Emergency Services, LLC / Copyright 2007 / Volume 07-81 TRAINING Click anywhere on page to view show in its entirety Click anywhere on page to view show

Emergency Services, LLC / Copyright 2007 / Volume 07-8 1

TRAINING

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FIRE MEDICS• PHTLS Training 4:Musculoskelet

al Trauma, Pt. 1• Quiz

EVOLUTIONS 2000• Kramer vs. Kramer• Program Quiz Answers

FIRELINE• Rural House Fire• Mercury Spill• Discussion Questions

HANDS-ON• Interoperability Box• Quiz• Rescue Search Dogs, Pt. 1• Quiz

Working Fire Training07-8 Training Materials


TRAINING

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All training methods and procedures presented in this Working Fire Training (WFT) video program and training materials are based on IFSTA, NFPA, NIOSH, OSHA and all other relevant industry regulations and standards and are presented as a part of generally accepted and acknowledged practices in the U.S. Fire Service. WFT should be used under the supervision of certified trainers in conjunction with national, state, and local training standards and protocols, and the standard operating guides and procedures of the Subscriber. WFT is intended to be an ancillary source of training information and should not be used as the sole source of training for any emergency service organization. WFT accepts no responsibility for how the Subscriber implements or integrates this program into the Subscriber’s own training program, nor does the use of this program by the Subscriber imply that WFT approves or endorses any specific training methods presented by the Subscriber to its own organization. WFT accepts no responsibility for the correct understanding or application of its training methods and procedures by emergency service personnel who view this program; nor for any performance or lack of performance by emergency service personnel who may view this program and use or apply these training methods and procedures incorrectly; nor does it accept any liability for injuries or deaths of emergency service personnel who may view this program and use or apply such training methods and procedures incorrectly. By presenting this program for viewing to its organization’s members, the Subscriber, and by viewing or reading materials presented by WFT, the members and students of the Subscriber, agree to hold harmless WFT, the University of Cincinnati, VFIS, and any persons or organizations who participate in the creation and/or presentation of this training material from any legal action which might result from any line-of-duty injuries or deaths of the Subscriber’s members or any other emergency service personnel who view this program and who may use or apply such training methods and procedures incorrectly.

LEGAL DISCLAIMER


DISPATCH/SIZE-UP• Residence was a wood frame structure with a wood

foundation and OSC siding. – Its insulation was not fireproof.

• Upon arrival, the fire was through the roof of the garage and starting on the roof of the house.

– Response time was approximately ten minutes.

• Did a hose lay on the fly and had water flowing in less than a minute.

Fireline Incident: Rural House Fire

07-8 Training Materials


INCIDENT COMMAND/INCIDENT ACTION PLAN• Set up a tanker shuttling operation with five tankers

to cover the six-mile distance to the water supply.

• Attack crews entered the house in areas where the fire hadn’t spread to in an attempt to head it off.

• Since the fire couldn’t be turned back, firefighters exited the building and the incident went defensive.




STRATEGY/TACTICS• A tanker shuttle was set up with a portable pen.

– The tankers could barely keep up with the demand for water.

• Fire crews entered the house with one 1-¼-inch line. Three other 1-¼-inch lines and a 2-1/2-inch were all in service outside.




EVENTS• Initial truck arrived on scene, laid hose, and got

water on the fire in less than a minute.

• An interior fire attack was turned back by the advancing flames.

• There was gun ammunition in the garage that was on the fire when firefighters arrived.

– Popping was heard; no one was hurt.




EVENTS• The homeowner had a number of animals in pens

and dogs that were running loose. – The Humane Society was called to handle the dogs.

• When the back wall collapsed, IC decided to go defensive.




REMARKS• The Humane Society was called to round up a

number of dogs that were loose on the property. This is an important issue for firefighter safety.

• Soft gravel roads presented difficulties for tankers.




REMARKS• Motorists would not give right-of-way to

tankers on narrow roads, in spite of lights and sirens in operation.




LESSONS LEARNED• Apparatus placement could have been better.

Sometimes when trucks arrive later, rather than all at the same time, optimum placement can’t be achieved.

– This prevented a second portable pen from being set up which would have facilitated water delivery to the fire.

• Older houses with wood foundations can present extinguishment problems.

– Pay attention to which structures in your jurisdiction might have them.




DISPATCH/SIZE-UP (by Haz-Mat division late on scene) • Weather was cold.

