STATE OF SAN ANDREAS FIRE DEPARTMENT |  |
Table of Contents
- Chapter I: Introduction & Radio Communication
- Chapter II: Vehicle Positioning
- Chapter III: Triage Protocol
- Chapter IV: Secondary Assessments
- Chapter V: Cardiac Arrest Management (CPR)
- Chapter VI: Penetrating injuries (GSW)
Introduction
Emergency medical services exists to fulfill the basic principles of first aid, which are to Preserve Life, Prevent Further Injury, and Promote Recovery. This common theme in medicine is demonstrated by the "star of life". The Star of Life shown here, where each of the 'arms' to the star represent one of the six points, are used to represent the six stages of high quality pre-hospital care, which are:
1. Early detection – members of the public, or another agency, find the incident and understand the problem.
2. Early reporting – the first persons on scene make a call to the emergency medical services (911) and provide details to enable a response to be mounted.
3. Early response – the first professional (EMS) rescuers are dispatched and arrive on scene as quickly as possible, enabling care to begin
4. Good on-scene / field care – the emergency medical service provides appropriate and timely interventions to treat the patient at the scene of the incident without doing further harm.
5. Care in transit -– the emergency medical service load the patient in to suitable transport and continue to provide appropriate medical care throughout the journey.
6. Transfer to definitive care – the patient is handed over to an appropriate care setting, such as the emergency department at a hospital, in to the care of physicians.
Radio Communication
TEN CODES
10-3 - Stop Transmitting[/highlight] (Command Staff Only)
10-4 - Understood.
10-7 - Out of service, unavailable for emergency calls.
10-8 - In service, available for emergency calls.
10-19 - Go to your station / Returning to the station.
10-20 - Report your location / My location is ______
10-22 - Disregard last assignment.
10-45 - What is the condition of the patient?
10-45A - Condition of the patient is good.
10-45B - Condition of the patient is serious.
10-45C - Condition of the patient is critical.
10-45D - Patient is deceased.
10-53 - Officer down.
10-55 - Coroner's case.
10-66 - Suspicious person, requiring assistance.
10-76 - Enroute to ______
10-84 - Estimated time of arrival (ETA).
10-97 - Arrived on scene.
C CODES
Code 1 - Acknowledge Call/Respond Over Radio.
Code 2 - Routine Call, No Lights or Siren.
Code 3 - Emergency Call, Lights and Siren.
Code 4 - No Further Assistance Needed.
Code 7 - Meal Break.
Code 8 - Fire Alarm.
Code 12 - False Alarm.
Code 14 - Resuming regular patrol, available for callouts.
Code 30 - Officer in danger, requires immediate assistance.
CALLSIGNS
Fire Truck: ENGINE
Ladder Truck: LADDER
Rancher: CHEETAH
Ambulance (EMS): FRU
Ambulance (FSR): BLS
Bike: BIRD
Helicopter: CLOUD
Bus: MISU
Supervisory Officer: WATCHER
Commanding Officer: CONNOR
Vehicle Positioning
Positioning the emergency vehicle correctly on a scene is an important requiry for the safety of everyone on scene. Below you'll find the general standard for securing a scene. Of course, this depends on resources. The most important thing to remember is to slant the vehicle and leave a buffer zone between the scene itself and the blocking vehicle. The heaviest vehicle on scene should be the blocker, typically this is an engine.
Triage Protocol
Triage is the act of classifying patients into categories based on their injuries and clinical stability. This is done using an algorithm named START, which stands for Simple Triage and Rapid Transport. Triage is used on large scale incidents, where number of patients are enough to stress down prehospital care givers on scene & system. Triage is done by assigning a color based on a patients condition, this color dictates who receives treatment and subsequent transport by priority of injury and clinical state. Patients tagged black are apneic or have injuries that no longer sustain life or will not sustain life long enough for transport to a higher level of care. Due to this, resources will be focused on those tagged with other colors. Patients tagged red have life threatening injuries and may have unstable vital signs. These patients require immediate transport to a higher level of care and treatment to sustain life. Patients tagged yellow have potentially life threatening injuries, though their clinical state is stable and they are unlikely to deteriorate over a period of several hours. These patients will require transport to a higher level of care at some point. Patients tagged green are those with minor or moderate injuries with a stable clinical state or those who are able to walk. These patients are unlikely to deteriorate over a period of several days and can usually ambulate themselves to a higher level of care should is be required.
