1	Chapter 10 Rescue Awareness and Operations
2	Topics Phases and Aspects of Rescue Operations PPE Needed for Rescue Operations Types of Rescues Process of Various Rescues
3	Introduction Rescue is the “act of delivering from danger or imprisonment.” In EMS, rescue means extricating and/or disentangling the victims who will become your patients.
4	Role of the Paramedic The role of EMS in rescue varies from area to area. Some areas may require training beyond the awareness level. In general, all paramedics should have the proper training and personal protective equipment (PPE) to allow them access to the patient, to provide assessment, and establish incident command.
5	Rescue is a dangerous activity, and safety is the number one priority.
6	Personal protection equipment can minimize risk of exposure to infectious diseases.
7	Rescuer’s Protective Equipment Helmets Eye protection Hearing protection Respiratory protection Gloves Flame protection Personal flotation devices Lighting Hazmat suits Wilderness protection
8	Patient Protection Eye protection Hearing and respiratory protection Protective blankets Protective shielding
9	Safety Procedures Steps in curbing “heroics” and maintaining optimum safety include: Rescue SOPs Crew assignments Preplanning
10	Dangerous techniques should be practiced frequently.
11	Rescue Operations Phase One—Arrival and size-up Phase Two—Hazard control Phase Three—Patient access Phase Four—Medical treatment Phase Five—Disentanglement
12	The first step of a rescue operation is arrival and scene size-up.
13	Phase 2 On-scene hazards must be identified with speed and clarity. A sampling of dangerous conditions you may encounter: Poisonous substances Biological agents Swift-moving currents Extreme heights
14	The third step of a rescue operation is gaining access to the patient.
15	The fourth step in a rescue operation is patient treatment.
16	Goals of Rescue Assessment Identify and care for existing problems. Anticipate changing patient conditions and determine in advance the assistance and equipment needed.
17	"In responding to rescues" In responding to rescues, you must be prepared to “shift gears” mentally to an extended-care situation.
18	The fifth step in a rescue operation is disentanglement.
19	The sixth step in a rescue operation is packaging and removal of the patient.
20	The seventh, and final, step in a rescue operation is transport of the patient.
21	Surface Water Rescues Water rescues may involve many kinds of water bodies—pools, rivers, streams, lakes, canals, flooded gravel pits, or even the ocean. It is imperative that paramedics participating in water rescues are trained and equipped properly.
22	A personal flotation device (PFD) is mandatory equipment for any water-related rescue.
23	Safe ice rescue requires proper equipment and protective clothing.
24	The basic water rescue model is: REACH THROW ROW GO
25	Moving Water By far the most dangerous water rescues involve water that is moving. Competency at handling the power and dynamics of swift-water rescues comes only with extensive training and experience.
26	The movement of currents can create a “drowning machine.”
27	Currents can force a person up against a “strainer.”
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29	Water rescue with possible spinal injury
30	Hazardous Atmosphere Rescues Confined-space rescues present any number of potentially fatal threats, but one of the most serious is an oxygen-deficient environment. 60% of all fatalities associated with confined spaces are people attempting to rescue a victim!
31	Look for warning signs.
32	Treat a culvert for what it is— a dangerous confined space.
33	Confined spaces, such as utility vaults, may be hazardous.
34	Entering confined spaces, such as silos, requires training, equipment, and experience.
35	Confined-Space Hazards Oxygen-deficient atmospheres Toxic or explosive chemicals Engulfment Machinery entrapment Electricity Structural concerns
36	Trenches should comply with OSHA regulations to minimize the possibility of collapse.
37	Highway Operations and Vehicle Rescues Traffic hazards Staging Positioning of apparatus Emergency lighting Redirection of traffic High visibility Other hazards Fire and fuel Alternative fuel systems Sharp objects Electric power Energy-absorbing bumpers Air bags Hazardous cargoes Rolling vehicles Unstable vehicles
38	Danger zone from downed electrical wires
39	Auto Anatomy Motor Vehicle Collisions (MVCs) present EMS with the most common access and extrication problems. You must know some basic information about automobile construction or “anatomy.” Considerations include: Frame/construction Firewall/engine-compartment components Types of glass Doors
40	Rescue Strategies Perform initial scene size-up. Control hazards. Assess the degree of entrapment. Establish circles of operation. Treatment, packaging, removal.
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42	Hazardous Terrain Rescues Activities such as mountain climbing, rock climbing, cross-country skiing, snowboarding, and hiking have drawn more people into rugged areas.
43	3 Types of Hazardous Terrain Steep slope or low-angle terrain Vertical or high-angle terrain Flat terrain with obstructions
44	High-angle rescue is dangerous and difficult.
45	Low-angle situations are not as difficult and are often used for training.
46	A basket stretcher
47	A basket stretcher is often used to carry patients over rough terrain.
48	Use of Helicopters Helicopters can be useful in hazardous terrain rescues. You must understand the capabilities of helicopters along with their advantages and disadvantages. More information on this topic appears in Chapter 13.
49	Extended Care Assessment (Such as During Wilderness Operations) Consider protocols addressing the following areas: Long-term hydration management Repositioning of dislocations Cleansing and care of wounds Removal of impaled objects
50	Summary Phases and Aspects of Rescue Operations PPE Needed for Rescue Operations Types of Rescues Process of Various Rescues