• Dispatch came from the Department of Environmental Protection, originating with the State Police.

• A Keyspan Gas Company truck carrying a cylinder of mercury hit a bump. The container came off the truck and was run over by a following motorist. The container blew out a tire and spilled about 3 ounces of mercury on the roadway.

Fireline Incident: Mercury Spill



DISPATCH/SIZE-UP (by Haz-Mat division late on scene) • About 200-300 feet of roadway was affected.

• Due to the cold weather that day, the mercury rolled down the street like bee-bees.

• The driver made the proper notifications. – A local fire company responded but apparently the Keyspan

people called Clean Harbors, a clean-up/mitigation service, before the Haz-Mat Division was alerted.

– Keyspan didn’t realize there was another vehicle involved.– Haz-Mat specialists didn’t arrive until an hour later.




INCIDENT COMMAND/INCIDENT ACTION PLAN• District Chief took command.

• The scene had to be properly secured and operations coordinated among responding agencies.

– Traffic in the area had to be controlled and brought down to one lane.




INCIDENT COMMAND/INCIDENT ACTION PLAN• The IAP had two areas of concentration:

– Mitigation of residual mercury on the roadway.– Decontamination of pedestrians, vehicles, and

responders

• Vacuums were used




STRATEGY/TACTICS• Jerome Mercury Vapor Analyzers were used to

monitor the environment. – Jerome meters use a gold film sensor to determine

mercury sources, the extent of mercury contamination, and to verify that no residual mercury remains after clean-up.




STRATEGY/TACTICS• Specialists wearing proper PPE and breathing

apparatus used vacuums to mitigate the roadway and the vehicles involved.




EVENTS• A truck dropped a container of mercury which was

then run over by a following vehicle, spreading the mercury.

• The driver made the proper notifications. – A local fire company responded but apparently the

Keyspan people called Clean Harbors, a clean-up/mitigation service, before the Haz-Mat Division was alerted.

– Haz-Mat specialists didn’t arrive until an hour later.




EVENTS• This was a Level 2 Haz-Mat response.

– Vehicles and the roadway were mitigated.– Pedestrians had to be deconned.

• The truck that dropped the mercury returned to the scene and ran over the mercury again.

• The road was shut down for a total of three hours.




REMARKS• Initially, the driver that dropped the mercury didn’t

know he had, but later returned to the scene once he did.

• The scene was not taped off and secured properly.– Some pedestrians who walked through the mercury had

to be deconned.

• A Veterans Hospital and a skating rink were on opposite sides of the street at the point where the spilled occurred.

– It was important that no mercury were tracked into either place.




LESSONS LEARNED• Proper scene identification and marking of such

must be done correctly.

• Earlier notification would have been better, so resources and personnel can get on scene quicker and in the appropriate numbers.

– This makes for a more accurate and efficient size-up and a determination of what exactly are affected.




LESSONS LEARNED• Training with private mitigation companies is

an excellent idea. – As they often respond jointly with the Haz-Mat

division, they function the same way as mutual aid companies.

• Consequently, co-training gets all responders on the same page.




Fireline Incident Discussion

The departments involved in this month’s training and WFT pose some discussion questions that you can use as discussion-starters in your own department’s training sessions.

How will your department handle these scenarios?



Rural House Fire / Donohue, IA Fire Chief Pat McBride, Donahue (IA) Fire Dept.

• For any department, but particularly departments with rural jurisdictions, response time is crucial. The quicker you get there, the more impact you can have on the incident. Nobody wants to just watch it burn.

• We have some structures with wooden foundation which are very hard to extinguish since they’re below ground. Be prepared to use plenty of water on them and extend your fire watch.

• Even in rural areas, motorists often don’t respect warning lights and sirens or give right away. Work with your local media to get stories written or broadcast about it. Let TV news ride along sometime and get a few offenders on the air.




Mercury Spill / Boston, MA Haz-Mat Specialist Fred Ellis, Jr, Haz-Mat Division,

Special Ops. Command, Boston (MA) Fire Dept.

• Early notification of specialty response squads is always important. Just like mutual aid, if we aren’t needed, we can go back to the station. But get us rolling early if you think we might be needed.

• That’s important, because in this case, a mitigation company arrived on scene before we did. Get to know your local mitigation departments and encourage them to call you if they get called.

• Always monitor the scene for atmospheric content and wear proper PPE and SCBA or PAPRs, if necessary.

