Why should fire trucks and ambulances always show up for a medical emergency?

Why should fire trucks and ambulances always show up for a medical emergency?

By Kelvin from Swift Emergencies Response Unit - Kenya

When a call comes in at the call center, dispatchers often are not given precise or complete information. As such, units are dispatched on a worst-case scenario. To ensure the highest level of care, the closest fire engine station is dispatched and EMS sends an ambulance (staffed with two paramedics and/or EMT's).

No medical call is “routine.” Most require assessing the patient, obtaining their vital signs, providing oxygen therapy, and moving them, at a minimum. EMS may also need to place an advanced airway, administer drugs intravenously, or monitor cardiac conditions. All of these procedures are completed more efficiently when the appropriate amount of help is on scene. Efficient care is our goal, and efficient care often is the difference between life and death.

Unfortunately, units have no way of knowing what they will encounter on a call until they arrive. They work in a “what if” and “all risk” business. Responding to the unknown is public safety. The public can help by calling emergency numbers quickly when there is an emergency and providing details of the emergency. Emergency hotlines are your instant go-to when the need arises. It is important that you know the numbers to call to get assistance and keep a copy with you.

Ambulance Services and Its Importance in Society

Ambulance Services and Its Importance in Society

 By: Kelvin from Swift Emergencies Response Unit - Kenya

Increase in medical ailments has led to the rise in hospitals and emergency medical services assisting patients who require emergency medical assistance at critical moments, helping them to reach the hospital on time thus saving their life.

Private and public ambulance transport services are operating in more numbers today as an inevitable service providing care to critical patients at crucial moments. In Kenya, ambulance operating centers are set up at every hospital and private EMS organization. These Ambulance operating centers function with adequate ambulance transport services to offer immediate medical care for patients. Private ambulance transport services depict a consistent rise in the growth curve each year offering non-emergency services unlike hospital ambulance transport services which primarily function for emergency needs. Some of the non-emergency services include shifting patients from one hospital to another, transporting patients for any scanning or laboratory services to the relevant facilities, or patients with any travelling disabilities in normal vehicles to hospitals for treatments.

Emergency ambulance services are usually equipped with adequate medical equipment and paramedical professionals. Sometimes, non-emergency ambulance transport services are also equipped with some basic medical aids and a para medical staff to cater the needs of immediate medical care to patients.

Let us discuss a few points about the pre-hospital medical professions - paramedics and emergency medical technicians (EMTs) who are the spine of ambulance transport services:

• Paramedics or EMTs are first treating patients even before doctors (pre-hospital care) thus saving patients through immediate medical procedures ensuring the vitals stable before reaching hospitals for further treatments.

• Paramedics and EMTs are trained healthcare professionals, authorized to attend patients with required medications and procedures based on their training level.

• Education level, standards, functions and skills of paramedics and EMTs vary with countries. However. certain standard functionalities remain common such as being trained to practice CPR procedures for cardiac arrest patients, usage of defibrillators, certain analgesic, paralytics and sedative medications for pain control, first aid to treat burns, fractures, childbirth complications, spine injury, airway management, blood control etc.

• One should respect the noble service of prehospital providers who form an integral part of ambulance services.

• The youth of our nation should involve themselves in such noble service, joining community life saving teams and can considering a career as a paramedic or EMT.

• The government could benefit from taking initiatives to support volunteer community first responders at the community level and to empower them to continue saving lives at the scene before qualified personnel arrives.

Introduction to the Principles of Emergency First Aid

By Howard Cohen

Not all firefighters are emergency medical technicians or paramedics, but often we are the first responders to scenes where it is necessary to provide life saving first aid.  Therefore, it is important for all firefighters to have at least a basic knowledge of first aid.  The purpose of this short article is to provide foundational principles for responding to trauma in situations where immediate life saving medical help is required.  In no way should this article be considered first aid training.  However, with the basic and limited information contained within, and no other training, you may still be able to save someone’s life.

Scene Survey: The First Task

Size up:  Regardless of your level of technical first aid training or medical knowledge, when responding to an incident that involves injuries your first task is to gather as much information as you can about the situation.  This is done through a careful size up.  It is critical that you assess the risks and dangers before rushing in to administer aid. Ask yourself, “What is trying to kill or harm me?”  Is it traffic, wildlife, fire, an unstable building, falling objects, or flooding waters? You do not want to become another casualty or cause further harm to the patient.

