bomb squad/e.m.s. interface 2005 i.a.b.t.i. emt training conference by sergeant/paramedic marty...

Bomb Squad/E.M.S. Interface

2005 I.A.B.T.I. 2005 I.A.B.T.I.

EMT Training Conference EMT Training Conference

ByBy

Sergeant/Paramedic Marty HietalaSergeant/Paramedic Marty Hietala

Davis County Sheriff’s Office, UtahDavis County Sheriff’s Office, Utah

Goals

Understand levels of emergency medical care

Understand trauma centers and burn centers

Understand the Incident Command System

Articulate potential hazards for EMS and Fire personnel

Articulate potential hazards and mechanisms of injury for the bomb technician

Demonstrate emergency doffing of the bomb suit and chemical suit

Why?

To ensure that emergency medical To ensure that emergency medical personnel and fire personnel will provide personnel and fire personnel will provide the highest level of medical care in the the highest level of medical care in the shortest amount of timeshortest amount of time

The golden hourThe golden hour

The Golden Hour?

After a traumatic event, a patient will have After a traumatic event, a patient will have the best outcome if rapid stabilization and the best outcome if rapid stabilization and surgical intervention is made within an hour surgical intervention is made within an hour of sustaining the injuryof sustaining the injury

Transport must be expedientTransport must be expedient Transport to an Transport to an appropriateappropriate facility facility

What EMS support is available in your jurisdiction?

Is this your Is this your ambulance?ambulance?

Will EMS need Will EMS need additional additional resources?resources?

What type of Fire Dept. support is available in your jurisdiction?

Is this the local fire Is this the local fire engine?engine?

Will the fire service Will the fire service need additional need additional resources?resources?

Levels of Emergency Medical Care

Basic life support Basic life support Advanced life supportAdvanced life support Hospital emergency roomHospital emergency room Trauma centerTrauma center Burn centerBurn center

Basic Life Support

BandagingBandaging SplintingSplinting Spinal precautionsSpinal precautions Oxygen therapyOxygen therapy Cardiopulmonary resuscitationCardiopulmonary resuscitation Automatic external defibrillatorAutomatic external defibrillator TransportationTransportation

Advanced Life Support

Basic life supportBasic life support Intravenous accessIntravenous access Advanced cardiac life supportAdvanced cardiac life support Advanced trauma life supportAdvanced trauma life support Pharmacological interventionPharmacological intervention EKG interpretationEKG interpretation Advanced airway placementAdvanced airway placement

Endotracheal IntubationEndotracheal Intubation

Advanced Life Support

Advanced invasive proceduresAdvanced invasive procedures Surgical cricothyrotomySurgical cricothyrotomy Chest tube placementChest tube placement Central line insertionCentral line insertion Intraosseous infusionIntraosseous infusion External jugular vein cannulationExternal jugular vein cannulation Nasogastric tube placementNasogastric tube placement

Trauma Centers

A designation made for a hospital that A designation made for a hospital that meets stringent requirements for providing meets stringent requirements for providing care to trauma patientscare to trauma patients

Board certified emergency physiciansBoard certified emergency physicians In-house neurosurgeonIn-house neurosurgeon In-house surgical staffIn-house surgical staff In-house radiology staffIn-house radiology staff

Burn Centers

Positive pressure isolationPositive pressure isolation HydrotherapyHydrotherapy Hyperbaric therapyHyperbaric therapy Surgical staffSurgical staff

DebridementDebridement Skin harvestingSkin harvesting Skin graftingSkin grafting

Incident Command System

A standardized system used by emergency A standardized system used by emergency services to manage incidents, regardless of services to manage incidents, regardless of sizesize

Initiated by first arriving assets and Initiated by first arriving assets and branches out based on primary dutiesbranches out based on primary duties

Required by OSHARequired by OSHA

Staging

Where should the command post, EMS and Where should the command post, EMS and fire assets stage?fire assets stage? UphillUphill UpwindUpwind Cold zoneCold zone

Hazards to EMS/Fire personnel

What are the potential hazards that EMS What are the potential hazards that EMS and fire personnel may face at the incident?and fire personnel may face at the incident? Secondary devicesSecondary devices FragmentationFragmentation Chemical, biological, radiological Chemical, biological, radiological

exposureexposure Exposure to residuesExposure to residues Blast pressureBlast pressure

Pre-arrival considerations

Prior to arrival at the scenePrior to arrival at the scene Notify medical controlNotify medical control Notify trauma centerNotify trauma center Use standing ordersUse standing orders Consider staging a medical helicopterConsider staging a medical helicopter

Pre-arrival considerations

Advise EMS/fire personnel what types of Advise EMS/fire personnel what types of hazards the technician may encounter so hazards the technician may encounter so they can prepare…they can prepare… R.F.I. HazardsR.F.I. Hazards

Turn off radiosTurn off radiosTurn off cellular phonesTurn off cellular phonesTurn off pagersTurn off pagers

Medical history data

Each technician should have information on Each technician should have information on scene for EMS providersscene for EMS providers Medical historyMedical history MedicationsMedications Allergies to medicationsAllergies to medications Blood typeBlood type Normal vital signsNormal vital signs

Bomb Technician Hazards

Blast pressureBlast pressure Ear injuryEar injury Lung damageLung damage Traumatic Traumatic

amputationamputation Internal Internal

hemorrhaginghemorrhaging

Bomb Technician Hazards

FragmentationFragmentation Possibility of Possibility of

fragments traveling fragments traveling in excess of in excess of 8900fps8900fps

Size Does Not Matter

Never underestimate Never underestimate the power of an the power of an explosive device by explosive device by it’s size. it’s size.