Patients are to be transported according to categories. (starting from the most critical, finished with the least critical ones)
NOTE: THIS IS A PROTOCOL, BUT YOU MIGHT BE TOLD OTHERWISE BY OVERSEERS ON AN ACTUAL SCENE, OBEY THEIR COMMANDS. BESIDES THAT, IF THERE IS NO OPERATION COMMAND PRESENT, USE YOUR PERSONAL JUDGEMENT TO SAVE AS MUCH PEOPLE AS YOU CAN.
Secondary Assessments
These assessments are to be performed after CAB. You should analyze the scene and utilize the needed method accordingly for the best of the patient.
OPQRST - used when a patient is experiencing pain, this pain will typically be pain not associated with trauma, to perform this assessment, you should have a contact with the patient, acronym stands for:
- O - onset (when did the patient start feeling the pain?)
- P - provocation (what makes the pain worse?)
- Q - quality (how does pain feel like? is it consistently happening or with intervals?)
- R - radiation (does the pain radiate anywhere else?)
- S - severity (how severe is the pain? use 1 to 10 scale)
- T - time of onset (when did the pain begin?)
- A - alert, patient is alert and responsive
- V - verbal, patient responds to verbal stimulation
- P - painful, patient responds to painful stimulation
- U - unresponsive, patient isn't responsive at all despite all the stimulation, unconscious
Cardiac Arrest Management
A cardiac arrest is simply when the heart ceases to beat properly or at all. In this state the patient has no pulse and will rapidly become oxygen deprived. Therefore it is important to give rapid and proper treatment.
A patient in cardiac arrest will either have a rhythm which is not able to be shocked or one which is. Ones that cannot include asystole and pulseless electrical activity. Ones that can include ventricular fibrillation and pulseless ventricular tachycardia.
The first thing to begin is chest compressions. This is done by interlocking your hands over the center of the chest and pressing down roughly 2 inches at a rate of 100 beats per minute. While this is ongoing another provider should apply a bag valve mask and begin ventilating the patient. Another provider should place automatic external defibrillator pads onto the patients chest. Every few rounds of CPR, the rhythm will be analyzed by the LifePak and a shock will either be advised or not advised. If a shock is advised, all providers will remove their hands from the patient and press the button to deliver the shock. After the shock, the providers will check if there is a pulse. If there is not, the process will start over.
In all cardiac arrest cases a Paramedic should be called as medication is required to properly resuscitate a patient.
Penetrating injuries
A penetrating injury occurs when an injury pierces the skin, injuring the tissue below. Injuries of this nature include gun shot wounds and stabbings. Penetrating injuries present a challenge to emergency medical personnel because they're often very destructive to underlying tissues well beyond what's apparent from external entry wound indications, and controlling bleeding for these injuries can be challenging.
The main concern with penetrating trauma is internal injury. Most commonly these patients will require rapid transport to the nearest trauma center to survive. On scene time should be limited to only life saving procedures. In many cases it may be appropriate to call for an advanced provider to begin intensive treatment before transport, you should use your discretion when making such a decision.
Should the wound be penetrating the chest in any way, it is imperative to apply a chest seal which will prevent air from entering the wound which can cause a collapsed lung.
Depending on the location, the methods which are to be used on penetrating injuries are following: wound-packing, application of tourniquet and chest seals. During wound-packing if the bleeding is so significant that packing alone cannot stop it, a provider should hold manual pressure until handed off to the receiving hospital. On the other hand, ourniquet slows the blood loss by constricting the large blood vessels. Tourniquets are only a temporary solution and the patient should be rapidly transported to the nearest trauma center.
