704 placard system
UN/DOT placards
Shipping papers
Material safety data sheets
The first phase of dealing with a hazardous materials incident is recognizing that one exists. As always, your personal safety is your priority in any emergency scene. Take the following steps in dealing with a hazmat emergency:
Report the incident to an EMD so that the appropriate agencies can be notified.
To maximize safety, approach and park uphill and upwind of a hazardous materials scene.
Stage a minimum of 2,000 feet from a suspected hazardous materials incident. If possible, attempt to identify the material using placards or ID numbers through binoculars while remaining at a safe distance from the area.
Avoid contact with the material. If there is no risk to you, remove patients to a safe zone.
Note the following safety zones:
The safe zone (also called the cold zone) is an area safe from exposure or the threat of exposure.
The warm zone is a controlled area for entry into the hot zone. It also serves as the decontamination area after exiting the hot zone. All personnel in the warm zone must wear appropriate protective equipment.
The hot zone is the danger zone. The size of the hot zone depends on the characteristics of the chemical, the amount released (or spilled or escaped), local weather conditions, the local terrain, and other chemicals in the area.
A mass casualty incident (MCI) may also be called a multiple-casualty incident or multiple-casualty situation (MCS). An MCI is any event that places a great demand on resources—equipment, personnel, or both.
The START triage system is used by many systems in dealing with MCIs. It stands for Simple Triage And Rapid Treatment.
Four areas are evaluated during your initial assessment:
The ability to walk (ambulation)
Respirations
Perfusion
Mental status
Based on your assessment findings, you categorize each patient according to one of four categories. Color-coded triage tags that correspond with these categories are placed on the patient and used to identify the level of injury sustained:
The JumpSTART triage system was developed for use with children. It specifies how the four color-coded tags are applied to pediatric patients.
The National Incident Management System (NIMS) was created to provide a consistent nationwide template that allows all government, private-sector, and nongovernment agencies to work together during domestic incidents.
The Incident Command System (ICS) is an important part of NIMS. The ICS is a standardized system developed to assist with the control, direction, and coordination of emergency response resources. The ICS can be used at an incident of any type and size.
An Incident Commander (IC) is responsible for managing all operations at an incident site. The Incident Commander has three priorities:
Life safety
Incident stability
Property conservation
At the beginning of an incident, the Incident Commander will be the senior Emergency Medical Responder who arrives at the scene. As more resources arrive, command is transferred to another person based on who has the primary authority for overall control of the incident.
Depending on the size of the incident, the Incident Commander may assign to others the authority to perform certain activities. Scene operations may be broken down into groups, such as treatment and extrication.
If you arrive on the scene of an MCI where the ICS has been established, report to the command post. Find out who the Incident Commander is. Identify yourself and your level of training. Follow the directions given by the Incident Commander about your assignment.
