Lamorinda CERT P atient Transport and Packaging

Lamorinda CERTPatient Transport and

PackagingReleased: 4 September 2013

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Patient Transport and Packaging

Why do we need to transport victims? How do we transport them? What problems are inherent in moving victims? How do we mitigate those problems?

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Need to Transport

Victims need to be moved for a few reasons: Victim is immediate danger Current location is unstable

• Building unstable• Fire• Water • Other hazards – gas, electrical, explosives, etc.

Victim needs more care than can be given at current location

Victim is blocking access to other victims

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How to transport

Several ways to transport Method depends on situation and victim condition Walking Assists Crawls and Drags Carries

Carried directly by rescuers Carried on equipment by rescuers

• May require immobilization

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How to Transport

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Walking Assist

1. Stand at the victim’s side and drape the victim’s arm across your shoulders.

2. Support the victim by placing your arm around his or her waist.

3. Using your body as a crutch, support the victim’s weight as you both walk.

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Shirt / Shoulder Drag

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Patient Packaging

What Is It? Patient packing is the process in which a patient is

prepared for transport, while providing for comfort and immobilization. This process should not interfere with the patient’s ability to continue with normal bodily function and yet should allow the transporting personnel the ability to maintain an accurate account of the patient’s vital signs, continue with the treatment of any and all illness and injury and provide the appropriate medical care.

This process must be able to be provided in a rapid and easy manner so as to not compromise scene time, the safety of the patient and rescue personnel, and not become a physical burden in its application.

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Patient Packaging

Why Is It Important? Moving a “loose” victim is likely to cause further

injury. A properly packaged patient can be moved easily

and transferred from one set of transporters to another seamlessly.

Packaging can be done for the type of movement needed, flat, low-angle, high-angle, vertical lift or descent.

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Patient Packaging

What Kinds of Packaging may a CERT Need To Do? Cervical Spine immobilization. Longboard (backboard) Chair Stretcher or Sling

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Spinal Motion Restriction

Mechanism of Injury Anything to suggest spinal injury? They say “my neck hurts” or “my back hurts”

Altered mental Status Head Injury? Which came first…

Findings on Assessment Pain, tenderness, swelling, or deformity in spine Muscle Spasm Neurological deficit

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Need for a C-Collar

A Cervical Collar provides: Temporary support to the head of a sitting or

standing patient until the patient can be placed in a supine position.

Frees the hands of rescuers while the patient is being moved & splinted to a Full spine board.

Reduces compression of the cervical spine caused by the head.

Minimizing axial loading / unloading of the spine that takes place during transport.

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Limitations of a C-Collar

The Cervical Collar:  Is NOT designed to immobilize the cervical spine,

let alone the rest of the spine. Restriction of movement of the head with a rigid

collar is at best 50% of normal movement. Is NOT designed to provide any traction to the

head, but is only designed to support the weight of the head.

Only prevents 50% of cervical spine movement. Provides no thoracic / lumbar spinal support. Has not been shown in any study to adequately

immobilize the cervical spine.

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Hazards of a C-Collar

A number of dangers may be associated with application of a Cervical Collar: If the jaw support of the collar clamps the teeth

together, airway compromise may result if the patient vomits.

Cervical Collars that place pressure on the neck (either via collar design or too small a Cervical Collar being applied), may cause an increase in intracranial pressure.

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Cervical Spine Motion Restriction

The technique Should be simultaneous with assessment. Place collar, if needed, prior to any patient

movement Don’t use force. More than one manufacturer of collars One collar does not fit all! Towel or Blanket rolls alternatives

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Typical C-Collars

Many manufacturers and many styles Inexpensive ($6-15 each) These were $7.50 each Directions are normally printed on package

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Backboards

Backboards come in many styles Longboards are full length rigid backboards in

either adult or pediatric sizes.

Shortboards are used for extrication and go from waist to head.

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Issues with Backboards

Now…a word about padding Skin breakdown can begin to occur in as little

as 1 hour Get victim off backboard as soon as possible Redistribute the weight off of the shoulder

blades, buttocks and heels Padding (not a lot) makes a huge difference Bending knees flattens the back, flattens the

feet to redistribute the weight

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Backboard Use Tips

Pad the board prior to placing the patient on it Leave the appropriate arm/arms accessible to

allow therapies and monitoring Cover over the top of the straps rather than under

them Make sure that the patient will not move side to

side if tipped Use specialty securing devices for little people if

they are available

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Backboard Special Circumstances

Severe closed head injuries Tilt head of backboard up

Penetrating back injuries May need to place victim on side May need to hold direct pressure

Impaled objects May need to get creative

Pregnant women Left side down-pad between knees

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Sleds

Rescue / Evacuation stretchers are rolled plastic sleds that, once unrolled and turned up on the edges, provides a rigid sled that can be dragged, lowered or hoisted.

Longboards can be used inside sleds.

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Litters

Litters are baskets, like the ‘Stokes Litter’ that enable rescuers to easily carry, hoist or lower a victim.

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Pole Stretchers

Pole stretchers have rigid poles, folding poles or breakdown poles.

Flexible webbing allows compact storage

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Flexible Stretchers

Low-cost flexible stretchers and chairs Does not immobilize the spine

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PerishableSkills Review

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Bleeding

Arterial…spurting

Venous…flowing

Capillary…oozing

Losing one liter can be life threatening

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Bleeding Control

Direct pressureElevationPressure points

No tourniquets!

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Wound Care

Control bleeding Prevent secondary infection

Objective of wound care:

Treatment of wounds: Clean wounds – don’t scrub Apply dressing to wound Apply bandage to hold

dressing in placeNo tourniquetsNo Hydrogen Peroxide

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Rules of Dressing

In the absence of active bleeding, remove dressing and flush, check wound at least every 4-6 hours, redress as necessary

If there is active bleeding, redress over existing dressing and maintain pressure and elevation

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Hemorrhagic Shock

Hypovolemic shock is the most common type of shock and is caused by insufficient circulating volume. Its primary cause is hemorrhage (internal and/or external), or loss of fluid from the circulation. Vomiting and diarrhea are the most common cause in children.

Hemorrhagic shock, a type of hypovolemic shock, is defined as a failure of adequate tissue perfusion resulting from a loss of circulating blood volume.

Cardiogenic shock results from heart damage. Vasogenic shock results from blood vessel dilation,

often from toxins like anaphylaxis. Neurogenic shock results from head or spine injury.

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External Hemorrhagic Blood Control

New protocols allow use of tourniquets. If you use a tourniquet, the limb below the tourniquet is to be considered forfeited.

Blood clotting agents are available to stop hemorrhagic blood loss. Hemostatic granules like Celox ~ $14 Hemostatic gauze like Celox Rapid ~ $41 Hemostatic sponge like QuikClot ~ $24

Always tape empty package to victim

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External Hemorrhagic Blood Control

New dressing materials staunch blood flow from traumatic hemorrhage wounds in pre-hospital emergency situations. Includes dressing and bandage with pressure applicator device. Israeli Bandage Battle Dressing

• 4” width ~ $6.50• 6” Width ~ $7.00• 12” Abdominal with 12x12 pad ~ $12.00

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Guidelines for Splinting

Support the injured area Assess color, warmth and sensation Splint injury in the position that you find it Don’t try to realign bones Immobilize above and below the injury After splinting, recheck for color, warmth,

and sensation below the injury site SAM splints are light, can be cut to

shape and are well padded ~ $12

All fracture & suspected fractures require splinting