Search and Rescue Medic Course

1. Search and Rescue Medic Course Presented by: 1LT Timothy Paquin, CAP Ground Team Leader, EMT-B

2. Introduction

3. Prerequisites • Valid CAP ID card • Valid CPR/First Aid Card (AED training is optional) • Minimum GES card with 101 qualification as a Ground Team member preferred • Positive mental attitude with ability to devote 110% of your attention and energy to the course • Good interpersonal relationship skills • Good sense of humor • A strong stomach and the ability to deal with views of traumatic injuries

4. TOPICS (not in any specific order) • Patient assessment and urgent care • Care of bleeding, wounds and burns • Musculoskeletal and soft tissue injuries • Splinting, dressing and bandages • Circulatory emergencies • Respiratory emergencies • Abdominal emergencies • Diabetic emergencies • Allergies • Physical and environmental hazards • Heat injuries • Cold injuries • Altitude emergencies • Poisons, toxins and poisonous animals • Bites and stings • Patient packaging and transportation • First aid kits and improvised supplies • Legal and ethical issues

5. What this course will do: -- Provide a form of continuing education to increase your skills in First Aid and CPR during Civil Air Patrol Search and Rescue missions. -- Introduce you to some technical skills and techniques that may be performed by medical professionals. -- Provide an overview of the legal and ethical issues involved in patient care.

6. What this course will NOT do: -- Certify you as a First Responder, Emergency Medical Technician, Paramedic, Nurse, or Doctor. -- Certify you in Wilderness First Aid through any agency or organization. -- Certify you to perform any skill above your current skill level (i.e. tracheotomies, IV’s, or intubations). -- Provide information in diagnosing specific injuries or illnesses.

7. EMS Basics and the Search and Rescue Medic (SAR-Medic)

8. History of EMS

9. Levels of Proficiencyin Colorado EMS • First Aid/CPR Certification • The base level for all EMS providers • Certification is provided by a number of different agencies, including: • The American Red Cross (ARC) • The American Heart Association (AHA) • The American Safety and Health Administration (ASHA) • Heartsmart, Inc. • The National Safety Council • Provides basic CPR and First Aid Skills for the average citizen • First Responder • Above First Aid/CPR certification but below the EMT-Basic level • Certification is governed by the US Department of Transportation • Provides certain additional skills to assist EMT’s and other medical professionals

10. Levels of Proficiencyin Colorado EMS (cont.) • EMT-Basic • Skills include Basic Life Support and EKG • Can Perform Intravenous Therapy (if certified) • Can provide and assist with the following medications, with medical direction: • Oxygen • Activated Charcoal • Oral Glucose • Metered Dose Inhalers (MDI’s) • Nitroglycerin • Epinephrine • EMT-Intermediate • Skills are between EMT-B and AMT-P • Can perform IV Therapy with additional medications • EMT-Paramedic • Highest skills in the field barring the presence of a Doctor or Nurse • Can provide IV Therapy with a full line of different medications • Advanced Cardiac Life Support, Pediatric Life Support, and Manual Defribulator Qualified • Can perform Tracheotomies and Intubation

11. The CAP SAR-Medic The Civil Air Patrol SAR-Medic is a volunteer who is specially trained in dealing with severe traumatic injuries, as well as common injuries, as related to various operations during Emergency Services Missions. SAR-Medic’s provide emergency treatment of accident victims when no EMS professionals are present, and additional assistance to those professionals upon arrival.

12. Hawk Mountain Medic Creed My task is to provide to the utmost limits of my capability the best possible care to those in need of my aid and assistance. To this end I will aid all those who are needful, paying no heed to my own desires and wants; treating friend, foe and stranger alike, placing their needs above my own. To no man will I cause or permit harm to befall, nor will I refuse aid to any who seek it. I will willingly share my knowledge and skills with all those who seek it. I seek neither reward nor honor for my efforts for the satisfaction of accomplishment is sufficient. These obligations I willingly and freely take upon myself in the tradition of those that have come before me. …These things we do so that others may live.

