Part 1: Ambulance Operations
After reading Part 1 of this chapter, you should be able to:
- Identify current local and state standards that influence ambulance design, equipment requirements, and staffing of ambulances.
- Discuss the importance of completing an ambulance equipment/supply checklist.
- Discuss factors used to determine ambulance stationing and staffing within a community.
- Describe the advantages and disadvantages of air medical transport and identify conditions/situations in which air medical transport should be considered.
Part 2: Medical Incident Command
After reading Part 2 of this chapter, you should be able to:
- Explain the need for the incident management system (IMS)/incident command system (ICS) in managing emergency medical services incidents.
- Define the terms multiple casualty incident (MCI), disaster management, open or uncontained incident, and closed or contained incident.
- Describe essential elements of the scene size-up when arriving at a potential MCI.
- Describe the role of the paramedics and EMS system in planning for MCIs and disasters.
- Describe the functional components (command, finance, logistics, operations, and planning) of the incident management system.
- Differentiate between singular and unified command and identify when each is most applicable.
- Describe the role of command, the need for command transfer, and procedures for transferring it.
- Differentiate between incident command structures used at small, medium, and large-scale incidents.
- Explain the local/regional threshold for establishing command and implementation of the incident management system including MCI declaration.
- List and describe the functions of the following groups and leaders in ICS as it pertains to EMS incidents: safety, logistics, rehabilitation/rehab, staging, treatment, triage, transportation, extrication/rescue, disposition of deceased/morgue, and communications.
- Describe the methods and rationale for identifying specific functions and leaders for the functions in ICS.
- Describe the role of both command posts and emergency operations centers in MCI and disaster management.
- Describe the role of the on-scene physician at multiple casualty incidents.
- Define triage and describe the principles of triage.
- Describe the START (simple triage and rapid transport) method of initial triage.
- Given color-coded tags and numerical priorities, assign the following terms to each: immediate, delayed, hold, deceased.
- Define primary and secondary triage and describe when primary and secondary triage techniques should be implemented.
- Describe need for and techniques used in tracking patients during multiple casualty incidents.
- Describe techniques used to allocate patients to hospitals and track them.
- Describe modifications of telecommunications procedures during multiple casualty incidents.
- List and describe the essential equipment to provide logistical support to MCI operations to include: airway, respiratory, and hemorrhage control; burn management; patient packaging/immobilization.
- List the physical and psychological signs of critical incident stress and describe the role of critical incident stress management sessions in MCIs.
- Describe the role of table top exercises and small and large MCI drills in preparation for MCIs.
Part 3: Rescue Awareness and Operations
After reading Part 3 of this chapter, you should be able to:
- Define the term rescue, and explain the medical and mechanical aspects of rescue operations.
- Describe the phases of a rescue operation, and the role of the paramedic at each phase.
- List and describe the personal protective equipment needed to safely operate in the rescue environment to include: head, eye, and hand protection; personal flotation devices; thermal protection/layering systems; high visibility clothing.
- Explain the risks and complications associated with rescues involving moving water, low head dams, flat water, trenches, motor vehicles, and confined spaces.
- Explain the effects of immersion hypothermia on the ability to survive sudden immersion and self rescue.
- Explain the benefits and disadvantages of water-entry or "go techniques" versus the reach-throw-row-go approach to water rescue.
- Explain the self rescue position if unexpectedly immersed in moving water.
- Describe the use of apparatus placement, headlights and emergency vehicle lighting, cone and flare placement, and reflective and high visibility clothing to reduce scene risk at highway incidents.
- List and describe the design element hazards and associated protective actions associated with autos and trucks, including energy-absorbing bumpers, air bag/supplemental restraint systems, catalytic converters, and conventional and non-conventional fuel systems.
- Given a diagram of a passenger auto, identify the A, B, C, and D posts, fire wall, and unibody versus frame construction.
- Explain the difference between tempered and safety glass, identify its locations on a vehicle, and describe how to break it.
- Explain typical door anatomy and methods to access through stuck doors.
- Describe methods for emergency stabilization using rope, cribbing, jacks, spare tires, and come-a-longs for vehicles found in various positions.
- Describe electrical and other hazards commonly found at highway incidents (above and below the ground).
