- We should slow things down but we wanted to do 100 pounds.
- You can't, yeah. - Okay.
- [Narrator] This module covers emergency
medical care guidelines from the Incident
Response Pocket Guide or IRPG.
All firefighters, regardless of their level
of medical training must be familiar with these guidelines.
They are a succinct reference
for emergency medical situations
within the wildland fire environment.
Additional information on the IRPG,
emergency medical care section,
such as patient assessment and Medical Incident Report,
or MIR should be referenced as needed.
As a medical responder, your first responsibility
is to provide for your own safety.
Only provide medical care,
which you are trained and authorized to perform.
Take accurate and legible notes,
record patient observations
and medical treatments you administer.
Use all personal protective equipment or PPE
that you have available on scene to protect yourself.
If you do not have PPE available and are not comfortable
administering care without it, stop.
Treatment principles.
Prevent further injury by removing from danger.
All firefighters must maintain situational awareness
of hazards that are present
in the wildland fire environment.
Before you can provide quality patient care,
you must first ensure the scene is safe.
You are no good to your patient if you are also injured.
It may be necessary to first move the patient
to prevent further injury and for the safety of responders.
Rapid assessment.
Airway, breathing, circulation,
and life-threatening injuries.
Conduct a rapid assessment to identify and correct
or prevent immediate life threats to your patient.
The rapid assessment involves checking
life-threatening injuries, airway,
breathing, and circulation.
This process is critical to triaging the patient's status
and developing a treatment and evacuation plan.
And must be implemented in a thorough yet urgent manner.
Control any major bleeding before proceeding with the ABC's.
Airway, is the patient's airway open or obstructed?
An unresponsive patient's airway can easily be obstructed
by a foreign object, body fluids, or a loss of muscle tone.
Establish and protect your patient's airway.
Manually remove obstructions,
drain fluids using the log roll and recovery position.
Open the airway with the head tilt, chin lift
or jaw thrust maneuver.
The airway is more important than a suspected spinal injury.
If the patient cannot get air in, they die.
Breathing, look, listen, and feel for breathing.
Do you see visible and equal chest rise and fall?
If breathing is observed,
is it normal or abnormal?
For example, infrequent breaths, labored breathing,
wheezing, shallow, et cetera.
If your patient is not breathing,
begin CardioPulmonary Resuscitation or CPR.
Refer to CPR in the IRPG
emergency medical care section.
Circulation.
Are you still managing life-threatening bleeding?
Are your treatments working?
What do you observe when evaluating the patient's skin?
Are they pale?
Is their skin clammy, sweaty or dry to the touch?
If you have initiated CPR,
continue until another rescuer takes over.
You become too fatigued or the scene becomes unsafe.
Thorough exam.
Look for method of injury.
Check for deformities, contusions, abrasions,
punctures, burns, tenderness, lacerations, or swelling.
Conduct a thorough exam to better understand
your patient's overall condition.
If your patient is conscious, ask them pertinent questions,
allergies, medications, events leading to the incident.
Being mindful of patient privacy and dignity.
Expose the patient's body
to perform a head to toe examination.
Look and feel for any deformity, contusion, abrasion,
puncture, burn, tenderness, laceration, or swelling.
Closely watch for any signs of painful response,
which may indicate additional, less apparent injuries.
Stabilize patient.
Once you have established
a baseline of your patient's condition,
you must stabilize the patient,
provide environmental protections for patient.
For example, shade, cooling or warming.
Recover after thorough exam.
Place the patient in a position of comfort
and proactively manage for shock.
Specific treatments for injuries and illnesses
are found in the IRPG emergency medical care section.
Transport decision.
Air or ground extraction.
Does your patient require immediate medical transport?
The transport decision should be made swiftly
while considering all available options.
Agency vehicle, agency aircraft, ground ambulance,
Life Flight, et cetera.
Factors to consider when making a transport decision include
are there life-threatening injuries?
What is the current and projected patient condition?
