Israel Lessons learned

Transcription

1 Israel Lessons learned No treatment while in direct engagement No treatment if there is no cover, unless absolutely necessary Know when to call off CPR early (in order to treat other patients if multiple casualties) 234

2 Call for Help Request an ALS ambulance Try to talk to the EMS dispatcher Patient assessment Pre-arrival instructions EMS response time Hospital notification 235

3 Tactical care The death rate increases with the time spent in the pre-hospital system. Trauma is a time related disease. Definitive treatment is usually surgical. The priority is fast transportation to an appropriate hospital. 236

4 Should you wait for the ambulance? EMS response time ALS or BLS response Ground or air ambulance Distance to the nearest hospital Distance to the nearest trauma center Rural or urban area 237

5 Should you wait for the ambulance? Consider transporting the patient yourself: EMS response time > 10 minutes Close to a trauma center After discussion with the EMS dispatcher In a rural area, consider setting a rendezvous with the ambulance and starting the transportation yourself TIME IS CRITICAL 238

6 Field Triage: Trauma Center Criteria Penetrating trauma to chest, abdomen, head, neck, groin or extremities proximal to the elbow or knee Glasgow Coma Scale < 14 Respiratory rate < 10 or > 29 Extrication time > 20 minutes (penetrating trauma) 239

7 On-Scene Helicopter Triage Patient with trauma center criteria Travel time by ground to trauma center> 15 minutes No ALS ambulance Multiple victims 240

8 Medical Threat Assessment - 1 Resources Hospital Trauma center (definition) EMS (access, response time, ALS or BLS) Air ambulance Know when and how to access it. 241

9 Medical Threat Assessment - 2 Potential problems Weather Extended operations (over 3 hours) Remote location HazMat, drug lab Known medical problems Have on file the medical history of fugitives (e.g., asthma) 242

10 Hospital: Advance Work Location, access route Direct phone to emergency department Change of shift Trauma center accreditation 243

11 EMS: Advance Work 911 access Direct phone number Radio access BLS or ALS service Availability 244

12 Rural Operations Travel time to hospital Rendezvous with EMS ambulance 245

13 Medical Threat Assessment High-risk situation: Need for a pre-staged ambulance Need for TEMS personnel 246

14 247

15 Medical Kits 248

16 249

17 Medical Kits Personal kit Warrant team kit Car kit Range kit 250

18 Personal Medical Kit Contents: Gloves (2 pairs) Military trauma dressings (2) Tourniquet (1) Rolls of gauze, sterile (2) Container: Zip-loc bag Should be carried at all times 251

19 Gloves Nitrile best Latex acceptable Avoid vinyl 252

20 Trauma Dressings Military field dressing ($2.10) Dressing, First Aid, Field, Camouflaged NSN by 6 ¼ to 7 ¼ inches Made by Elwyn Industries Cederroth Bloodstopper ($2.50) First Care Products Emergency Bandage ($4.20) Israeli bandage NSN

21 Tourniquets: Triangular Bandages US military triangular bandage Bandage, Muslin, Compressed, Camouflaged, 37 x 37 x 52 inches NSN Made by Elwyn Industries Hansaplast Viscose Mitella triangular bandage 96 x 96 x 136 cm Made by Beiersdorf AG Any cheap triangular bandage (37 x 37 x 52 inches) 254

22 Other Tourniquets Several one-handed tourniquets on the market Do they really work? Rangers (weight!) SEALs 255

23 Roll of Gauze Disorganized conforming bandage Kerlix 256

24 Hemostatic Dressings They actively stop the bleeding. Do they really work? Dry fibrin Chitosan Quick Clot

25 Other Supplies Co-Ban cohesive bandage (sticks only to itself) SAM splint Xeroform dressing (non-adherent) Laerdal pocket mask 258

26 Sources Gall s Bound Tree Adventure Medical Kits Wilderness and travel medical kits Chinook Medical Gear Medical supplies for expeditions 259

27 Personal Medical Kit Contents: Gloves (2 pairs) Military trauma dressings (2) Tourniquet (1) Rolls of gauze, sterile (2) Container: Zip-loc bag Should be carried at all times 260

28 Warrant Team Kit Contents - 1: Personal medical kits (at least 2) Dressing materials: Bandage strips, tape wound closure Various trauma dressings, non-adherent dressings 4 x 4 gauze pads Tape Elastic wraps Safety pins 261

29 Warrant Team Kit Contents - 2: Space blankets Pocket mask Splint EMT shears Cold compresses Medications: acetaminophen, ibuprofen, triple antibiotic ointment Artificial tears (saline) Antiseptic 262

30 Warrant Team Kit Optional equipment (with additional training): AED Nasopharyngeal airway Oropharyngeal airways C-collar Should be available during training Can be carried in a backpack Can be staged just outside the door 263

31 Car Kit Similar to the warrant team kit Separate trauma kit and medical kit for minor problems Rigid case 264

32 Car Kit Similar to the warrant team kit Separate trauma kit and medical kit for minor problems Rigid case 265