Transcript Routine Calls, What can they teach us?

ROUTINE CALLS
What can they teach us?
MEDICAL BOX 902, 1801 HARVARD STREET,
FOR THE 76YOF WITH TROUBLE BREATHING.
AMBULANCE 92 IS DUE; NO MEDIC
AVAILABLE.
Scenario slide 1
A92 MARKS UP WITH A CREW OF 3 AND
ARRIVES ON THE SCENE. THE CREW
KNOCKS ON THE FRONT DOOR, BUT THERE
IS NO ANSWER. THE DOOR IS UNLOCKED.
Scenario slide 2
ONCE THE CREW GAINS ENTRY, THEY FIND THE ELDERLY
PATIENT IN THE BEDROOM AT THE BACK OF THE HOUSE,
LYING IN BED, UNCONSCIOUS.
Scenario slide 3
THE SOUND OF BREAKING GLASS IS
HEARD FROM THE GARAGE
Scenario slide 4
2 MINUTES AFTER THE CRASH IS HEARD,
EVERYONE IN THE HOUSE BEGINS TO FEEL SICK.
Scenario slide 5
AS THE PROVIDERS TRY TO EXIT THE BEDROOM,
THEY ARE MET BY A GUNMAN WHO IS
SURPRISED BY THEIR PRESENCE.
Scenario slide 6
WHAT MISTAKES DID THE CREW MAKE?
WHAT ADDITIONAL RESOURCES
WOULD HAVE BEEN HELPFUL?
WARNING SIGNS OF A CLANDESTINE DRUG LABORATORY
Types of Calls
Outside Conditions
Ordinary Materials used in Manufacturing
WARNING SIGNS OF A CLANDESTINE DRUG LABORATORY
Types of Calls
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Burns and/or smoke inhalation
Man Down
Explosions or loud booms
Sick Buildings (condemned due to mold or chemicals)
Multiple medical patients
WARNING SIGNS OF A CLANDESTINE DRUG LABORATORY
Outside Conditions
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Privacy Fence
Multiple Surveillance Cameras
Large Exhaust Fans
Multiple Air Conditioners
Covered Windows
Unkempt Yard (trashy, lack of lawn care…)
WARNING SIGNS OF A CLANDESTINE LABORATORY
ORDINARY MATERIALS USED IN MANUFACTURING
• Pseudoephedrine, a drug contained
in over the counter cold medicines
• Aluminum foil
• Paint Thinner
• Lithium camera batteries
• Mineral Spirits
• Charcoal lighter fluid
• Anhydrous ammonia
• Denatured Alcohol
• Matchbooks and matchbook striker
plates
• Rock, table, or Epsom salt
• Camp fuel
• Gas line antifreeze
• Muriatic acid
• Iodine
Sulfuric Acid
Lye (soap)
Ammonium nitrate
Dry Ice
Acetone
Coffee filters, cheese cloth, or napkins
Pots, pans, stoves, or pressure cookers
Glass jars
Blenders
Ice Chests
Liquefied Petroleum Gas (LPG)
cylinders
• Turkey basters
• Chemical containers
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POSSIBLE CDL (CLANDESTINE
DRUG LAB)
COMPLACENCY KILLS
This was a CDL
So was this
NOTICE THE SECURITY FENCE
TOP TEN HAZARDS
Top Ten Hazards
1. Flammable or explosive atmosphere
2. Oxygen-deficient or toxic atmosphere
3. Leaking or damaged gas cylinders
4. Labs in confined spaces
5. Water reactive and pyrophoric chemicals
6. Damaged and leaking chemical containers
7. Electrical hazards and sources of ignition
8. Reactions in progress, which can include containers under high heat and high pressure
9. Incompatible chemical reactions
10. Bombs and booby traps
RESPONSE GUIDELINES
On Scene Actions
• Evacuate all structures surrounding the incident, and initiate hazmat zones
• If drug lab is found after entering, back out immediately and notify other personnel on the
scene
• Retreat to a safe area
• Call for additional resources
• Hazmat
• Police
• Environmental Protection Agency
• Use care when interacting with a meth user
RESPONSE GUIDELINES
DOs
• Do Maintain Personal Protection
• Do Limit Time Exposed
• Do Stay upwind and a safe distance
away
• Do shield yourself behind large
objects and buildings \
• Do decontaminate yourself and
clothing
• Do treat the area as a crime scene
DON’Ts
• Don’t use electronic devices within the
isolation zone
• Don’t turn on or off any electrical power
or light switches
• Don’t eat or drink in or around the CDL
• Don’t open or remove containers with
chemicals or suspected chemicals
• Don’t sniff any containers
MARYLAND PROTOCOLS
POTENTIALLY VOLATILE ENVIRONMENTS WITH LIFESUSTAINING INTERVENTIONS
(PAGE 204-8 THRU 204-13)
• Protocol should be used:
• In conjunction with general patient care practices, which should
be followed once the active threat has been mitigated.