13. Hippocratic Oath I swear to fulfill, to the best of my ability and judgment, this covenant:I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.I will prevent disease whenever I can, for prevention is preferable to cure.I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

14. Medical Direction

15. Medical Direction Medical direction is the process by which a physician or, occasionally, group of physicians guide and oversee the patient care provided by an emergency medical services (EMS) system. Law requires medical direction for all advanced life support (ALS) service providers. Most states require basic life support (BLS) agencies to have a medical director as well. Medical direction from a physician is recommended for all EMS activities. There are two forms of medical direction: on-line and off-line.

16. Off-Line Medical Direction The medical director of an EMS system is responsible for off-line medical control actions, including the following: • Development and implementation of protocols and standing orders • Supervision of any initial and recertification training programs provided by the EMS agency • Retrospective review of the care delivered (to ensure compliance with patient care standards) • Liaison of activities between EMS professionals and others, including other physicians; ED personnel; and regional, state, and local EMS authorities • Providing input on dispatch, mutual aid, disaster planning, and hazardous materials response activities • General supervision of physicians who provide on-line medical control • Acquiring and maintaining up-to-date knowledge of EMS issues • Support of EMS research, where practical • Problem solving Generally, an EMS system has one overall medical director for off-line activities and a group of physicians designated as the source of on-line medical control.

17. On-Line Medical Direction On-line medical control involves directing the care of a single patient. The on-line medical control physician evaluates information given by medics, makes decisions regarding immediate patient care, and gives appropriate orders. Medics and their patients benefit from having immediate access to an emergency physician for advice in difficult or unusual situations. In addition, the EMS medical director may use mandatory on-line physician authorization to maintain tight control of certain potentially dangerous pre-hospital treatment options (i.e., pre-hospital thrombolytic administration, for stroke victims).

18. Legal Issues

19. Advance Directives An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to the hospital, the hospital staff will probably talk to you about advance directives. A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don't want certain kinds of treatment. However, they can also say that you want a certain treatment no matter how ill you are. Advance directives can take many forms. Laws about advance directives are different in each state.

20. Types of Advance Directives The three most common types of Advance Directives are: • Living Wills • Durable Power of Attorney for Health-care • Do Not Resuscitate Orders

21. Living Will A living will is one type of advance directive. It only comes into effect when you are terminally ill. Being terminally ill generally means that you have less than six months to live. In a living will, you can describe the kind of treatment you want in certain situations. A living will doesn't let you select someone to make decisions for you.

22. Durable Power of Attorney for Health Care A durable power of attorney (DPA) for health care is another kind of advance directive. A DPA states whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A DPA is generally more useful than a living will. But a DPA may not be a good choice if you don't have another person you trust to make these decisions for you. Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care. Ask your doctor, lawyer or state representative about the law in your state.

23. “Do Not Resuscitate” Orders A “Do Not Resuscitate” (DNR) order is another kind of advance directive. A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless given other instructions, EMS staff will try to help all patients whose heart has stopped or who have stopped breathing.) You can use an advance directive form or tell your doctor that you don't want to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states. Most patients who die in a hospital have had a DNR order written for them. Patients who are not likely to benefit from CPR include people who have cancer that has spread, people whose kidneys don't work well, people who need a lot of help with daily activities, or people who have severe infections such as pneumonia that require hospitalization.

24. What this means to you • If you attempt to resuscitate a person who has an advance directive on their body, you may be held criminally and/or civilly at fault. • The key is that the advance directive must be on the patient’s body where you can see it. Check it to make sure that it is accurate, for the patient, and current before stopping any resuscitation efforts. • Most victims that we treat will not have any form of AD, but always check first. NEVER assume anything.

25. Patient Care Reports(PCR’s) Patient Care Reports (PCR’s) come in many different formats, however they generally contain the same information: - Patient age and sex - Baseline and additional vital signs - Known Patient History - Medical Interventions - Drug Administrations - Name of Agency and Person providing care

26. Filling out the PCR REMEMBER: Anything that you do goes on the PCR. If you do not write it down, it didn’t happen. Make sure all information is as complete, accurate, and legible as humanly possible. Mistakes can lead to improper future care and severe legal issues. Never attempt to diagnose a patient’s specific injury or illness. Leave that to the doctors, that’s what they are paid for.