• Always expect that civilians will be involved and may have to be deconned. Remember, they may be very frightened!




OBJECTIVES/OUTCOMESAfter watching this segment, the student shall understand:• the concept of telecommunications interoperability• how to connect different radios and communication devices together and make them communicate effectively.

CODES, STANDARDS & REGULATIONS• NFPA 1221 Standard for the Installation, Maintenance, and Use of Emergency Services Communications Systems

Hands-On:Interoperability Box



DISCLAIMER• From time to time, Working Fire Training likes to make

subscribers aware of new or innovative equipment that are available. New technologies or techniques should be important news to departments and as they ultimately has an impact on training and responder safety.

• This month we are featuring the concept of an interoperability communications unit which facilitates the integration of diverse communications systems.

• Our demo product is the ACU-1000 JPS Interoperability Box by the JPS Division of Raytheon Corporation.




DISCLAIMER• Working Fire Training receives no compensation from

JPS/Raytheon Corporation who manufactured the ACU-1000, the product featured in this segment. In fact, WFT has identified over 80 products from manufacturers such as Cisco IP, Sharp, CoCo Communications, Drakontas LLC.

• Working Fire Training urges all departments to do due diligence to arrive at a solution that best fits the individual department’s or mutual aid group’s needs. Such decisions may depend upon the involvement of neighboring departments.

• Download a Communications Interoperability Guide (.PDF) from the 07-8 Training Materials, for more information on strategies and products.



http://www.workingfire.com/trainingmaterials.html

http://www.workingfire.com/trainingmaterials.html


CONCEPT• Interoperability systems are designed to integrate

various and numerous communications methods and technologies that may show up at a response scene.

• In this way responders and/or civilians may communicate with any other responder, regardless of the system each is using.




DEMONSTRATION PRODUCT• The product used for demonstration is the ACU-1000 JPS

Interoperability Box made by the JPS Division of Raytheon and was demonstrated at the Clayton Fire department in Clayton, Missouri.

• As noted above, there are many other systems available that responder departments and agencies may investigate including a newer version available from Raytheon, the ACU-2000 which has IP control capability.

• This is a demonstration of the basic functions of the ACU-1000.




EXAMPLES OF POSSIBLE INTEROPERABILITY• Here are some examples of devices which may

communicate with each other using the Interoperability Box as an interface.

– A VHF system may talk to a UHF system– Different signaling formats may be integrated: A P-25

communication system may talk to a conventional system or a trunking communication system

– A Nextel two-way radio unit may talk to a standard VHF radio

– Someone remote from the scene may call in on a standard phone line and talk with a radio user.




INTERFACE• This system is capable of five inputs, one reserved

for telephone and the other four for any type of radio user.

• To hook up to the box, you need the radio for each communications system that you want to integrate and a connecting cable for that particular radio.

– Only use approved cables to connect devices!




INTERFACE• Each cable is unique to each make and model of

radio. – A manufacturer may make a UHF and a VHF radio with the

same style and model number with a cable that will work with both.




USERS• Users can be very diverse and firefighters are a

typical users group. – At a fire scene you will have many departments and diverse

jurisdictional agencies show up with different means of communication.

• The Interoperability Box will allow members of different agencies or specialties to speak with members of other agencies without intermediaries.




USERS• Local or mutual aid departments, police, military –

any participant in a unified command scenario can now have communications access to other participants as if they are on the same radio system.

• You can also set up sub-networks so that different conversations can go on at the same time.

– Permissions can be set up so that some agencies may be able to listen and talk to each other while other agencies can only listen or be listened to.




CONFIGURATIONS• The Interoperability Box comes in essentially three

configurations:– The ruggedized portable unit– A rack-mounted unit with more inputs and outputs and

designed to be in a more fixed position, such as in a mobile command vehicle or trailer

– A smaller desktop unit. It’s not as durable as the other units but it’s designed for quick and easy connection, perhaps from a management team such as an LEPC or at a SEMA/ FEMA level.




SYSTEM OVERVIEW• Though appearing imposing at first, the Box can be

set up quickly, easily, and be operational with just a few button pushes.

• The JPS system consists of a(n):– keypad– handset for direct talking– interface cable between the Box and a radio that would

plug into it.




SYSTEM CONTROL• The unit can be controlled three ways:

– By a keypad– By a computer interface to a computer– Over the air using a DTMF (touch-tone) pad on a radio.