• When the situation is unique, preventing the use of standard
practices that could unnecessarily jeopardize the safety of the
patient and/or medical provider(s).
• When Potentially Volatile Environments with Life-Sustaining
Interventions (PVE/LSI) protocol is declared
ZONES OF CARE/OPERATIONS: HOT ZONE
• Direct and immediate threat to safety or health
• Priority: Mitigation of the immediate threat
• Medical providers must be integrated tactical
medic (MD Protocol V. T.)
• CPR is not indicated
ZONES OF CARE/OPERATION: WARM ZONE
• Indirect threat; limited life saving interventions
• Priority: evacuation of patients to safe area
• Potential benefits of treatment weighed against
delay of evacuation
• Casualty Collection Point (CPP) is concealed
and covered from the immediate threat
• Patients are triaged
ZONES OF CARE/OPERATION: WARM ZONE
Limited medical care follows the mnemonic
“MARCHED”
M: Massive hemorrhage control
• usually the greatest threat to trauma patients
• tourniquets are preferred
• if not possible use impregnated hemostatic dressing
ZONES OF CARE/OPERATION: WARM ZONE
Limited medical care follows the mnemonic
“MARCHED”
A: Airway Management
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Consider oxygen
Chin lift or jaw thrust
Nasopharyngeal airway
Recovery position (or position of comfort if conscious)
ZONES OF CARE/OPERATION: WARM ZONE
Limited medical care follows the mnemonic
“MARCHED”
R: Respirations
• Apply occlusive dressings to open chest wounds
• Recognize tension pneumothorax and get patient to
ALS for needle decompression
ZONES OF CARE/OPERATION: WARM ZONE
Limited medical care follows the mnemonic
“MARCHED”
C: Circulation
• Hypotension due to head injury or hypovolemic shock =
IV therapy
• Cardiac arrest due to trauma should be considered
deceased
ZONES OF CARE/OPERATION: WARM ZONE
Limited medical care follows the mnemonic
“MARCHED”
H: Hypothermia
• Easier to prevent than treat
• Minimize heat loss
ZONES OF CARE/OPERATION: WARM ZONE
Limited medical care follows the mnemonic
“MARCHED”
E: Everything else
• Consider Mark I/DuoDote for suspected
organophosphate/nerve agent exposure
• Treatment of burns, eye injuries, and pain is dependent
on resource availability and are managed according to
Maryland Medical Protocols
ZONES OF CARE/OPERATION: WARM ZONE
Limited medical care follows the mnemonic
“MARCHED”
D: Documentation
• Key findings
• Interventions
ZONES OF CARE/OPERATION: COLD ZONE
Cold Zone: Traditional Patient Care Protocols
• Patients are moved from the Warm zone to the
Cold zone via an Evacuation Corridor
• Re-triage
• Medical care dictated by resource availability
and casualty count (including CPR)
SUMMARY
Remember:
Look for warning signs
CDLs are very volatile and hazardous
Follow response guidelines
Review Maryland Protocols