Even small explosive Even small explosive devices can cause devices can cause death or serious injury.death or serious injury.

This injury was caused This injury was caused by a dry ice bomb.by a dry ice bomb.

Effects of a Dry Ice Bomb

Explosive Injuries

Blasting cap injury Blasting cap injury

Injuries Continued

Effects of improvised fireworksEffects of improvised fireworks

Explosive Force

Pressure and Fragmentation effects of high explosives Pressure and Fragmentation effects of high explosives

Russian Bomb Russian Bomb Technician Technician attempting to attempting to disarm a disarm a backpack device backpack device

Blast Over Pressure Injuries

Blast Over Pressure Injuries

The results The results of trying to of trying to

crimp a crimp a blasting blasting cap with cap with

your teethyour teeth

Blast Over Pressure Blast Injuries Blast Injuries

5 PSI over pressure 5 PSI over pressure Slight chance of eardrum rupture (without Slight chance of eardrum rupture (without

hearing protection) hearing protection) 15 PSI over pressure 15 PSI over pressure

50% chance of eardrum rupture 50% chance of eardrum rupture 30 to 40 PSI over pressure 30 to 40 PSI over pressure

Slight chance of lunge damage Slight chance of lunge damage

Blast Over Pressure Blast Injuries Blast Injuries continuedcontinued

80 PSI overpressure 80 PSI overpressure Severe Lung damageSevere Lung damage

100 to 120 PSI overpressure 100 to 120 PSI overpressure Slight chance of death Slight chance of death

130 to 180 PSI overpressure 130 to 180 PSI overpressure 50% chance of death 50% chance of death

200 to 250 PSI overpressure 200 to 250 PSI overpressure Nearly 100% chance of death Nearly 100% chance of death

Bomb Technician HazardsBlast Effects

Bomb Technician Hazards

Spinal injurySpinal injury EMS should know how the bomb suit EMS should know how the bomb suit

ensemble is donned/doffedensemble is donned/doffed When the bomb technician’s safety is at When the bomb technician’s safety is at

risk, the suit may need to be cutrisk, the suit may need to be cut

Bomb Technician Hazards BurnsBurns

Chemical or thermal burnsChemical or thermal burnsSecond or third degree burns greater Second or third degree burns greater

than 10% of body surface area will than 10% of body surface area will require transport to a burn centerrequire transport to a burn center

Circumferential burns, burns to hands, Circumferential burns, burns to hands, face, groin or respiratory tract will face, groin or respiratory tract will require transport to a burn centerrequire transport to a burn center

Bomb Technician Hazards

Heat stressHeat stress Monitor vitals signs Monitor vitals signs

HR >100, diastolic BP>110 should HR >100, diastolic BP>110 should rehab prior to donning PPErehab prior to donning PPE

Monitor core temperature, 105F Monitor core temperature, 105F degrees can be life threateningdegrees can be life threatening

Bomb Technician Hazards

Heat stress injuriesHeat stress injuries CrampsCramps Heat exhaustionHeat exhaustion Heat strokeHeat stroke

Heat stroke is life threateningHeat stroke is life threatening

Bomb Technician Hazards

Heat stress preventionHeat stress prevention HydrationHydration CoolingCooling

ShadeShadeAir conditioningAir conditioningCooling systemsCooling systems

Fire Department Concerns

Utility locationsUtility locations GasGas Power Power SewerSewer Water lines, hydrantsWater lines, hydrants

Fire Department Concerns

Hazardous chemicalsHazardous chemicals Combustible gasesCombustible gases Fire loadFire load WeatherWeather DecontaminationDecontamination

Fire Department Concerns

Staging location for a rapid intervention Staging location for a rapid intervention team (RIT)team (RIT) Protected locationProtected location Hose lines connectedHose lines connected Water supply readyWater supply ready PPE/SCBA donnedPPE/SCBA donned

Summary

Levels of EMSLevels of EMS Trauma centersTrauma centers Hazards for EMS/fire personnelHazards for EMS/fire personnel Hazards for the bomb technicianHazards for the bomb technician Importance of vital sign monitoringImportance of vital sign monitoring Donning/doffing of PPEDonning/doffing of PPE

Questions? Comments?

Sergeant/Paramedic Marty HietalaSergeant/Paramedic Marty Hietala

Davis County Sheriff’s OfficeDavis County Sheriff’s Office

800 West State Street800 West State Street

Farmington, Utah 84025Farmington, Utah 84025

801 451 4188 Office801 451 4188 Office

801 451 4167 Fax801 451 4167 Fax

801 510 4081 Cellular801 510 4081 Cellular

martyh@co.davis.ut.usmartyh@co.davis.ut.us