HOOKING UP A VHF to UHF RADIO CONNECTION• Here’s how to hook up a Motorola HT1250, a VHF

radio using a frequency commonly used by many fire departments to a UHF radio.

– Hook up the radio to the HT1250 port on the Box using the interface cable.

• In this case Port #3 was selected.

– This unit is now the dedicated unit for VHF communications to the Box and it cannot be removed while in service.




HOOKING UP A VHF to UHF RADIO CONNECTION– On the keypad, enter * 03 to enable the connection through

Port #3. A voice confirms the connection and the port light becomes lit.

– Hook up a UHF radio to Port #2. • On the keypad, enter *02 to enable the connection through

Port #2. A voice confirms the connection.

• We now have connectivity between the two radios, as well as the handset connected to the Box.




HOOKING UP A VHF to UHF RADIO CONNECTION• The monitor speaker on the Box may be muted if

so desired.




HOOKING UP A NEXTEL WALKIE-TALKIE HANDSET• Here’s how to interface a Nextel handset.

– Connect the Nextel interoperability connecting cable to the ear/microphone jack of the Nextel unit.

– Connect the cable to Port #4 and enter *04 on the keypad. • A voice confirms the connection and the port light becomes

lit.

– In the scroll list of the Nextel unit, scroll to the Nextel unit we’ve configured, and push to talk.




HOOKING UP A NEXTEL WALKIE-TALKIE HANDSET• The Nextel unit is now communicating with the VHF

and UHF radios and the handset on the Box.




TO DISCONNECT A UNIT• The standard disconnect code is *33.

– So, to disconnect Port #4, on the keypad enter *3304.– A voice command confirms the disconnection and the port

light goes out.




REAL-WORLD SET UP• The initial installation of the unit for the Clayton (MO)

Fire Department that uses the ACU-1000 was handled by professional technicians who trained the fire department in its use.

• Clayton Fire surveyed its mutual aid partners and responding agencies and created a list of what communications devices might arrive on scene at an incident.

– Clayton then purchased the appropriate connecting cables to fit those units.




REAL-WORLD SET UP

• When units respond, they provide a radio unit to be connected to the box.

• Clayton was hesitant at first regarding the proper usage of the Interoperability Box but uses the provided training video for review monthly or bimonthly so that its operations remain fresh in mind.

• Responsibility for its operation will fall to the chief officers, captains, and medical officers.




REAL-WORLD SET UP• Another reason for the selection of such a device

has eliminated the need for a person to relay communications between non-compatible radio/communications units.

• Now, agencies such as the FBI or Secret Service may communicate along with important civilians such as the Mayor or City Managers who can be hooked into the communications network from their Nextel or land-line telephones.




Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____1. True or False: To hook a radio to the Interoperability Box,

any interconnection cable may be used.

2. True or False: With this Box, even the President could talk to local responders.

3. True or False: The unit can be controlled three ways: by a keypad, by a computer hard drive, or over the air using

a DTMF (touch-tone) pad on a radio.

07-8 Training MaterialsQuiz: Interoperability Box


Date___________ Firefighter/PM____________________ Chief/T.O.___________________ Education Credits _____Select the best answer:

4. Which procedure order is correct?

a. Hook up a radio to the box – punch *03 to connect to port #3 -- Hook up another radio to Port #2 by punching *02 – Handset is hooked in to the two radios.

b. Hook up a radio to the box – punch *02 to connect to port #2 -- Hook up another radio to Port #3 by punching *03 – Handset is hooked in to the two radios.

c. Hook a handset to two radios – punch *03 to a radio connect to port #3 -- Hook up another radio to Port #2 by punching *02 – The radios are hooked up.

d. None of the above e. Two of the above




5. Which code is used to disconnect Port 3?

a. *04

b. *03

c. *3303

d. *33XX depending upon the Port

e. 3303(Answers on Slide 106)

Printable quizzes following answers on slide 108 on .PDF version



OBJECTIVES/OUTCOMESAfter watching this segment, the student shall learn about:• the origins and training of search dogs• what’s involved with training a search dog • procedures for a dog and handler rappelling from an aerial ladder.

CODES, STANDARDS & REGULATIONS• NFPA 1670: Standard on Operations and Training for Technical Search and Rescue Incidents

Hands-On:Rescue Dogs, Pt. 1



INTRODUCTION• This training is to demonstrate the importance in

using rescue dogs for live searches and cadaver recoveries and as a backup to law enforcement and fire personnel.