- Define low-angle rescue, high-angle rescue, belay, rappel, scrambling, and hasty rope slide.
- Describe the procedure for Stokes litter packaging for low-angle evacuations.
- Explain anchoring, litter/rope attachment, and lowering and raising procedures as they apply to low-angle litter evacuation.
- Explain techniques used in non-technical litter carries over rough terrain.
- Explain non-technical high-angle rescue procedures using aerial apparatus.
- Explain assessment and care modifications (including pain medication, temperature control, and hydration) necessary for attending entrapped patients.
- List the equipment necessary for an "off road" medical pack.
- Explain the different types of "Stokes" or basket stretchers and the advantages and disadvantages associated with each.
- Given a list of rescue scenarios, provide the victim survivability profile and identify which are rescue versus body recovery situations.
- Given a series of pictures, identify those considered "confined spaces" and potentially oxygen deficient.
Part 4: Hazardous Materials Incidents
After reading Part 4 of this chapter, you should be able to:
- Explain the role of the paramedic/EMS responder at the hazardous material incident.
- Identify resources for substance identification, decontamination, and treatment information.
- Identify primary and secondary decontamination risk.
- Describe topical, respiratory, gastrointestinal, and parenteral routes of exposure.
- Explain acute and delayed toxicity, local versus systemic effects, dose response, and synergistic effects.
- Explain how the substance and route of contamination alters triage and decontamination methods.
- Explain the employment and limitations of field decontamination procedures.
- Explain the use and limitations of personal protective equipment (PPE) in hazardous material situations.
- List and explain the common signs, symptoms, and treatment of exposures to corrosives, pulmonary irritants, pesticides, chemical asphyxiants, and hydrocarbon solvents.
- Describe the characteristics of hazardous materials and explain their importance to the risk assessment process.
- Describe the hazards and protection strategies for alpha, beta, and gamma radiation.
- Define the toxicologic terms and their use in the risk assessment process.
- Given a specific hazardous material, research the appropriate information about its physical and chemical properties and hazards, suggest the appropriate medical response, and determine the risk of secondary contamination.
- Identify the factors that determine where and when to treat a hazardous material incident patient.
- Determine the appropriate level of PPE for various hazardous material incidents.
- Explain decontamination procedures including critical patient rapid two-step decontamination and non-critical patient eight-step decontamination.
- Identify the four most common solutions used for decontamination.
- Identify the body areas that are difficult to decontaminate.
- Explain the medical monitoring procedures for hazardous material team members.
- Explain the factors that influence the heat stress of hazardous material team personnel.
- Explain the documentation necessary for hazmat medical monitoring and rehabilitation operations.
- Given a stimulated hazardous substance, use reference material to determine the appropriate actions.
- Integrate the principles and practices of hazardous materials response in an effective manner to prevent and limit contamination, morbidity, and mortality.
- Size up a hazardous material (hazmat) incident and determine: potential hazards to the rescuers, public, and environment and potential risk of primary contamination to patients and secondary contamination to rescuers.
- Given a contaminated patient, determine the necessary level of decontamination, level of rescuer PPE, decontamination methods, treatment, and transportation and patient isolation techniques.
- Determine the hazards present to the patient and paramedic given an incident involving a hazardous material.
Part 5: Crime Scene Awareness
After reading Part 5 of this chapter, you should be able to:
- Explain how EMS providers are often mistaken for the police.
- Explain specific techniques for risk reduction when approaching highway encounters, violent street incidents, residences, and "dark houses."
- Describe the warning signs of potentially violent situations.
- Explain emergency evasive techniques for potentially violent situations, including threats of physical violence, firearms encounters, and edged weapons encounters.
- Explain EMS considerations for the following types of violent or potentially violent situations: gangs and gang violence, hostages/sniper situations, clandestine drug labs, domestic violence, and emotionally disturbed people.
- Explain the following techniques: field "contact and cover" procedures during assessment and care, evasive tactics, and concealment techniques.
- Describe police evidence considerations and techniques to assist in evidence preservation.
- Given several crime scene scenarios, identify potential hazards and determine if the scene is safe to enter, then provide care preserving the crime scene as appropriate.
