Scene Management

Subject located!

1. Evaluate Hazards

    -Can you reach the subject

    -Rock fall from above

    -Hostile crowds

    -CDC precautions

    -Unstable/steep terrain (secure subject and yourself)

    -Weather (protect subject and yourself)

    -Traffic

    -Hostile crowd/blood/needle

    -Others considerations

 2.) Size up

    -Brief Radio report of incident conditions

    -Patient condition

    -Brief description of immediate action taken

    -Any obvious safety concerns for other teams in the area or responding units

    -Incident location

    -Assumption of command

    -Plan system

3.) Establish command

    -Name incident after your location or establish Rescue Group

    -Delegate tasks and maintain global picture

    -Scene safety is the first concern

    -Start to develop plan, consider input from others

    -Stay in one place and available on radio

4.) Order needed resources

    -Number of personnel (typical carry-outs require at least 12 to 18 people)

    -Medical equipment needed

    -Rescue/carryout equipment needed

    -Determine best route out (mark path well and clear obstructions) (do good recon.)

5.) Initial Medical considerations

    -ABC's

    -Assign full-time medic

    -Always do secondary and vitals on all finds. After being found subjects can deteriorate quickly

    -Patient comfort first/but do not compromise c-spine!

    -Remove wet clothing/shelter patient

    -Medical radio report-have responsible agency respond

6. Details of scene management

    -Develop plan-continue to re-evaluate plan

    -Establish safe staging area away from patient

    -Set goals and time lines

    -Delegate (establish teams below as needed)

        -medical

        -rescue

        -route finding

        -safety officer

        -other tasks

    -I.C. should always be available (that means listen to radio too!)

    -Make sure plan is known to all-disseminated through chain of command

    -Use chain of command/route needs through I.C.

    -Communicate/coordinate/cooperate

    -Consider use of tactical channel

    -5 : 1 manageable span of control, max. 7

7. BLS MEDICAL CARE

    -Unconscious/Nausea-Left lateral patient package

    -Consider cannula, less O2 over longer period of time

    -Keep V-Vac suction handy

    -Keep B/P cuff in place

    -Maintain access to distal pulses/cap refill

    -Patients with trauma are predisposed to hypothermia

    -Communicate well with patient

    -Package O2 so its secure but easy to change out

    -Back boards last resort for a long carry-out. Full body vacuum splint best

    -Aviod putting a helmet on a patient with C-spine injuries

8. Carry out equipment needs

    -Litter

    -Litter shield

    -Wheel

    -Medical Pack

    -Lots of 02 may be needed

    -C-Spine equipment

    -Rope rescue equipment

    -Hypothermia kit

    -ALS medical care considerations (lot's of IV fluids)

    -Get the request for equipment right the first time!

9. SAR personnel Equipment needs

    -Sufficient food and water

    -Proper clothing for anticipated weather

    -Ability to make harness and connect to litter

    -Head lamp

    -Gloves and helmet

    -Ensure responders have endurance and proper training for carry-outs

10. Helicopter Considerations

    -If patient is poor risk for a carry-out

    -Carry out would be dangerous to rescue personnel

    -Check for available heli-spots

    -Evaluate weather, light prior to request

    -Take note of wind speed and direction, hazards to helo such as power lines

    -Keep LZ clear of people, mark it well

    -Set up common frequency with incoming ship

    -Capabilities of different ships: HENRY 1, CHP, COAST GUARD, REACH and CAL-STAR

    -Always have back up plan in place if helicopter is unable to carry out the mission.

    -LZ prep and Hello operations covered in future class

HELICOPTERS ARE INHERENTLY DANGEROUS

Prepared by Michael St. John