• Members of rescue dog teams are members of fire departments or law enforcement. The group in this training is also a member of and responds with the Heavy Rescue Strike Force Team in the St. Louis metropolitan area.




TRAINING• Dogs start out when they are around 12 weeks old

with formal training beginning when they are about six months old.

• It takes about two years for a dog to become fully certified in both live-find and cadaver work.

• A dog will continue to work until she’s around 10 years old.




SEARCH DOG BREEDS• Many dogs come from the Czech Republic which is

known for breeding and training search and rescue dogs.

• Most dogs on the team are German Shepherds, but this team has also had Labrador Retrievers, Blue Healers and others. Nearly any dog can be trained but working dog breeds are particularly well-suited.




COMMAND LANGUAGE• Many trainers talk to their talks in German or Czech,

so that not just anyone can take control of the dog. This is an added safety feature.




SAFETY NOTE• All search dog team members are fire department

members and receive regular high-angle and confined space training.

– Consequently, all are knowledgeable in these skills and can back each other up -- another safety point.

• Safety is a primary concern for team members, their dogs, and their victims. All riggings are checked before they are stressed.




AERIAL LADDER LIFT• When is an aerial lift used?

– A building is burned out or collapsed and the upper stories need to be searched.

– Access from the ground is unsafe or not possible.– In such cases, dogs must be trained to ride under an aerial

ladder bucket.




AERIAL LADDER LIFT• Obedience & Fear

– While the handler prepares the rigging, the dog obediently waits for his command to come.

– Obedience is important because knowing where the dog is at all times leads to safer incidents.

– An obedient dog will stay where he is told to stay.

• Fear of heights– Dogs have a fear of heights just as people do. – Handlers will often carry their dogs over their shoulders like

a sack of wheat to help the dogs overcome their fear.




AERIAL LADDER LIFT• Dog Harness Rigging

– The lifting harness for the dog is specially designed for canine use

– It’s padded at the contact points (knee and elbow joints).– Two straps hold the harness on the dog until rigging is

complete.– The harness is weight-rated just like all firefighter gear;

absolute weight rating for a 100 lb. dog, shock-loading, appropriate hardware for the weight, etc.




AERIAL LADDER LIFT• Dog Harness Rigging (cont.)

– Carabiners are used to secure all straps giving the harness eight points of contact.

– Four straps in the rear and four in the front are brought together with two separate carabiners to form a front and rear lifting point.




AERIAL LADDER LIFT• Dog Harness Rigging (cont.)

– This spreads the weight more evenly than bringing all eight straps together with one carabiner.




AERIAL LADDER LIFT• Aerial Bucket Rigging

– Two separate systems are rigged underneath the bucket: a primary and a secondary anchor.

• Good fire service procedure calls for backing up the primary anchor in case the first one is lost.

• Additionally, a back-up safety or belay line is rigged from the top of the bucket during training or a demonstration to add an additional safety margin.

– In most cases, the dog teams arrive after the fire departments and specialty teams, so much of this rigging is already set up and ready to go.




AERIAL LADDER LIFT• Handler Rigging

– The dog’s harness is locked into the handler’s harness.• This gives him complete control over the dog as the dog rides

below the handler, between his legs.

• The handler’s harness supports the dog in his harness.

• The handler is then free to maneuver without the dog interfering with his movements.




AERIAL LADDER LIFT• Handler Rigging (cont.)

– The dog’s harness is locked into the handler’s harness.

• As the dog is positioned between the handler’s knees, he is able to direct the dog’s movement.

• The handler uses a brake rack to assist in the rappel which will come later.




COMMUNICATIONS• Radio communications are maintained between the

handler and the bucket operator.• The truck operator can also communicate with the

bucket operator.• The handler will be directing the bucket operator as

far as where the handler and dog need to go: higher or lower and in which direction.




EVOLUTION – SET-UP• In this evolution, the handler and dog will be lifted up

and over the roof line and then rappel to the training tower’s roof surface.

• This is to simulate getting a dog and a handler over a downed building, debris pile, swift water current, or some impassible object where traversing would not be possible.




EVOLUTION – IN OPERATION• As the slack on the bucket haul line is taken out, the

handler weighs down or loads the system before he and the dog are lifted off the ground, to insure that the rigging is safe and holding.

• The dog, once accustomed to the height, enjoys the airborne lift.

• The backup belay line from the top of the bucket is controlled by the bucket operator.




