Any Suggestions?

[VFFforpeople]

I'll run it by the person setting up the rescue portion. I'd love to do the OB stuff just to see how they react, but I think the Techncial Rescue Team Leader my not want me to take over what is going to be 80% rescue and 20% medical. The last think the IC needs to here topside is, "We've got 8 immediates and 0 delayed!"

However, all suggestions give here will be copied, pasted, and presented to the Technical Team Leader to see how out there she want's to make it. or maybe I could just throw all teh suggeestions into one patient. She a drunk 8 year old about to give birth, experienceing siezers, with a history of strokes and diabetes, and she has a open femur fracture! AHHHHH!!!

HAHAHA that would make any one nervouse lol!!! Glad I could put some ideas out there and help!

 

[yowzer]

Please say that no one tried to insert the airways in a fake patient! Although, my old instructor wouls spray a lido0type spray on a NPA and self insert it to shw us how it would look on a real patient. Great guy... kinda wierd.

One of my instructors demonstrated OPA placement... on himself. :blink:

 

[aandjmayne]

lmao... how did that work out..??? I have too much of a gag reflex ... h34r:

 

[NEMed2]

I know a FF that will insert OPA & NPAs for laughs at parties. He's not allowed near the ambulance anymore.

 

[aandjmayne]

lol:lol:Special

 

[Mountain Res-Q]

I know a FF that will insert OPA & NPAs for laughs at parties. He's not allowed near the ambulance anymore.

I know that all people in EMS are a little bent, but doesn't there come a point when someone is just a little TOO crazy to be allowed near patients? :wacko:

 

[BossyCow]

I like to keep my training scenarios within the realm of possibility but also challenging. I pull some from actual calls with variations. One good one is a spleen rupture. Doesn't show up for a while, so if the pt denies belly pain initially but starts to manifest with symptoms during the walk out. I've used this scenario with two subjects. Both fell down into a drainage. One has obvious trauma to lower extremeties requiring rope rescue and a pack out. The other seemingly minor injuries, able to climb out with assistance. But the signs of spleen rupture show up during the walk out.

It covers the need for ongoing assessment, the need to fully examine all subjects. It hits on our tendency to get tunnel vision over what is obvious. And it also covers the real life situation where a pt will minimize the injuries. I generally include some sort of hints that the second pt may be more severely hurt than he is letting on, mechanism of injury, skid marks on the slope, abrasions to the abd. etc

 

[Mountain Res-Q]

I like to keep my training scenarios within the realm of possibility but also challenging. I pull some from actual calls with variations. One good one is a spleen rupture. Doesn't show up for a while, so if the pt denies belly pain initially but starts to manifest with symptoms during the walk out. I've used this scenario with two subjects. Both fell down into a drainage. One has obvious trauma to lower extremeties requiring rope rescue and a pack out. The other seemingly minor injuries, able to climb out with assistance. But the signs of spleen rupture show up during the walk out.

It covers the need for ongoing assessment, the need to fully examine all subjects. It hits on our tendency to get tunnel vision over what is obvious. And it also covers the real life situation where a pt will minimize the injuries. I generally include some sort of hints that the second pt may be more severely hurt than he is letting on, mechanism of injury, skid marks on the slope, abrasions to the abd. etc

Here's the thing that I have to consider in any training I orgaize for the team: In order to join SAR you have to maintain (at minimum) First Aid/CPR, Low Angle Rope Rescue, and ICS 200. Half the team has no medical interest and barely maintains First Aid/CPR. The rest of the team is comprised of people who have Advanced First Aid, First Responder, Outdoor Emergency Care, EMT, Wilderness EMT, and Paramedic. We even have an ER Doc on the team now. But teh majority of those people who will be performing over-the-bank rescues are First Aid only. So trying to train the team and offer scenerios is hard. IF I dumb it up too much for the First Aiders, then the EMT's Paramedics, and especially the MD's are not gonna care. But if I make it too hard, then the First Aiders are doomed for failer. While the team policy is to sent at least one MFR (or higher) with every team that goes out/down, we can never garuntee it. When training, I like to send First Aiders out on their own to see if they can do it on their own. So, I think that what I will have to do is print out all you r suggestions (and a few of my own) and depending on who shows for the drill use different situations that challenge people based on their level of training with setting them up for failure.

