The EMS operations in these photographs offer a number of points to ponder. Well give you a few, in no particular order of importance. Write to us with your own operational considerations of the scenarios depicted, and well publish them in a future issue.

Los Angeles, California: Los Angeles City firefighters and paramedics work for two hours to free the driver of an overturned vehicle that struck a tree. (Photo by Keith Cullom.)

  • Consider the mechanism of injury: If there is soft tissue damage to the head, face, or neck due to a sudden deceleration injury, assume there is a spinal injury and treat accordingly.
  • Take every precaution against converting a possible spinal injury into spinal cord damage by immobilizing the cervical spine before removing the patient.
  • Secure patients having possible spinal injuries found in seated positions to short spine boards or vest-style extrication devices and then transfer them to a long spine board.

Dade County, Florida: An automobile traveling at 60 mph struck the rear of an empty, stopped school bus. Three people in the auto were injured. The auto’s air bag activated. (Photos by Joe Starling.)

  • Approximately 75 percent of those involved in motor vehicle crashes sustain at least minor facial trauma. Because of the many blood vessels that lie close to the skin surface, scalp and face wounds may bleed profusely even though a major vessel has not been severed.
  • You can manage most soft tissue injuries of the scalp and face as you would other soft tissue injuries, with one exception: Do not attempt to clear or clean the wound surface—wiping actions or irrigation with water could drive objects through breaks in the skull.
  • When treating a patient with facial injuries, keep in mind that there also may be an associated breathing problem as well as neck and spinal injuries.

Shreveport, Louisiana: Incidents involving emergency childbirth, although tense, are some of the most rewarding experiences for emergency responders. This delivery is marked by another stork decal on the emergency response vehicle.

(Photos by Richard Lazarus.)

  • Determining whether there is adequate time to transport a woman in labor to the hospital is one of the first decisions facing the emergency responder. Previous deliveries, contractions less than two minutes apart, and the urge on the part of the mother to push—all signal impending delivery.
  • The three main objectives in caring for the newborn are as follows: provide adequate ventilation through stimulation and oxygen administration, with intermittent suctioning, if required, to clear the airway: provide cardiac resuscitation if the newborn’s heart rate is inadequate or nonexistent: and keep the baby warm.

Goleta, California: Santa Barbara City and County firefighters work to save the lives of two traffic accident victims trapped inside a vehicle that struck a tree. Both died of their injuries. (Photo by Keth Culiom.)

  • In multiple-patient situations, rescuers must modify the focus and method of approach. It is important to (1) establish order. (2) locate and stabilize all who are seriously injured and treat their critical needs, (3) rapidly summon additional help, (4) transport the most critical patients first, and (5) reassess others for missed injuries.
  • Traumatic cardiopulmonary arrest is con sidered a “load-and-go” situation-transport the patient rapidly. Most procedures should be performed in the ambulance during transport. Do not waste valuable time.
  • Maintaining a patient’s airway at times requires constant vigilance and care on the part of the rescuer. Portable suction devices are considered basic equipment for field trauma care.

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.

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