EVOLUTION – IN OPERATION• The operator provides sufficient slack so the handler

can maneuver at his own pace, but the line would come into play should the main line fail.

• The truck or turntable operator radios to the bucket operator to let him know when the handler and dog are off line, so he can release the slack on the safety line.




EVOLUTION – IN OPERATION• Once secured on the roof, the dog is ready to work.• The turntable operator of the aerial controls the

raising and lowering of the bucket. – He is at a disadvantage when raising the handler and dog

to a higher position, such as a roof top, as he cannot see them.

– So he relies heavily on the bucket operator who can see, to provide direction.

– Once the handler and dog clear the roof line on removal, he can see them.





1. True or False: Rescue dogs are often commanded in other languages.

2. True or False: A rescue dog just starts getting proficient at ten years of age.

3. True or False: A dog can be afraid of heights.

07-8 Training MaterialsQuiz: Rescue Dogs, Pt. 1



4. Which of the following do NOT belong in a dog harness rigging?

a. Eight points of contact

b. Ropes weighted and shock-rated for a dog

c. Four carabiners from the front and the back are combined to hook into two carabiners, one in front and one in back.

d. Swivels

e. None of the above




5. Which of the following are NOT part of the Aerial Bucket Lift?

a. Communications between operators

b. Loading of the system by the handler

c. Prusik wraps

d. Primary and secondary anchors

e. None of the above(Answers on Slide 106)




OBJECTIVES/OUTCOMESAfter watching this segment, the student shall understand:

• the pathophysiology of musculoskeletal (MS) trauma• management of MS trauma in:

– multisystem trauma – isolated extremity trauma

CODES, STANDARDS & REGULATIONS• Pre-hospital Trauma Life Support Training, National Association of Emergency Medical Technicians and the American College of Surgeons.

Fire Medics:PHTLS Training 4: Musculoskeletal Trauma



INJURY STATISTICS• 23.8 million musculoskeletal injuries occur annually

(CDC, 2003).• That’s 83 per 1000 population so these injuries are

very common: sprain, strain, fracture, bleeding, etc.




MS TRAUMA• Management depends on the situation• Multisystem trauma (even a potential one) vs. simple

isolated injury is the issue.• The problem is, one can complicate the other. • For example, a simple isolated fracture or injury

could be a distracting injury from a more severe, multisystem problem you find out about later.




MS TRAUMA• You have to look at the kinematics of the

situation, the mechanism of injury, and the patient’s overall status using the primary survey and the secondary survey to help you decide between the two.




SCENARIOS• Patient #1

– An intoxicated male has cut his arm on window glass– Upon arrival you see a lot of blood and glass by the front

door– A 40 year-old male, sitting in a chair, presents with heavy

bleeding from the upper arm.– Upon examination, you see a laceration of the antecubital

fossa with copious bright red bleeding.

– What are your first thoughts?




SCENARIOS• Patient #1 (cont.)

– Possible conditions• Arterial bleeding

• Shock

• Hypovolemia

– Are there any life-threatening injuries? Absolutely!– We may find them even by doing our primary survey ABCs

(airway-breathing-circulation). • In the circulation phase, we check the pulse, condition of the

skin, and major, arterial bleeding, so this patient might have life-threatening injuries.





– What are examples of life-threatening MS injuries?• Life-threatening hemorrhage or bleeding – for example, with

Patient #1• Multiple, large-bone fractures

– What ways exist to control the bleeding?• Use the “Depth” pneumonic acronym

– Direct pressure– Elevation– Pressure– Tourniquet– Help





– Does this injury require rapid packaging and transport?

– Is this a “load and go” patient? Absolutely!





– A 24 year-old female has fallen while skiing.– She was brought to the lodge by the Ski Patrol– She complains of severe right thigh pain.

– What are your first thoughts?• A femur fracture is possible.

• Alone, this would be an isolated injury.

• But a broken femur could easily distract from a multisystem injury, perhaps an abdominal injury.





– Primary Survey• A – Patent airway• B – Normal breathing• C – No external hemorrhage, normal pulse rate, skin is warm

and dry• D – GCS score: 15

– Conclusions based on these findings:• Her injury seems isolated since her primary survey looks

okay. • Could she develop something like compensatory shock, later

on? Possibly.





– Secondary Survey– A swollen right thigh– How much blood could a patient lose from this type of

injury?• The patient could lose 1-2 liters internally.

• It doesn’t have to be an external wound to lose that quantity of blood.