However, if the MD is sent over-the-bank, He... He... He... I will be taking all your suggestions as stated above and she will have to face... a drunk 8 year old about to give birth, experienceing siezers, with a history of strokes and diabetes, and she has a ruptures spleen and a open femur fracture!

As I said before, Thanks for the suggestions. We will see what happens when the drill comes around... but the Technical Team Leader organizing the drill is being very closed-lipped on the details, so I will probably have to adjust the patients conditions seconds befoer the drill. I will resurrect this thread after the drill and tell y'll how it went. Pictures too?

 

[BossyCow]

...trying to train the team and offer scenerios is hard. IF I dumb it up too much for the First Aiders, then the EMT's Paramedics, and especially the MD's are not gonna care. But if I make it too hard, then the First Aiders are doomed for failer.

Part of our training has to include all levels as you list them in your post. But part of being a good wilderness EMS provider is being able to utilize those who have little or no training. So, rather than seeing it as a failure of those who are FA trained only, the one who fails would be the one more well credentialed

 

[ffmedic08]

what about.....

... and impaled object. As simple as a tree into the chest causing a pneumo..... or asucking chest wound... or something that is effecting the airway- are these medic "newbies"? See if they can cric or trach. An impaled object must be stailized, but one affecting the airway could really happen, and could really toss an interesting turn.

or flail chest... DKA actually sounds like an interesting one- although close to alcohol symptoms, make them think. They gotta learn to think on their feet and be accurate at some point- better in a training situation!

Sounds like an awesome opportunity, and I'm kinda jealous! LOL Good luck!

 

[Mountain Res-Q]

... and impaled object. As simple as a tree into the chest causing a pneumo..... or asucking chest wound... or something that is effecting the airway- are these medic "newbies"? See if they can cric or trach. An impaled object must be stailized, but one affecting the airway could really happen, and could really toss an interesting turn.

or flail chest... DKA actually sounds like an interesting one- although close to alcohol symptoms, make them think. They gotta learn to think on their feet and be accurate at some point- better in a training situation!

Sounds like an awesome opportunity, and I'm kinda jealous! LOL Good luck!

How do you propose we fake that injury?

Mostly First Aid!

We don't do crics or traches!

Flail or DKa... I'll put them on the list of maybe's.

Don't be jealous. This winter has SUCKED for SAR. With the economy, no one is going to play in our forests. With the poor snow pack, those who do come to play are not getting in any type of jam. That usually translates into a poor spring, becasue our primary "business" in spring is Swiftwater Rescue Calls and overdue hikers who get lost on the ill-defined spring trails. I would trade all the drills in the world for a good Swiftwater Rescue or Helicopter Short-Haul! Hell, this training is even interferring with some agility training I have scheduled for my dog!

 

[Mountain Res-Q]

ACTUALLY, the team just had a class put on by a long-time ER Doctor, Ben Schifrin, MD, FACEP. We was one of teh founding 13 members of our team in 1975. He is also an avid backpacker and has writen many guide books for the entire Sierra Nevada Mountains and the Pacific Crest Trail. He left the team 15+ years ago to pursue the writing and otehr teaching oppurtunities, but contacted us this last month to see if we would like him to come our way and put on some classes. HELL YA!

This last Thursay 19 of our 35ish Team Members attended a REALLY GREAT 2hour presentation on hypothermia. The combination of his outdoors experience, his 15-20 years with SAR, and his position as a Doc at a major Central California Trauma Center that recieves a good portion on the wilderness patients throughout the Central Portion of the Sierras means that we got a lot of really great info. No real changes in treatment, but a lot of new thoughts that really drove home the thought that hypothermia is the most inportant medical condition we will ever encounter in SAR. VERY ENLIGHTENING!!! For instance (one of dozens of cool things): Did you know that once the Liver reaches 94 degrees F it's ability to properly help blood clot is almost completely compromised? Or that only 1/2 of all hypothermia pateints are seen in the Winter?

