Lamorinda CERT P atient Transport and Packaging

1. Lamorinda CERTPatient Transport and Packaging Released: 4 September 2013

2. Patient Transport and Packaging • Why do we need to transport victims? • How do we transport them? • What problems are inherent in moving victims? • How do we mitigate those problems?

3. Need to Transport • Victims need to be moved for a few reasons: • Victim is immediate danger • Current location is unstable • Building unstable • Fire • Water • Other hazards – gas, electrical, explosives, etc. • Victim needs more care than can be given at current location • Victim is blocking access to other victims

4. How to transport • Several ways to transport • Method depends on situation and victim condition • Walking Assists • Crawls and Drags • Carries • Carried directly by rescuers • Carried on equipment by rescuers • May require immobilization

5. How to Transport

6. Walking Assist 1. Stand at the victim’s side and drape the victim’s arm across your shoulders. 2. Support the victim by placing your arm around his or her waist. 3. Using your body as a crutch, support the victim’s weight as you both walk.

7. Shirt / Shoulder Drag

26. Patient Packaging • What Is It? • Patient packing is the process in which a patient is prepared for transport, while providing for comfort and immobilization. This process should not interfere with the patient’s ability to continue with normal bodily function and yet should allow the transporting personnel the ability to maintain an accurate account of the patient’s vital signs, continue with the treatment of any and all illness and injury and provide the appropriate medical care. • This process must be able to be provided in a rapid and easy manner so as to not compromise scene time, the safety of the patient and rescue personnel, and not become a physical burden in its application.

27. Patient Packaging • Why Is It Important? • Moving a “loose” victim is likely to cause further injury. • A properly packaged patient can be moved easily and transferred from one set of transporters to another seamlessly. • Packaging can be done for the type of movement needed, flat, low-angle, high-angle, vertical lift or descent.

28. Patient Packaging • What Kinds of Packaging may a CERT Need To Do? • Cervical Spine immobilization. • Longboard (backboard) • Chair • Stretcher or Sling

29. Spinal Motion Restriction • Mechanism of Injury • Anything to suggest spinal injury? • They say “my neck hurts” or “my back hurts” • Altered mental Status • Head Injury? • Which came first… • Findings on Assessment • Pain, tenderness, swelling, or deformity in spine • Muscle Spasm • Neurological deficit

30. Need for a C-Collar • A Cervical Collar provides: • Temporary support to the head of a sitting or standing patient until the patient canbe placed in a supine position. • Frees the hands of rescuers while the patient is being moved & splinted to a Full spine board. • Reduces compression of the cervical spine caused by the head. • Minimizing axial loading / unloading of the spine that takes place during transport.

31. Limitations of a C-Collar • The Cervical Collar: • Is NOT designed to immobilize the cervical spine, let alone the rest of the spine. • Restriction of movement of the head with a rigid collar is at best 50% of normal movement. • Is NOT designed to provide any traction to the head, but is only designed to support the weight of the head. • Only prevents 50% of cervical spine movement. • Provides no thoracic / lumbar spinal support. • Has not been shown in any study to adequately immobilize the cervical spine.

32. Hazards of a C-Collar • A number of dangers may be associated with application of a Cervical Collar: • If the jaw support of the collar clamps the teeth together, airway compromise may result if the patient vomits. • Cervical Collars that place pressure on the neck (either via collar design or too small a Cervical Collar being applied), may cause an increase in intracranial pressure.

33. Cervical Spine Motion Restriction • The technique • Should be simultaneous with assessment. • Place collar, if needed, prior to any patient movement • Don’t use force. • More than one manufacturer of collars • One collar does not fit all! • Towel or Blanket rolls alternatives

34. Typical C-Collars • Many manufacturers and many styles • Inexpensive ($6-15 each) These were $7.50 each • Directions are normally printed on package

35. Backboards • Backboards come in many styles • Longboards are full length rigid backboards in either adult or pediatric sizes. • Shortboards are used for extrication and go from waist to head.

36. Issues with Backboards • Now…a word about padding • Skin breakdown can begin to occur in as little as 1 hour • Get victim off backboard as soon as possible • Redistribute the weight off of the shoulder blades, buttocks and heels • Padding (not a lot) makes a huge difference • Bending knees flattens the back, flattens the feet to redistribute the weight

37. Backboard Use Tips • Pad the board prior to placing the patient on it • Leave the appropriate arm/arms accessible to allow therapies and monitoring • Cover over the top of the straps rather than under them • Make sure that the patient will not move side to side if tipped • Use specialty securing devices for little people if they are available

38. Backboard Special Circumstances • Severe closed head injuries • Tilt head of backboard up • Penetrating back injuries • May need to place victim on side • May need to hold direct pressure • Impaled objects • May need to get creative • Pregnant women • Left side down-pad between knees

39. Sleds • Rescue / Evacuation stretchers are rolled plastic sleds that, once unrolled and turned up on the edges, provides a rigid sled that can be dragged, lowered or hoisted. • Longboards can be used inside sleds.

40. Litters • Litters are baskets, like the ‘Stokes Litter’ that enable rescuers to easily carry, hoist or lower a victim.

41. Pole Stretchers • Pole stretchers have rigid poles, folding poles or breakdown poles. • Flexible webbing allows compact storage

42. Flexible Stretchers • Low-cost flexible stretchers and chairs • Does not immobilize the spine

43. Perishable Skills Review

44. Arterial…spurting Venous…flowing Capillary…oozing Bleeding Losing one liter can be life threatening

45. Bleeding Control • Direct pressure • Elevation • Pressure points No tourniquets!

46. Wound Care Objective of wound care: • Control bleeding • Prevent secondary infection Treatment of wounds: • Clean wounds – don’t scrub • Apply dressing to wound • Apply bandage to hold dressing in place No tourniquets No Hydrogen Peroxide

47. Rules of Dressing • In the absence of active bleeding, remove dressing and flush, check wound at least every 4-6 hours, redress as necessary • If there is active bleeding, redress over existing dressing and maintain pressure and elevation

48. Hemorrhagic Shock • Hypovolemic shock is the most common type of shock and is caused by insufficient circulating volume. Its primary cause is hemorrhage (internal and/or external), or loss of fluid from the circulation. Vomiting and diarrhea are the most common cause in children. • Hemorrhagic shock, a type of hypovolemic shock, is defined as a failure of adequate tissue perfusion resulting from a loss of circulating blood volume. • Cardiogenic shock results from heart damage. • Vasogenic shock results from blood vessel dilation, often from toxins like anaphylaxis. • Neurogenic shock results from head or spine injury.

49. External Hemorrhagic Blood Control • New protocols allow use of tourniquets. If you use a tourniquet, the limb below the tourniquet is to be considered forfeited. • Blood clotting agents are available to stop hemorrhagic blood loss. • Hemostatic granules like Celox ~ $14 • Hemostatic gauze like Celox Rapid ~ $41 • Hemostatic sponge like QuikClot ~ $24 • Always tape empty package to victim

50. External Hemorrhagic Blood Control • New dressing materials staunch blood flow from traumatic hemorrhage wounds in pre-hospital emergency situations. Includes dressing and bandage with pressure applicator device. • Israeli Bandage Battle Dressing • 4” width ~ $6.50 • 6” Width ~ $7.00 • 12” Abdominal with 12x12 pad ~ $12.00