– Is this enough to cause shock? Absolutely.





– Management Priorities• Transport and start an IV en route.

• Even though this is a likely isolated extremity injury, we are still going to do a rapid transport.

• Start O2. Oxygen should be initiated to keep O2 saturation levels above 95%.





– A 45 year-old male pedestrian was struck by an SUV.– He smells of alcohol.

– What are your first thoughts?• Look for pelvis, chest injuries.

• This patient has a lot of potential for multisystem trauma.





– Primary Survey• A – Patent airway• B – VR rapid and shallow, clear BS• C – Blood oozing from multiple soft tissue injuries, weak and

rapid radial pulse• D – GCS score: 13 (E-3, V-4, M-5)

– When you gently stress his pelvis, crepitus is noted and the patient screams in pain.

– What is the potential blood loss for a patient with an injured pelvis?

• It could be extremely high.




SCENARIOS

• Patient #3 (cont.)– Conclusions based on these findings:

• The patient could very quickly be going into compensated or decompensated shock.

– Management Priorities• On scene, package for transport.

– If the patient has a pelvic fracture:• Consider using a P.A.S.G. (Pneumatic Anti-Shock Garment)

• Inflate all the compartments all at once until the Velcro crackles.

• Immobilize on a backboard/longboard

• Rapid transport

• Start an IV and O2 en route.





– A 22 year-old male crashed while riding a mountain bike.– Because of the remote location, you reach the patient 1.5

hours after the injury occurred.

– What are your first thoughts?• Without question, the Golden Hour has passed.

• This patient may have potential for multisystem trauma.





– Primary Survey• A – Patent airway

• B – VR slightly increased

• C – No external hemorrhage, rapid and weak radial pulse

• D – GCS score: 15

• E – Deformities noted to left upper arm and to both lower legs

– Conclusions based on these findings:• We have multiple, isolated fractures which combine to

become a multisystem event.





– Secondary Survey• VR 24• Pulse 122• BP 104/72• There is no abdominal or pelvic tenderness

– Management Priorities• Shock is almost a certainty• O2 application• C-Spine immobilization• Packaged on a backboard/longboard

– Only splint injuries if there is time during transport• Consider a different kind of transport• Access to helicopter or quicker mode of transport





– Estimated Blood Loss (mL)• Rib 125

• Radius or Ulna 250 – 500

• Humerus 500 – 750

• Tibia or Fibula 500 – 1000

• Femur 1000 – 2000

• Pelvis 1000 – massive

– If you think the patient has a broken pelvis, treat the patient as if he will be in shock if he isn’t already.





– There are lots of vascular structures and vessels in the pelvis.

– With a broken pelvis, if it’s angulated or bones are in positions where they shouldn’t be, blood vessels could easily be ruptured, resulting in major blood loss





– A 70 year-old woman slipped on ice and fell down a staircase.

– Upon your arrival, she is complaining of pain in her left wrist and left ankle.

– On examination, deformities are founding both extremities.





– What are your first thoughts?• If the flight of steps is maybe twelve steps, we should be

looking for a mechanism of trauma.

• If it’s only two or three steps, trauma should be considerably less.

• Depending on how far the fall, we’re probably looking at two isolated extremity injuries unless there appears to be shock in evidence.

• Deformities in both extremities might mean problems with pulses and profusion in both extremities.





– Primary Survey• A – Patent airway

• B – VR slightly fast

• C – Moderate hemorrhage from oozing and open ankle, irregular pulse

• D – GCS score: 15

• VR 22

• Pulse 105

• BP 110/70

• Complains of pain at fracture sites.





– Any other possible contributing medical factors?• Based on her age, atrial fibrillation, irregular heart rate? A

secondary survey should be done to check further for other contributing factors.

• Is there a potential for shock? Absolutely.

– Are there life-threatening injuries present? • The fractures are not.

– Conclusions based on these findings:• We have multiple isolated fractures which combine to become

a multisystem event.





– Management Priorities• Preparation for transport

• O2 application

• Immobilization techniques

• Consider using extra padding when immobilizing

• Consider splinting possible fractures to decrease pain and keep her from moving more

• Start an IV

• Manage her pain; consider giving her a narcotic




SUMMARY• Although MS injuries can be dramatic, always begin

with the primary survey.• This would entail:

– checking the airway.– checking for signs of circulation problems.– checking the heart rate.– looking at the skin for signs of shock.– making sure there is no life-threatening hemorrhaging;

arterial bleeding, etc.




