Professional Development & Training MM3. Firefighter Prehospital Care Program. Maintenance Module 3 Course Mill Version

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Jeremy Harmon
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1 Professional Development & Training MM3 Firefighter Prehospital Care Program F T Maintenance Module 3 Course Mill Version S

affects the human body review the anatomy and trauma related injuries to the thoracic cavity review the anatomy and

2 Objectives Upon successful completion of the Firefighter Prehospital Care Maintenance Module 3 Program, on line knowledge evaluation and inclass practical session, the firefighter will: review the meaning of trauma and how it affects the human body review the anatomy and trauma related injuries to the thoracic cavity review the anatomy and trauma related injuries to the abdominal cavity briefly review the functions and use of the stretcher and stair chair utilized by paramedics

3 Professional Development & Training Kinematics of Trauma

4 The Law of Newton 1. Objects at rest tend to stay at rest, and objects in motion tend to stay in motion, unless they are acted upon by some force. 2. Force (F) equals Mass (M) times Acceleration (A) F=MA 3. For every action, there is an equal and opposite reaction.

5 Blunt vs. Penetrating Trauma Blunt trauma is caused by a force to the body and injuries do not penetrate soft tissue or organs. Penetrating trauma is caused by objects that pierce the surface of the body such as bullets, knives, etc.

Motor Vehicle Collisions By assessing a motor vehicle collision, the mechanism of injury ( MOI ) may be determined which will able you to predict the types of injuries that may have happened at the

6 Motor Vehicle Collisions By assessing a motor vehicle collision, the mechanism of injury ( MOI ) may be determined which will able you to predict the types of injuries that may have happened at the time of impact. There are three types of crashes: collision of car against another car or object, collision of passenger(s) against interior of car collision of passenger s internal organs against the solid structures of the body

Always remember that supplemental restraint systems cannot prevent all injuries and that serious injuries may still

7 Types of Motor Vehicle Collisions There are five types of collisions which each have a different effect on the body. They are Frontal, Lateral, Rear-end, Rollovers and Spins In frontal collisions evaluate seat belts and airbags. Always remember that supplemental restraint systems cannot prevent all injuries and that serious injuries may still have occurred. Check for contact points. Steering wheels can also cause chest injuries, especially if no airbag is present.

8 Types of Motor Vehicle Collisions Rear-End collisions are the common cause of whiplash-type injuries. Unrestrained passengers will be thrust forward into the dashboard and back seat passengers wearing only lap belts might have a higher incidence of lumbar and thoracic spine injury. Lateral collisions are responsible for the highest incidence of deaths as there may be intrusion into the passenger compartment. In Rollover collisions, injury patterns differ if patients are unrestrained. The most unpredictable injuries are to unrestrained passengers as ejection is the most common life-threatening injury.

Significant Falls Injury potential is related to the height of the fall. A fall either 15' or three times the person s height is considered significant.

9 Significant Falls Injury potential is related to the height of the fall. A fall either 15' or three times the person s height is considered significant. You should always suspect internal injuries from a significant fall. When determining if a fall is significant consider the height of the fall, the surface struck, the part of the body that hit first, followed by the path of energy displacement.

Penetrating Trauma Penetrating trauma is the second largest cause of death after blunt trauma. Penetration can be low-energy, or medium- or high-velocity.

10 Penetrating Trauma Penetrating trauma is the second largest cause of death after blunt trauma. Penetration can be low-energy, or medium- or high-velocity. The greater the speed of penetration, the greater the injuries. Low energy penetrating trauma is caused accidentally by an object or intentionally with a weapon. Injury is caused by the sharp edges of the object moving through the body. Medium velocity and high velocity penetrating trauma is usually caused by bullets. Bullets can change shape, ricochet within the body and the pressure waves cause cavitation.

Effects of Trauma on the Body Trauma to the head can cause bruising or tearing of the brain. These injuries can cause bleeding or swelling inside the skull and are often life threatening.

