Robert French, MD, MPH

Track Handout

 

Bringing Advanced Medical Care to the Entrapped Patient

Introduction:

Prolonged technical rescue operations that involve injured patients require that agencies that provide pre-hospital emergency medical services deviate from the practice of "scoop and run" trauma care. One cannot "scoop" if the patient is inaccessible or entrapped. These occurrences, while uncommon, are not rare in busy Fire/Rescue/EMS systems. Agencies should plan for such occurrences and have mechanisms in place to safely and quickly bring advanced emergency medical care to the entrapped individual. This talk will cover planning and preparation for such occurrences as well as a discussion of what issues may be encountered and what interventions may be required.

Course Outline:

  1. Reasons To Bring Advanced Medical Care to the Field Setting

    2. Prolonged Entrapments

    Complex Evacuation/Remote Location

    Multiple patients requiring Extrication or Evacuation

  2. Models for Bringing Advanced Care to the Field

    3. Maritime Medical Access

    Medical Component of the Urban Search and Rescue System

    DC Fire and EMS/George Washington University Advanced Medical "Go-Team"

  3. Safety

    4. Personal Safety

    Training

    Personal Protective Equipment

    Professional and Financial Safety

    Malpractice

    General Liability

    Disability Insurance

    Life Insurance

  4. "Go Team" Personnel

    5. ED Attending

    ED Nurse

  5. "Go Team" Supplies

    6. Medical/Surgical Equipment

    Medications

    VI. Patient Assessment

  6. Clinical Entities in Collapsed Structures
  7. Procedures in Confined Space
  8. The Trapped Extremity
  9. Field Amputation

The Decision To Amputate

Rescue Impossible without Amputation

Site Hazardous

Unstable patient

The Procedure

Evacuation Plan

Pain Control

This is not a final amputation

Preservation of as much tissue as possible