SUMMARY• Multisystem trauma patient

– Focus on primary threats to life revealed by primary survey• Airway

• Breathing

• Circulation

– Most MS trauma is splinted with spinal immobilization; if done correctly, additional splinting should not be necessary in most cases.




SUMMARY• Isolated MS injury

– Splint as appropriate, assuming the injury is isolated and you’re not worried about shock

• Rigid Splints (be sure and use padding with this type)• Traction Splints• Hard Splints• Using the other side of the body as a splint

– If no P.A.S.G is available, use a sheet or blanket wrapped around and pulled as tight as possible.

• A KED (Kendrick Extrication Device) may also be used for a pelvic fracture.

• If you are not familiar with this device, go here: http://en.wikipedia.org/wiki/Kendrick_Extrication_Device



http://en.wikipedia.org/wiki/Kendrick_Extrication_Device


SUMMARY• Isolated MS injury (cont.)

– If you think the patient has possible shock or hypovolemia due to blood loss, it could be a problem to take the time to do all the immobilization. You might have just to load and go.

– If you have multisystem trauma, respect and honor the Platinum 10 Minutes!




SUMMARY• Consider pain management

– On any isolated injury or injuries where shock isn’t an issue, pain management should be provided if the patient is in pain.

– Be careful, of course, if either compensated or decompensated shock is present, but pain management should be considered.

– That means start an IV during transport.– If your protocols won’t allow you to start pain meds,

contact your incoming hospital or trauma center and see if they can’t get you started with some pain management.




SUMMARY• Consider pain management (cont.)

– Later on, patients may not remember the isolated injury they had, but they will remember whether they were in pain or not.

– Pain could be viewed as a vital sign that can be responded to.

– You owe it to your patient to give consideration toward treatment of the pain as well as the injury.





1. True or False: A broken leg is far away from the heart; it could never be life-threatening.

2. True or False: A decent primary survey could be proved wrong when a secondary survey is conducted.

3. True or False: Based on this primary survey… A – Patent airway; B – Normal breathing;

C – No external hemorrhage, normal pulse rate, skin is warm and dry; D – GCS score: 15

…this patient is in no immediate danger.

07-8 Training MaterialsQuiz: PHTLS Training 4: Musculoskeletal Trauma



4. Considering the “D.E.P.T.H.” pneumonic acronym, which item is correct?

a. Deviation

b. Elevation

c. Profusion

d. Tamponade

e. Hemoglobin




5. When packaging a broken pelvis for transport, which of the following is NOT correct?

a. Consider using a P.A.S.G. (Pneumatic Anti-Shock Garment)

b. Inflate all the compartments all at once.

c. Immobilize on a backboard/longboard

d. Transport normally

e. Start an IV and O2 en route.(Answers on Slide 108)




Kramer vs. Kramer Essay QuestionsTelecommunications Interoperability

1. What are the advantages of having total interoperability in telecommunications among responders at major emergency incidents?

2. What are the drawbacks of having total interoperability in telecommunications among responders at major emergency incidents?

3. Describe efforts, or lack thereof, of telecommunications interoperability in your area. What suggestions do you have for

improvement?

If you’re enrolled in the Open Learning Fire Science Program at the University of Cincinnati, complete written responses to the following three essay questions to earn one college credit hour for watching Working Fire Training.

07-6 Training MaterialsEvolutions 2000 – Continuing Education


ENROLLMENT INFORMATION:

For more information on enrolling in the Open Learning program to gain college credit, call Working Fire Training at 800-516-3473 for a brochure or, to register directly, call the University of Cincinnati at 513-556-6583. Associates and Bachelors programs are available. Call to have your transcripts evaluated.

Send your responses to:

Professor Bill KramerUniversity of Cincinnati

College of Applied Science2220 Victory Parkway, ML #103

Cincinnati, Ohio 45206

07-8 Training MaterialsEvolutions 2000 – Continuing Education


Thanks so much for viewing Working Fire Training!

See you next month – stay safe!

Answers:

Hands-On – Interoperability Box: Quiz on Slides 47-49:1. False 2. True 3. False 4. e 5. c

Rescue/Search Dogs, Pt. 1: Quiz on Slides 69-71;1. True 2. False 3. True 4. d 5. c

Fire Medics – PHTLS Training 4: Quiz on Slides 103-105:1. False 2. True 3. True 4. b 5. d

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