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Confined Space Confined Space
Medical ConsiderationsMedical Considerations
1989- San Francisco1989- San Francisco
2001- Pentagon2001- Pentagon
2005- Katrina2005- Katrina
ImpedimentsImpediments
Poor Access
Poor Lighting
Timing with Rescue Squad
Communicating needs
Poor Access
Poor Lighting
Timing with Rescue Squad
Communicating needs
Special EquipmentSpecial Equipment
ObstaclesObstacles
Loss of basic services
Medical system chaos
Race against time
High risk environment
Loss of basic services
Medical system chaos
Race against time
High risk environment
Personal PerformancePersonal Performance
PPE
Austere environment
Concerns about personal safety…
No assurance – tight space and equipment issues
PPE
Austere environment
Concerns about personal safety…
No assurance – tight space and equipment issues
Medical Care Problems Medical Care Problems
Inherent delay in starting treatment
Unusual medical problems
No – scoop and run
No back up
Inherent delay in starting treatment
Unusual medical problems
No – scoop and run
No back up
Event PatternsEvent Patterns
Injury variation- Flood, quake, tornado, IED….
Time of day
Type of response- intact infastructure?
Injury variation- Flood, quake, tornado, IED….
Time of day
Type of response- intact infastructure?
Generalizations-Golden Day
Injury severity classification
Common medical problems
Unusual Injuries
Crush, blast, compartment syndrome, Dust Impaction
Generalizations-Golden Day
Injury severity classification
Common medical problems
Unusual Injuries
Crush, blast, compartment syndrome, Dust Impaction
CSM Common Medical IssuesCSM Common Medical Issues
Fractures/Lacerations
Multiple Trauma
Closed Head
Hypothermia
Dehydration
Fractures/Lacerations
Multiple Trauma
Closed Head
Hypothermia
Dehydration
Factors in DeathFactors in Death
Entrapment
Severity of injury
Entrapment
Severity of injury
Golden Hour- Fagetaboutit
4-24 hours- Shock/Airway- intervention critical to survival
LateSepsis
Multiple organ failure
Golden Hour- Fagetaboutit
4-24 hours- Shock/Airway- intervention critical to survival
LateSepsis
Multiple organ failure
Injury PatternInjury Pattern
Wood- Lac/Punctures
Brick/Concrete – dust/crush
Wood- Lac/Punctures
Brick/Concrete – dust/crush
CSM ObjectivesCSM Objectives
Bring EMS, emergency medicine, and critical care unit to the patient
Expedite the extrications
Stabilize the patient
Immobilized Fractures
Pain Control
Package and transfer the patient
Bring EMS, emergency medicine, and critical care unit to the patient
Expedite the extrications
Stabilize the patient
Immobilized Fractures
Pain Control
Package and transfer the patient
OperationsOperations
Responder safety
ABCs
Have a plan
Responder safety
ABCs
Have a plan
CMS Medical PracticeCMS Medical Practice
Acquire patient and environment data
Monitor rescue team victim impact
Prep and pre position
Coordinate with rescue team
Eval- begins with first contact
Full Eval- outside of environment
Acquire patient and environment data
Monitor rescue team victim impact
Prep and pre position
Coordinate with rescue team
Eval- begins with first contact
Full Eval- outside of environment
Patient reached/Structure Stabilized= Treatment
Re evaluate after each significant move
Patient reached/Structure Stabilized= Treatment
Re evaluate after each significant move
Medical OperationsMedical Operations
FunctionsProvider
Anticipator
Med Control
Recorder/Safety
Supply
FunctionsProvider
Anticipator
Med Control
Recorder/Safety
Supply
ProviderProvider
Hands on patient
Performs evals and interventions
Thinks/Acts = OUT LOUD
LimitationsPhysical Characteristics
Tech needs
Personal – fatigue
Hands on patient
Performs evals and interventions
Thinks/Acts = OUT LOUD
LimitationsPhysical Characteristics
Tech needs
Personal – fatigue
AnticipatorAnticipator
Listens to the OUT LOUD Thinking of the Provider
Askes what is need…. Anticipates what
Ensures equipment and supply is prepped and delivered
Listens to the OUT LOUD Thinking of the Provider
Askes what is need…. Anticipates what
Ensures equipment and supply is prepped and delivered
SupplySupply
Obtains
Prepares
Monitors cache supply
Obtains
Prepares
Monitors cache supply
Med ControlMed Control
Intact infrastructure
Non Intact infastructure
Intact infrastructure
Non Intact infastructure
Patient Data - ASAPPatient Data - ASAP
Age
PMH
Allergies
Hazards
Estimated Extrication Time
Entrapment time
Complaint
Injuries
Age
PMH
Allergies
Hazards
Estimated Extrication Time
Entrapment time
Complaint
Injuries
Rescue Team ImpactRescue Team Impact
Dust
CO
Rubble Movement
Evaluation begins at first voice contact
Monitor the rescuers
Dust
CO
Rubble Movement
Evaluation begins at first voice contact
Monitor the rescuers
VoiceVoice
Determines illness/injury
Anticipate needs – don’t wait for physical assessment
Determine problems
Considerations may require alterations in rescue team plans
Determines illness/injury
Anticipate needs – don’t wait for physical assessment
Determine problems
Considerations may require alterations in rescue team plans
General Patient ApproachGeneral Patient Approach
Protect from harm
Work with what you have
Use BTLS- ITLS ;;whatever
Communicate with patient
Protect from harm
Work with what you have
Use BTLS- ITLS ;;whatever
Communicate with patient
Rescue TeamRescue Team
Communicate
Plan
Re Evaluate after every move
Communicate
Plan
Re Evaluate after every move
SummarySummary
Obstacles to quality of care
Medical Team organization and function
Systematic approach
Evaluation and Treatment
Hand Off
Obstacles to quality of care
Medical Team organization and function
Systematic approach
Evaluation and Treatment
Hand Off
Thanks For What You do… what ifThanks For What You do… what if