Ben has offered to continue to put on presentations every month on any wilderness topics we want (backboarding, hyperthermia, fractures, drownings, envenomations). Keeping this in mind, I think that no matter what the specific injuries I give these patients, all will have some degree of hypothermia, just to see how the First Aiders who attended the presentation react.

 

[BossyCow]

This winter has SUCKED for SAR. With the economy, no one is going to play in our forests. With the poor snow pack, those who do come to play are not getting in any type of jam. That usually translates into a poor spring, becasue our primary "business" in spring is Swiftwater Rescue Calls and overdue hikers who get lost on the ill-defined spring trails. I would trade all the drills in the world for a good Swiftwater Rescue or Helicopter Short-Haul! Hell, this training is even interferring with some agility training I have scheduled for my dog!

I've found that we are doing less and less search and more rescue.. with the cell phones and GPS units, we usually can pinpoint where they are and just have to go get them.

 

[Mountain Res-Q]

I've found that we are doing less and less search and more rescue.. with the cell phones and GPS units, we usually can pinpoint where they are and just have to go get them.

We believe that this is a factor as well. In addition we have noticed a huge decrease in tourism aimed at going far afield. We are so urbanized that no one wants to hike 2 miles to that really cool waterfall, when they can stay in camp with running water, tolilets, electricty, gameboys, dvd players, etc... Cell phones are still hit and miss for us (mostly miss) and so far the gps/911 units haven't really worked too well in this county (another story). The other factor we have is that the less SAR is used. the less SAR gets used. i.e. most fire guys, dispatchers, forest servies guys, and LEOs don't realize we still exist and are still highly trained to handle cals that they find difficult. Our last rescue for a guy that roled his ATV on himself in teh middle of nowhere. Fire was also dispatched and a has faster response time so they get on scene of the call and dispite not having the correct gear, training, or legal authority, they hiked in and despite their faster respone time took 3 times as long to mitigate the call. We get halfway there just to turn around. Our team was once one of the busiest in California (100-120 calls a year and over 10,000 man hours a year). Now we run 30-50 a year and pull in 2,000-3,000 hours of work. Membership drops, training drops, and readiness drops. Meanwhile we are the only agency in teh county equipped, trained, and authorized to perform Swiftwater Rescue, Dive, and High Angle Rope Rescue. On top of that, the County Administrators keep reasureing people after every disaster on TV that "county SAR trains all the time for this and is ready for it" (i.e Major Bridge Collapse, Building Collapse, Massive Flooding, Severe Winter Storm Power Outages). How do we continue to provide those services when SAR is unpaid and doesn't handle the amount of calls that most perspective team members want. It sucks. But i'm not complaining, I'll just continue to respond and do my part!

 

[Mountain Res-Q]

I am the newely elected Medical Team Leader for my counties SAR Team. We like to run training drills now and again; ropes, search, swiftwater, dive, etc... Whenever we do so we are expected to run a full medical drill on the pateint as well (great practice for the newbies). The next drill is next month. The Rope Rescue Team Leader is going to run some type of low angle rope rescue call to get the newbies involved. She would like me to organize some type of medical assessment and training that the newbies will do (mostly First Aiders and some Ski Patrolers and First Responders) She is keeping the details of the rescue scenerio under wraps, but wants me to come up with some good injuries that need addressing. We will be "rescueing" several people. Any suggestions on cool injuries and complications I should throw at them?

AS I PROMISED:

Thanks for the input from you all. The drill was scheduled for 2 weeks ago but got moved to this last Saturday. We ran it like a real call. Got paged out in the mornig to respond to the Cache, got briefed by the Deputy (who by Law is our IC, appointed a Operations person, fired up the vehicles and responded. As Medical Team Leader I was put in charge of the medical aspect of it all, but the organizers of this drill decided to keep me out of the loop on the exact call type, since part of teh call meant that I also got to "run" the medical aspect w/o any fore knowledge. So while all your suggestions were appreciated, I didn;t get to set up injuries on this one, but I'll keep them in mind for the next one I get to set up, maybe in a month or so.

