[OP] Operational Procdure

[Chris Vlades]

This letter is made in an educationally purpose, and it is what you must follow and respect. Not following these procedures and regulations, might get you fired, and jailed if you are unlucky. That is if failure of doing this results in someone's death, or causes a person to suffer, which in the end might lead to him/her sueing the LS-EMS.

Walking into an emergency scene without making things worse for you or your patient is a simple skill that anyone can master quickly.

Learning how to actually help someone while you’re there is an art.

Experienced paramedics seem to have a sixth sense - they walk into a scene and immediately know what is going on. This sixth sense is called ‘scene awareness’, and it is something that develops gradually over years of working in EMS. However, you don’t have to wait years.

You can quickly develop scene awareness by learning to focus your attention on specific facets of what is happening around you in an orderly and disciplined way. It takes concentration, practice and patience, but you can do it.

First you ensure your own safety, then you assess and treat the Airway, Breathing and Circulation of your patient. Then you make important Decisions about their care. However, the memonic does more than that.

In the following pages we will work through each part of this mnemonic to discover how it directs us to approach an EMS call. Remember, you will be learning to pay attention to what is around you in a focused and organized way. Learn the steps, master them, and then follow them on every call.

Make sure you find them all...

We all hate it when we can’t find things. Not finding a patient is a hundred times worse.

Before you allow yourself to get too involved in the care of a single patient, you have to make sure that there isn’t anyone else on scene that you haven’t discovered. The very important next step after determining ‘what happened’ is to figure out ‘how many patients are there’?

When we go into a scene we are usually dealing with one patient at a time. In a pinch, a medic crew can usually handle two, as long as they are not both critically ill. But if you have more than one critically ill patient, or more than two patients all together you have what is called an ‘MCI’ – a Multi Casualty Incident. An MCI is any incident in which there are more patients than the rescuers there can handle.

When that’s the case you have to call for help (which is the next step).

So knowing how many patients there are, and having a rough idea of how sick they are is an important early step in handling an EMS call.

Be aware that there might be more patients than you can initially see when you first walk into the call.

In trauma calls, especially in car accidents, be sure to search around the accident for patients that might have been thrown clear of the cars, or for pedestrians that might have been struck and thrown.

Also, patients who are confused may wander away from the scene. Be sure to examine scenes for clues that someone might be missing. If there’s a car seat and diaper bag, where’s the baby? If there’s a purse, where’s the woman who owns it?

Just because there is a purse or car seat doesn’t mean that there HAS to have been a woman or baby in the car, but it certainly means you should at least check.

Bystanders who aren’t used to seeing blood can pass out watching you take care of someone who is horribly injured. So be sure to keep an eye on any ‘crowd’ that gathers around you to make sure you don’t suddenly have further, unexpected patients.

Medical calls can involve more people than you initially predicted too. There’s a classic story in EMS circles about the call for one sick child that turns out to be for an entire family with carbon monoxide poisoning.

Also, it’s not uncommon for people to be so upset by their loved ones getting sick that they start to get sick too. There might be that certain call where a man has a heart attack, and this becomes so distressing for his wife that she ends up having a stroke while treating her husband

These things happen do happen, so make sure you find them all

Don’t go where it ain’t safe.

Gloves and goggles are important but they won’t prevent you from getting hurt. Before we walk into a scene we need to think about ‘scene safety’ as well. This means making sure you are not about to get hurt.

First of all, you should always have at least two ways to call for help. Usually paramedics carry a portable radio and a cell phone.

Make sure your dispatcher knows that you’re on scene. Ask if there are any known dangers. Have the Police arrived yet? Has there been any known violence? Is this address ‘flagged’ as dangerous in the dispatcher system?

You have to maintain an awareness of the structures that surround you, the safety of the environment in that structure, and the danger posed by other creatures that might be in there with you.

There’s a basic rule of scene safety that this illustrates: If everyone ‘in the box’ is sick, then you will be too if you go in there. The corollary to that is that if everyone ‘in the box’ is dead, then you probably will be too if you go in. So don’t go in.

This means that sometimes you will be standing outside a box watching people suffer inside. It’s tempting to run in and be the hero, but you mustn't. There are people that love you waiting for you to come home, and people who are going to have an emergency tomorrow who need you to be there on duty for them.

Sometimes the helpers need help.

People call us when their lives are falling apart and the situation has gotten beyond their ability to cope. Although there is a lot that we as paramedics can do that the general public can't ... we can't do it all.

A good rescuer knows when they need help, what help they need, and how to get that help to arrive quickly and safely to the right place.

Obviously, the first thing you need to know before you call for help is … where on earth you are! Usually this isn't a problem because we call our dispatchers to get help to us, and they (should) know where we are. However, if you are not where your dispatcher thinks you are, you need to let them know that. You also need to let them know the best way to get to the scene and the best way to leave the scene.

Remember … you can call for help at anytime. In fact medics often ensure that help is requested as soon as we hear the dispatch update (e.g. asking for police to attend to a big fight).

The final thing you need to know when you're calling for help is ... what help is out there?

The people you’ll call the most are usually the police, the fire department and of course, other paramedics.

The police helps controlling traffic, they control crime scenes, they are the most credible legal witnesses to what happens on a scene and they are the wonderful men and women who step up when someone tries to hurt us - often at great risk to themselves.

The fire department helps contain hazardous materials, secure unsafe structures, fight fires, and they often go and get our patients and bring them to us when the environment is too dangerous for us to go in.

Other medics can help us to deliver patient care, especially if they have higher levels of medical training than we do. They can help with lifting, or with just providing an extra pair of skilled hands.

Calling for helicopter medical evacuation is often a good idea in remote areas where our land transport times are more than an hour or so.

Make sure you’re always safe!

This reminds you to look up now and then and just make sure that there aren’t any obvious environmental threats to you or your patient that you might have missed, or that might have appeared while you were doing your quick assessments.

The sort of threats we worry about are things like: traffic, people, animals, structural damage … anything. Basically, you are doing a quick scene survey again to make sure you’re not in danger.

Then take a quick look at your patient to make sure they’re still as you thought they were. Again, you’re just doing a quick check to make sure that they aren’t in some new danger.

Signed