Training Connections: Part 3
By Steve Piluso
Using EMR and Psychological First Aid training in rescue situations
By Steve Piluso
Within different disciplines, first responders are taught different priorities. Real life situations are complex and we need to work on how we blend our training and knowledge to provide the best care and response possible.
In our first article, we explored incorporating psychological first aid into everything we do as first responders. Through our dress and deportment, body language and tone of voice, as well as through expressing empathy and having patience, we can impact our patients in a positive way. In this article, we are looking at how we can make our rescue training and responses more holistic. By prioritizing the use of our medical training and psychological first aid, we can help to create an even higher level of response.
Blending EMR, psychological first aid, and rope rescue considerations during rope rescue
From a rope rescue perspective, your priorities are to establish safety zones, anchors, set up the system, access the patient, transfer the patient to your system and extricate them. The missing piece is that you are not rescuing an object, but a person. We can fill this gap by considering the medical and psychological well-being of the patients, and we do this by drawing from our EMR and psychological first aid training. The medical piece is so important— by following the standard rope rescue protocols, you rescue the person safely, but what if they succumb to a life-threatening bleed before you are able to extricate them? The psychological aspect is also an important piece with a responsive patient, and it can begin even before a rescue system is in place. The first responder on the scene can begin speaking to the patient, providing reassurance and giving guidance to the patient while the rest of the team is setting up for the rescue.
Unlike the priorities for a rope rescue, priorities from our EMR training focus on the patient’s well-being and start with safety, circulation, airway and breathing. From any first aid training, you would remember the ABCs (Airway, Breathing and Circulation), and in a serious trauma, we move circulation before airway and breathing in terms of priority (CAB). After completing CAB with the patient, you move on to a rapid body survey during which you could encounter any number of injuries that would require immediate intervention, including an injury that would require spinal precautions. Depending on the severity of the circumstances, you may also have the time/opportunity to manage a variety of non life-threatening injuries before moving the patient.
A recreational rock climber falls at a local conservation area. She was climbing with a friend when her system gave way and had a significant fall resulting in trauma to her chest. Her friend called emergency services and the rescue team arrived 30 minutes later. When incident command arrived, they establish hot, warm and cold safety zones. A person is assigned to the edge of where the rescue will be taking place, and they begin making verbal and visual contact with the patient. They use their psychological first aid to establish visual and verbal contact with the patient, using their body language, tone of voice and empathy to help keep them calm. The edge person can also ask SAMPLE questions to gain relevant medical information for the rescuer and incident command. The patient is responsive, although sounds weak, has difficulty breathing, is uncomfortable and scared.
The anchors are selected and the crew starts setting up the system, taking into account any relevant information they receive from the edge person from speaking to the patient. The rescuer gets ready, having both the right equipment and some starting information about the patient they are rescuing. After the final safety check, the rescuer goes over the edge. They take over the contact with the patient. Once within reach, they immediately pick off to ensure the patient isn’t at risk of a further fall. Once this initial step is complete, they initiate a rapid body survey and manage any immediate threats to life to the best of their ability. During the assessment, the rescuer does their best to visually and verbally assess the patient, recognizing important information to pass on to the next level of care. As they get more information about the patient’s medical condition, they are aware that adjustments may need to be made to the rescue plan. Once those are managed they can continue with packaging and extricating the patient. Once extricated, they move to a more thorough and ongoing assessment which includes any secondary treatment.
Patient care and hypothermia considerations in an ice rescue
It is understandable that in an ice rescue situation, we are eager to get the person out of the water as quickly as possible. It usually takes time to get on-scene where a rescue is required, and we feel the pressure of time weighing on our rescue efforts. It is also uncomfortable for the rescuer if the safety gear is large and cumbersome, making it harder to see, walk, move, and grip in the way that you normally would. When you put these two factors together, our instinct can be to hoist the person in need of rescue out of the water as quickly as possible, even when it means handling them roughly or not properly managing their airway.
In an ice rescue situation, however, our medical training gives us an understanding of hypothermia, and that the priority isn’t speed of rescue, but proper handling of the patient and preparation for medical care when the patient is out of the water. In severe hypothermia, over handling can cause the “stale blood” in the extremities to
recirculate to the heart and possibly cause sudden cardiac arrest, therefore rescue efforts require a smooth and prepared approach to patient treatment. If the patient is alive, the highest immediate risk to them is drowning, not hypothermia. In fact, there are some situations where hypothermia can actually slow down more significant conditions giving us more time.
Before pulling them out of the water, we need to wait until we are ready on shore and on the ice. We need to think in advance how to pull the person from the water while keeping them as horizontal as possible, manage their airway issues, and be aware of spinal precautions. This may mean taking more time to have the right equipment and rescuers available for the extrication. We also want to ensure that once we take them out of the water, they get to warmth and medical care as quickly as possible. It is better for them to spend more time in the water than time waiting for medical care outside of the water, as long as we can ensure/manage safety.
A snowmobiler was heading home from his friend’s house at night and goes through the ice wearing a full snowmobile suit. His friend was lucky enough not to go through the ice as well, and called 911. Rescuers arrive on the scene just over one hour later. It is dark, snowing, -20 C, with 40 km /hr winds. It is hard to see and hear.
The first step is to consider the situation from the big picture and not rush into the rescue. Before moving ahead with the rescue, rescuers need to slow down and consider all aspects of the rescue and medical treatment, stage EMS, stage advanced care, set up safety zones, plan and ensure a safe path to the patient.
As they approach the patient, they find him responsive and the rescuers can use their psychological first aid, using body language and tone of voice to help keep them calm and informed about what is happening. Rescuers have a safe path on the ice to approach the patient and are able to slowly and carefully submerge a basket next to the patient, transfer them carefully inside while still in the water and then quickly and smoothly pull them out with rope support to the basket from shore. They are transported quickly to the staging area where they can begin receiving immediate medical treatment. The priority here is to take our time in setting up a safe and prepared rescue, and then moving quickly once the actual rescue is initiated in order to expedite a rapid transfer to advanced medical care.
By bringing together our EMR, psychological and rescue training in scenarios like these, you see how all of the elements of the situation are considered and addressed. In training for rope rescue, it’s important to include the components beyond the technical aspects of a rescue, and remember that it is a person you are training to rescue, not a mannequin! In ice rescue, we need to consider the medical needs of the patient, and how best to mitigate these and not exacerbate them through the rescue process. By training this way, we are training for the real world, and making ourselves accustomed to a holistic approach to respond with the priority on the patient.
Steve Piluso is an experienced EMRI, AEMCA, military veteran, and multidisciplinary technical rescue instructor. He is the owner and operator of Swift Response, providing high quality, real-world training in Emergency Medical Response, First Aid, CPR/AED and Rescue. Contact Steve: Steve@SwiftResponse.ca or visit swiftresponse.ca.