CALL: 3 ATVers go onto provate property and go off an embankement. None injury per dipatch, but they are unable to get out on their own. We respond with 4 vehicles, 11 team members, the 4 quads, and out full compliment of tech and medical gear. Ops sends out 2 ATvers (one first Aid and one paramedic intern) to scout it out. They find 2 victims on the backside of the property and the intern scrambles down the 70-80 foot embankment to assess the injuries. One tib-fib fx and one rad-ulna fx. Everything else was normal on those two, other than the MOI of crashing an ATV. (It was set up that way because they wanted the focus on this part of teh drill to be proper ropes techniques.) Scouts requested rope gear, rescuers, BLS bag, two baskets, and two sets of c-spine gear (largely becasue of the MOI - something that was debated latter... in the wilderness setting, without any neck pain, neck cleared by Medics, should the arm injury have been boarded?). The third victim was reported to have eandered away from the scene. 2 searchers are sent out to try and track that girl while the rest of us get into the scene for the two located victims and begin seting up the ropes. The BLS bag gets sent down and the Paramedic Intern, a OEC certified Ski Patroller, and a First Aider begin c-spining and splinting the patients. Meanwhile, the search team locates the wandering victim. She is alert but very disoriented (A+0x1). She knows her name but not much else. Seeing as how our team for this call was largly First Aiders, I headed out to met the search team and evaluate for myself. She has a mild head laceration, but not much else going on. She is altered, complaining of head pain, but after a rapid trauma assessment is found to have no other significant injury. Considering our undermanned staus, I make teh call to bandage the wounds at scene, monitor vitals, and transpoirt by ATV wagon to the "trailhead" for the waiting Ambulance. Within 15 minutes we have transfered the patient and are available to assist with the ropes. First Patient is braught up and two of us (Paramedic and me) take over patinet care up top, transfer him to the wating ATV and get him to the waiting ambulance. The rappeling team was dead tired, so I was sent down to replace them for the last patient. I disagreed with boarding him, but once the Intern made the call, we went with it. From onscene to end of call: 2 hours, not bad for a wilderness rescue.

We had several people as observers there with cameras to document for latter analysis. We also had a Fire Instructor/FEMA USAR guy there to evaluate us. We did a lot of things right, and somethings taht we could improve on. From a medical standpoint there were no glaring issues, other than a debate over c-spine. I (and several other Paramedics) say that if their is not pain/deformity that we don't. The other issue for us was that the BLS bags need some major restocking as the bandages are getting sparse and out normal backboards (Millar Boards for Water Rescue) need to be augmented with regualr boards (something I have advocated for a while and we will probably barrow from the county ambulance). GOOD DRILL. I have some pics, but have yet to load them up. Once I do I will repost so that you can check them out.

THANX ALL.

 

[Mountain Res-Q]

I've got three new pictures posted under my profile from the mock drill. I am still waiting to get the pictures that were taken offcially by the photographer we had their to document theings for future training purposes. So these ones aren't the best and don't really show the full extent of our search, rope rescue, and medical care...

 

[mycrofft]

WOld you guys open your classes and lectures to non-members?

We have folks downhill here who might want to learn more about fastwater and wilderness recue. If so (maybe charge for nonmembers?), let us know in advance. I can pass it on to locals or put them in contact with you, details to be discussed.

 

[mycrofft]

Second shot: exercise medical support

In my Guard units, I watched a man die during an exercise partly because the expectation was for Medical to simultaneously supply players and provide "real world" support. (The victim was a visitor who accidentally drove into the clinic parking lot, then expired from a massive MI). Exercise "players" stopped our ambulance from responding because it was thought the ambulance was being used to represent a vehicle under duress, so not allowed into area where victim was. After that, I consistently fought for and usually got a medical cadre kept as "non-players".

What's your opinion, should a medical element be kept out of play to provide tx for real life injuries to players, real calls, etc.? If they leave on a real call, should play stop until they are replaced?

 

[Jon]

YES. We just did a full-scale active shooter drill. There was a BLS unit tasked to the event, wearing "safety officer" vests indicating that not only were the crew out of play, what they said was the begining and end... and we also had a safety word... "lobster"