Number of patients:  Once you’ve made the scene safe and stable now is the time to determine how people are part of the incident.  It is easy to get fixated on patients who are calling out in pain, overlook those who are unconscious, or miss those who are not visible.  It is also easy to rush to aid a person whose injuries appear more life threatening than they are, for example someone who is bleeding from a superficial head injury, while someone else nearby has stopped breathing.

Primary Survey:  The Second Task

The primary survey is an assessment of the three main life supporting functions.  These are the respiratory, circulatory, and nervous systems, also known as the ABCDs.  Any problems involving one of these systems represents an immediate threat to the life of the patient and must be addressed immediately.   

ABCDs:  Once size up is completed, the scene is safe (or as safe as you can make it), and you have a sense of the number of patients needing aid,  initiate a primary survey of the patients by checking the status of the three conditions which represent an immediate threat to life.

Airway:  Check to be sure that the mouth and airway are cleared and air is actually going and out.

Blood is Circulating:  Check to make sure that blood is not pouring out and that it is circulating.

Disabled:  Check to see if the spine is stable and the central nervous system is operating normally.  Due to the limited scope of this article I will not be saying any more about injuries that involve the head, neck or spine.

Basic Life Support (BLS)

Basic life support is the immediate treatment of one of the three life threatening emergencies found during your primary survey.  The purpose of BLS is to provide temporary support to keep the patient alive while a secondary survey is conducted and/or until advanced treatment is available.

The simplest way to begin a primary survey is to ASK the patient, “How are you?” If he answers then you know that his airway is not obstructed (A), his heart is beating (B & C) and the brain is functioning (D).  If the patient does not respond or responds in an unusual way you will need to look more closely.  

Airway:

Airway problems are a result of an obstruction to the pharynx or larynx.  The obstruction can be complete or partial.  A complete obstruction is rapidly fatal, but can be effectively and dramatically treated by clearing the airway.  There are various ways an airway can become obstructed such as from vomit, a foreign object or swelling caused from trauma, an irritant or allergic reaction.  It is imperative that you clear the airway but you must do so without causing any additional harm to the patient.

Breathing:

It is possible for a person to have an open airway but still have difficulty breathing.  This can be the result of an injury to the brain, spinal cord or diaphragm.  The method for assisting a patient with breathing when more advanced medical care is not available is called positive pressure ventilation or artificial respiration (mouth to mouth).  The rate of inflation should be about 12 breaths per minute or one every 5 seconds.  Breaths should be about 1 to 1.5 seconds.  Faster breaths can force air into the stomach which can lead to vomiting.

Bleeding & Circulation:

Uninterrupted circulation of blood is essential to staying alive.  There are essentially two kinds of disruption to the circulation of blood that you can address as a first responder:  cardiac arrest and bleeding.  Cardiac arrest means the heart has stopped beating.  While doing your primary survey if you discover that the patient has no pulse it means her heart has stopped beating and she is in cardiac arrest.  It is important to note that under adverse situations, or if the patient is in shock, it can be hard to find a pulse.  The carotid pulse is the strongest to feel and easiest to access.  It is found on either side of the larynx in the neck.  If there is no carotid pulse, the heart is not beating. CPR (cardiopulmonary resuscitation) is the only treatment for cardiac arrest.  Even with hands-on training, it has limited potential to restore and sustain life.

The second kind of disruption to circulation is caused by a major loss of blood.  Blood loss must be controlled as a part of BLS.  Bleeding can be internal and both hard to identify and stop, or external, but not necessarily obvious.  Addressing internal bleeding is beyond the scope of this article and most first responders in the field.  External bleeding is controlled by direct pressure over the bleeding site with your hand, but preferably with a cloth or bandage.  This is not to absorb the blood.  It is to provide even pressure across the wound.  Expect to apply direct pressure for 10 or more minutes.  If the bleeding is not stopping, remove the bandage and check for the source of blood and then reposition your hand.  

There is no easy rule for deciding when bleeding is severe.  A rule of thumb is that if it looks like a lot of blood, then it probably is.  However, it is worth noting that severe  bleeding can be missed if the patient is wearing a lot of clothing or the blood is absorbed into the ground around the patient.

Conclusion:

When it comes to developing first aid skills, like all skills a firefighter needs to master, training and practice are essential.  At the same time, it is important to read about the principles and theories undergirding these skills.  However, there is no substitute for training and practice.

