(Continued from Part 1.)
FIRST RESPONSE AT THE SCENE – BE SAFE!
- Be aware of the hazards involved in responding to a call for help.
- Develop an understanding of the safety and priorities at the scene of an incident.
- Know how to call for assistance (you do have your Baofeng (12) or equivalent, don’t you?)
Most accident scenes are uncontrolled and potentially dangerous. DO NOT BECOME A CASUALTY YOURSELF – STOP, LOOK, LISTEN and SMELL. The first priority at any accident scene is your own safety, followed by safety of the victim. Finally, the safety of everyone on site must be considered.
LOOK – For obvious hazards, but take care, many hazards are not immediately obvious.
LISTEN – Many less obvious hazards may be heard e.g. gas escaping from ruptured pipes or the crackle of electrical cables shorting out.
SMELL – You cannot see gases – and some poisonous gases, like Carbon Monoxide / H2S, you cannot smell either. So always be alert and remember, just because you can’t smell anything does not mean that the scene is safe to be breathing in. And, while ‘Common Sense’ can warn you of possible hazards e.g. fire or gas leak, common sense is much less common in an emergency. Consider also the time of day, the weather conditions, and the illumination; dusk, night, and dawn may mean hazards are not visible.
THINK BEFORE YOU ACT – DO NOT BECOME A CASUALTY YOURSELF
The safety of the victim is the second priority. When there is a residual and immediate hazard AND you know what to do AND it is safe for your to do – sure, remove the hazard. However, many hazards are beyond our control and it is all-over smarter to move the victim away from the danger. Now this can get tricky for trauma especially if head / neck / spine are involved; if we can, we should try to move the victim “maintaining the posture in which found” as Dr Pompous states. “Avoid bending or rotating the victim as these may cause further injury.” Yeah, right. But remember, if the patient’s survival is at risk – what’s the lesser of two evils? It’s your call if you decide to use the Fireman’s Carry (see below) if you think you MUST MOVE this casualty RIGHT NOW without assistance.
People are naturally curious and can also be a hazard. An accident scene especially if gory / noisy will usually attract unwanted bystanders. If you’re in a ‘built=up area’ or say a resort, bystanders can put their own safety at risk as well as others around them, plus usually get in the way and often are of no real assistance. We have to not to allow them to distract us from our own safety and assisting the victim. You could ask / co-opt / deputize two or three yeah, big and imposing*, people to control the crowd and move them to a safer position while you assist the victim. *But not loud-shouters. Shouting raises everyone’s stress levels.
Some bystanders will be helpful when you nudge them nicely out of ‘Rubberneck Mode’. Give them clear directions. Ask them to assist under your direction e.g. moving debris etc.
RAPID ASSEMBLY OF THE STRETCHER
I like the Ferno basket stretcher. I have no commercial relationship with the Ferno people either – but I have used various iterations of their basket stretcher for decades and I know what it can do and what it can’t and how I can use it and how I shouldn’t.
It’s made of hard hi-viz (‘rescue orange’) plastic designed to provide for a variety of applications based on specific needs, while still being light and portable (makes it particularly well suited for use in confined spaces – and if you have to slide people over rough surfaces, hedges, lift them over fences, slide them down stairways, etc. you can do that without them coming to harm.
A Ferno ‘stretcher package’ includes:
• 1x Backpack Carrying Case (if stretcher ‘split’)
• 1x Stretcher with Straps
• 1x Lifting / Winching Harness
The stretcher has a heavy-duty aluminum frame and will support any practicable patient weight.
If a split stretcher (easier to store and carry!), the stretcher halves store nested together and the basket stretcher is assembled and secured with pins, comme ça:
1. Remove the stretcher from any pack and place two halves on the ground close by the patient
2. Line up both ends and slide together taking care that the joining rope does not become trapped by the join in the middle of the stretcher
3. Unfasten the safety belts and lay over the sides.
4. If a vacuum mattress is to be used lay it flat in the stretcher, taking care that the wide (head) end of both mattress and stretcher are at the head end of the patient. The mattress should now lay flat in the stretcher without any wrinkles.
5. Lift the patient carefully (see next section) and lower into the stretcher. Use the chest, pelvis and leg straps to secure the patient to the vacuum mattress and the mattress to the stretchers.
Doing steps 1 to 5 can actually take no more time than it takes to read them out loud when you have a practiced team. We should all practice steps 1 to 4 regularly and we should all be as good as anyone else.
RIGGING FOR HORIZONTAL LIFT/DESCENT & SLIDING
The stretcher’s built-in brass grommets provide four strategically positioned lifting points to ensure a safe and effective means of raising or lowering the patient. These are designed to be used ONLY with the Ferno ‘Adjustable Lifting Harness’, a nylon webbing harness with carabiner locks horizontal lifting or lowering of the stretcher. Note that in this configuration we will attach at least 2 guide ropes attached to the stretcher top and bottom, to stop it spinning (‘belay’ lines).
We can also attach a tow rope or strap to the head of the stretcher to pull it short distances in confined spaces, under pipes, across icy and other slippery surfaces, or even up or down a ‘tight’ flight of stairs. It is not likely we are going to need to lift or lower the stretcher vertically but one day it will happen if we do enough movements and so we need to practice that too.
HOW TO SAFELY MOVE A PATIENT ONTO A SPINAL BOARD IN CASE OF SPINAL INJURY, FRACTURES ETC.
If the patient is on his side he will first need to be turned by the log-roll turn (doing this means that at all time the spine and head are kept in alignment so as to prevent damage to the spinal cord which could paralyze the patient is he is not turned carefully.
Note: Minimum 4 (four) preferably five (5) people are needed to perform this log-rolling procedure:
(1) one to maintain manual, in-line immobilisation of the patient’s head and neck
(2) one for the torso (including the pelvis and hips)
(3) one for the pelvis and legs
(4) one to direct the procedure and move the spine board.
If you only have four people and you can’t spare one to be a team leader, then the person at the head and neck of the patient runs the process. It ain’t a democracy. Five people is better, as you’ll read shortly.
Warning: We are describing the process in detail, but you need to learn it under trained Professional supervision. You’ll first learn it with a ‘Crash-test-dummy’ or equivalent; and then you’ll do it with me as the patient and I warn you, you’ll get feedback if you start messing with my bodily integrity!
(To be continued tomorrow, in Part 3.)