Is the patient mobile?
What is the projected transport time
to definitive care by air and by ground?
Are there environmental conditions that may impact medevac
weather, fire activity, time of day?
What resources are available on scene
to aid with the medevac?
Document all on-scene observations and treatment,
send with patient.
When documenting a medical incident,
legibly record all patient information
and all treatments administered.
If available, identify a dedicated scribe.
This scribe may be you.
The scribe may assist the medical IC
in communicating with dispatch,
incoming definitive care personnel
or the receiving hospital staff.
Special consideration should be given
to recording times of any treatment rendered,
administered medications,
placement of a tourniquet, patient's vitals, et cetera.
Provide all documentation at the next level of medical care.
Medical response procedures.
All injuries must be reported to direct supervisor.
All injuries must be reported to your direct supervisor
no matter the severity, for example, poison Oak exposure,
sprains, strains, cuts, et cetera.
Ego, pride or fear of reprimand should not be a factor
in communicating injuries.
Even minor injuries may develop into severe injuries.
Depending on the severity or complexity of the incident.
You may contact your crew lead, division supervisor,
incident commander, or dispatch.
Follow the chain of command
and predetermined incident response procedures.
Reporting ensures proper documentation
and may prevent out of pocket expenses
for undocumented injuries.
In case of medical emergency, contact incident supervisor
or communications dispatch
or using the Medical Incident Report on page 118.
The Medical Incidents Report or MIR is a standardized form.
The intent of the form is to,
establish control of the incident,
whether routine or life-threatening
by initiating a new incident command system.
Standardize a systematic process
for reporting medical incidents or injuries,
similar to a fire size up for initial attack.
And enable any firefighter with prior training and direction
to fill it out and transmit the information.
The medical incident report provides a succinct process
of communicating both non-emergency
and emergency information to dispatch.
Or the respective medical personnel
at the Incident Command Post, ICP.
On an incident that is being managed by an IMT
the MIR will be included in the Incident Action Plan, IAP
within the medical plan, ICS 206.
And will include standard operating procedures
for communicating medical emergencies,
contact information for nearest hospitals,
burn centers, et cetera.
Communication plan, including
air to ground frequencies, et cetera.
All firefighters, regardless of training should know
where this checklist is within the IRPG and how to use it.
Medevac is an incident within an incident.
One person needs to become the on-scene incident commander
and transfer command later if necessary.
The on-scene incident commander or medical IC
takes control of the medical emergency in the same way
in which the IC takes control of the wildfire incident.
Depending on the complexity of the medical incident,
the IC may identify specific incident needs and positions
such as a dedicated scribe, a primary medical provider,
a squad to secure and move the patient,
a saw team to cut a Helispot,
a dedicated individual
to speak on air to ground frequencies, et cetera.
Any firefighter, regardless of experience level
may have to act as on-scene incident commander.
Identify nature of incident,
number injured, patient assessments and location,
geographic and GPS coordinates.
Dispatch needs to know if the medical incident
is an emergency or non-emergency event.
You must objectively describe the scene and situation
so that dispatch may activate the correct level
of medical incident response.
You must provide accurate GPS coordinates
and geographic description to ensure an efficient response.
Do not use patient names on the radio,
do not transmit personally identifiable information
over the radio.
Transmit only information that is pertinent to patient care.
Determine transport plan.
Limited visibility or darkness may delay
or negate air transport.
Identify and initiate multiple transport options.
Primary, alternate, contingency, and emergency.
The wildland fire environment is dynamic.
There is a constant struggle between the time wedge
and viable operational tactics.
There is a similar yet even more urgent balance
when transporting patients to definitive care,
lives lie in this balance.
Once an informed transport plan is made, execute it.
The IRPG emergency medical care guidelines
is a practical tool that is relevant to all firefighters.
Familiarize yourself with the list prior to engaging
in an actual medical incident to instill both confidence
and competence in caring for one of our own.
(upbeat music)