27. The PCR

28. Scene Safety

30. Blood borne Pathogens Training for Ground Team Members & Leaders Developed as part of the National Emergency Services Curriculum Project

31. What are Bloodborne Pathogens? • BBPs are disease causing microorganisms that may be present in human blood. They may be transmitted with any exposure to blood or other potentially infectious material. • Two pathogens of significance are Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV)

32. What is Hepatitis B? • One of the five viruses that causes illness directly affecting the liver • Major cause of viral hepatitis which is preventable through immunization

33. Hepatitis B Symptoms • Weakness, Fatigue, Anorexia, Nausea, Abdominal pain, Fever, Headache, Possible jaundice( a yellow discoloration of the skin) • Blood will test positive for the HBV surface antigen within 2 to 6 weeks after symptoms develop • May show no symptoms, and therefore not be diagnosed

34. HBV Facts • 200 out of 8700 health care workers contracting Hepatitis B yearly will die • HBV is more persistent than HIV in that it is able to survive for at least a week in dried blood on environmental surfaces or contaminated instruments • Approximately 85% of patients recover in 6 to 8 weeks

35. What is HIV? • Human Immunodeficiency Virus is a virus that infects immune system T4 blood cells in humans and renders them less effective in preventing disease • It is the virus identified as being responsible for Acquired Immunodeficiency Syndrome (AIDS)

36. HIV Symptoms • Night sweats, Weight loss, Fever, Fatigue, Gland pain or swelling, Muscle or joint pain • May feel fine and not be aware of exposure to HIV for as much as 8 to 10 years • Blood tests may not show positive for as long as a year, and therefore multiple tests may be required to determine if the person has been infected

37. HIV Facts • Estimates in the US say that 1 out of 250 people are infected with HIV • There are over 100 case reports of health care workers whose HIV infection is associated with occupational exposure • Over 200,000 AIDS patients have been reported to the CDC, 84 of which are health care workers with no other identified reason for infection

38. Exposure Prevention for Bloodborne Pathogens • Engineering Controls • Work Practice Controls • Personal Protective Equipment • Universal Precautions

39. Engineering Controls • Structural or mechanical devices CAP provides for its’ ES personnel • Hand washing facilities • Eye wash stations • Sharps containers • Biohazard labels

40. Work Practice Controls • The behaviors necessary to use engineering controls effectively • Using sharps containers • Using an eye wash station • Washing your hands after removal of personal protective equipment

41. Work Practice Controls Continued • Hand washing is considered to be the most effective method of preventing transmission of BBPs • Alternatives such as hand cleaners and towelettes are acceptable alternatives for those without ready access to wash facilities, but the individual should still wash their hands with soap and warm water after contact with blood or other possible infectious material

42. Work Practice Controls Continued • Procedures involving blood or other potentially infectious material will be performed in such a way as to minimize or eliminate splashing, spraying, splattering, and generation of droplets of these substances • Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses is prohibited in work areas where exposure is likely

43. Personal Protective Equipment • Equipment provided by CAP at no cost to you, which it is to your advantage to use, and should be reported to supervisors when not in working order • Latex gloves • Masks • Aprons, Gowns, or Tyvek suits • Face shields

44. Personal Protective Equipment Continued • Whenever you need to wear a face mask, you must also wear eye protection • When wearing personal glasses, you must use side shields and plan to decontaminate your glasses and side shields according to schedule

45. Personal Protective Equipment Continued • Personal protective Equipment is acceptable if it prevents blood or other possible infectious material from contaminating work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes.

46. What is wrong with this picture?

47. Use your Personal Protective Equipment! Answer: Rubber Gloves were not worn for the patient’s assessment

48. Removing Gloves Grasp the outer surface of one glove with the other gloved hand "rubber to rubber" and pull off the glove. Discard the glove into the designated receptacle. Removing the second glove. Note that the person touches only the "inside" surface of the glove with his bare hand.

49. Contaminated Clothing • Your clothing may be exposed to potentially infectious materials, and must be handled appropriately if that happens • Clearly label contaminated materials and put them into separate leak proof containers to be sent to a facility following OSHA standard • Don't handle contaminated clothing more than absolutely necessary

50. Contaminated Clothing Removal • Remove it in such a way as to avoid contact with the outer surface • Rolling the garment as it is pulled toward removal will decrease chance of contact with the contaminated area • After rolling it up, carefully pull it off to avoid contact • If it cannot be removed without contamination, it is recommended that the item be cut off