References:  

The Outward Bound Wilderness First-Aid Handbook; Jeff Isaac & Peter Goth.

The Field Guide of Wilderness & Rescue Medicine; Jim Morrissey & David Johnson.

Opening an Unconscious Patient’s Airway with a Manual Manipulation:  

https://www.youtube.com/watch?v=AifzmrpA7ao

https://www.redcross.org/take-a-class/cpr

About the Author

Howard retired from the Bennington Fire Dept as a deputy chief.  He spends a lot of time writing and teaching various aspects of firefighting.  He religiously works out every morning, doing a mix of high intensity interval training (HiiT), dumbbells, kettlebells, barbells and cycling. When he is not doing something for the fire service or working out he is the rabbi of two small congregations.

Firefighter Safety- Using your PPE

By Brad Banz, Retired Chief, Colwich, Kansas Fire Dept. and Retired Captain, Wichita, Kansas Fire Dept.

 Today’s firefighters are asked to do much more than just respond to fires.  In the modern world, we respond to automobile accidents, dangerous goods (haz-mat) incidents, various types of rescue calls, utility emergencies, EMS calls, and now add in terrorism and pandemic to the list, not to mention anything else that may occur.  

    Firefighters are exposed to a spectrum of hazards as a result of the wide variety of incidents that we respond to.  We are exposed to environmental heat from working around fire, as well as the excess heat our bodies produce from extreme exertion.  The fires today we are responding to burn hotter than they did even 30 years ago.  An example is burning a cotton mattress versus a modern sofa made of polyurethane foam and polyester fabric.  The cotton mattress when burned will release heat at a rate of 140-350 kilojoules per second.  The sofa will release heat at a rate of 3,210 kilojoules per second.  Ten times the amount of heat.  We are exposed to cold, falling objects and debris, blood and biohazards, suffocation hazards, and crushing hazards.  We are also exposed to a toxic assortment of chemicals, not only from the dangerous goods incidents we respond to, but from each fire, no matter what the contents.  

   The reason I share this is not to scare anyone from the job, but to hopefully educate everyone on the hazards that are there so they can better equip themselves to more safely do the job.  Because we respond to more incidents and are exposed to a wider variety of hazards, we must do a better job as firefighters of focusing on safety.  One of the most fundamental things firefighters can do is to wear their PPE.  

     Let’s talk a little about how PPE makes us safer.  Coats and pants are made of 3 layers of material.  The outer shell provides a first layer against heat and cold, and some protection against moisture.  The middle layer is the vapor barrier.  As the name implies, it provides a barrier against steam and some chemical vapors.  The inside layer is the thermal barrier.  The layering of it, along with the outer layers, create a stronger barrier against heat.  The level of heat protection is dependent upon the materials the coats and pants are constructed of.  They will give limited protection against some dangerous goods, but are not meant to be the primary PPE for all responses.  In any circumstance, to insure maximum protection, coats and pants should be fastened all the way.  Boots can be constructed of leather or rubber and must have steel toe and foot protection to protect from crushing injuries as well as penetrations.  Gloves are made of leather or other materials.  They are lined to protect our hands from thermal injuries and have wristlets to protect our wrists as well.  Hoods are made of Nomex or carbon fibers.  An adequate hood offers protection to our necks and overlaps down on to the tops of our shoulders, and protects our necks and all exposed skin on our heads from heat.  They should be pulled up whenever operating in a hazardous environment.  A good helmet should have an adequate face shield, chin strap and neck protection.  It should also be clean and not cracked.  The face shield should be in a down position when working in an environment where tools or equipment are being used or blood, biohazards, or other chemicals may be present.  

    Any time we are entering an environment that is filled with products of combustion, heat, fire, or unknown atmosphere we should be wearing a breathing apparatus.  This includes during the overhaul process after the fire is contained.  If your department/brigade does not have BA then you need to structure your firefighting tactics accordingly.  

    As I addressed earlier, one of the biggest hazards we face is responding to medical and trauma related emergencies, and the risk of biohazards.  We need to make sure to protect ourselves by wearing the proper gloves, protective glasses, masks, and if the situation calls for it, gowns and facial protection.

    I have briefly covered the hazards and the PPE we can use to lessen the risks that we face.  Firefighters need to consistently practice an attitude of safety every day, and watch out for each other.  Thank you, and let’s all stay safe out there.