EMS POINTS TO PONDER
The EMS operations in these photographs offer a number of points to ponder. We’ll give you a few, in no particular order of importance. Write to us with your own operational considerations of the scenarios depicted, and we’ll publish them in a future issue.
(Photo by Roger Courtney.)
- Bandaging skills are essential to quality emergency care. Too often hemorrhage continues because the bandaging technique distributes the pressure over the entire wound site rather than focusing on the bleeding source.
- Often patients in hypovolemic (blood-loss) shock are anxious, apprehensive, even combative, to a point of interfering with the efforts of emergency personnel. This behavior may be accentuated if the patient is intoxicated or “high.”
- Nonrebreather masks are the preferred method of oxygen administration for patients in shock because they deliver the highest concentration of oxygen.
(Photo by Keith Cullom.)
- Basic life support is the mainstay of cardiac-arrest therapy, but early defibrillation, when available, takes preeminence in the presence of a patient with ventricular fibrillation.
- The rescuer operating the defibrillator always should verbalize a warning of the shock to other rescuers and visually confirm that everyone is clear of the patient.
- Do not interrupt CPR for more than seven seconds, except in special circumstances such as for intubation, defibrillation, or moving the patient. Avoid interruptions of more than 30 seconds.
(Photo by E. Joseph Hoffman.)
- Consider the possibility of inhalation of superheated air, steam, and toxic products of combustion with any fire victim. Each of these agents can result in upper-airway obstruction due to edema and laryngospasm and associated bronchospasm and lower-airway edema.
- Evaluating the adequacy of ventilation is not a totally objective process. Patients may be found with various degrees of respiratory depression that make decision making somewhat ambiguous.
- Adequate ventilation is evaluated overall by observing chest rise and respiratory rate.
- The emergency care of respiratory depression or arrest is directed primarily toward establishing an airway and initiating positive-pressure ventilation with 100 percent supplemental oxygen.
(Photo by Jack Jordan.)
- Research shows that if the severely injured patient can be in surgery within one hour of the accident, his/her chances of survival are greatly enhanced. This one-hour window is known as the “Golden Hour.”
- Generally, the EMS system is given 10 minutes (1/6 of the “Golden Hour”) of on-scene time to assess, correct the immediate lifethreatening problems of, package, extricate, and begin transporting the critical or potentially critical patient.
- EKG evaluation to detect life-threatening dysrhythmias is appropriate when circumstances of decelerating trauma indicate possible myocardial contusion (for example, in cases involving a collapsed steering wheel).
(Photos by Joe Starling.)
- The visual examination of an auto accident and determination of whether passenger restraint devices were used can tell you a great deal about what happened to the patient and what injuries to expect.
- Protecting the patient from flying debris and breaking glass during extrication is one of the rescuer’s primary concerns. Assigning an EMT to explain the rescue process to the patient while continuing patient care can help reduce the fear and anxiety caused by the unfamiliar sounds of rescue tools.
- If patient transportation is not 6n immediate concern, splint long-bone fractures to immobilize the adjacent joints (the joints above and below the fracture).
If you would like to submit photos for Rescue or EMS Points to Ponder, send them with a short description of the incident to: Points to Ponder, Fire Engineering. Park 80 West, Plaza II, 7th Floor, Saddle Brook. NJ 07662.