11 Effects of Trauma on the Body Trauma to the head can cause bruising or tearing of the brain. These injuries can cause bleeding or swelling inside the skull and are often life threatening. Some patients may not have signs and symptoms related to the injury. Trauma to the neck can cause tearing or swelling of trachea which can cause life-threatening airway problems. Injury to large blood vessels in the neck may produce swelling that prevents blood flow to the brain and open wounds to neck veins bleed heavily or allow air to enter the circulatory system.

12 Effects of Trauma on the Body Trauma to the chest can cause broken ribs which may interfere with chest s ability to expand normally. Additionally, large vessels may tear, causing massive bleeding. Trauma to the chest may also cause a pneumothorax which is when air collects between lung tissue and chest wall. Compression of lung tissue interferes with oxygen exchange and may also interfere with the functioning of the heart (tension pneumothorax)

13 Effects of Trauma on the Body Trauma to the abdominal organs can tear, lacerate, or fracture, causing serious bleeding and death. Hollow organs can leak digestive fluids. Trauma patients who complain of abdominal pain may have abdominal bleeding Always remember that when assessing a trauma patient, if their injuries involve more than one body system they are deemed as having Multisystem Trauma.

14 Professional Development & Training Chest Trauma

15 Organs of the Chest great vessels heart lung diaphragm

16 Signs & Symptoms When assessing a patient suffering from chest trauma always remember that closed chest injuries can be caused by blunt trauma which include car accidents, falls and assaults. Open chest injuries are caused by penetrating trauma such as assaults or accidental. Blast injury s affect hollow organs more often than solid ones. Organs prone to injury from blasts include the lungs and the gastrointestinal tract. Signs and symptoms may include pain at site of injury, pain aggravated by increased breathing, bruising to the chest wall, crepitus with palpation of chest, shortness of breath, failure of chest to expand normally, rapid weak pulse with low blood pressure and cyanosis around lips or fingernails

Immediate Interventions If the patient is suffering from a penetrating chest injury, apply an occlusive dressing taped on three sides or utilize the ascherman chest seal.

17 Immediate Interventions If the patient is suffering from a penetrating chest injury, apply an occlusive dressing taped on three sides or utilize the ascherman chest seal. Stabilize any paradoxical motion with a large bulky dressing and 2'' tape. Apply oxygen via non-rebreather mask at 15 L/min and if the patient is experiencing inadequate ventilations, ventilate with a BVM that is attached to supplemental oxygen at 15 L/min. Provide cervical spine immobilization.

If the patient suffers an open or penetrating wound to the chest with bubbling around the injury, the injury is called a sucking chest wound.

18 Pneumothorax A pneumothorax occurs when air accumulates in the pleural space due to air entering through a hole in the chest wall. The lung may collapse in a few seconds or a few minutes. If the patient suffers an open or penetrating wound to the chest with bubbling around the injury, the injury is called a sucking chest wound. Some people are born with or develop weak areas on the surface of the lungs. Occasionally, the area will rupture spontaneously, allowing air into the pleural space. The patient will experience sudden chest pain and trouble breathing with no underlying cardiac cause. These injuries are referred to as a Spontaneous Pneumothorax.

As with a pneumothorax, the lung on the affected side may collapse in a few seconds or a few minutes.

19 Hemothorax A hemothorax occurs when blood accumulates in the pleural space due chest trauma. If the patient has suffered penetrating chest trauma and there is no bubbling occurring at the injury site, suspect a hemothorax. As with a pneumothorax, the lung on the affected side may collapse in a few seconds or a few minutes. If the patient suffers an open or penetrating wound to the chest with bubbling around the injury, the injury is called a sucking chest wound. If both air and blood are present in the pleural space, it is called a Hemopneumothorax.

$Rib Fractures Rib fractures are very common in older people. A fractured rib may lacerate the surface of the lung causing further injury.$

20 Rib Fractures Rib fractures are very common in older people. A fractured rib may lacerate the surface of the lung causing further injury. If a patient has experienced a fractured or cracked rib they will avoid taking deep breaths and breathing will be rapid and shallow. The patient will often hold the affected side to minimize discomfort. A Flail Chest occurs when a segment of chest wall has detached from the rest of thoracic cage due to three or more ribs fractured in two or more places. This injury will create paradoxical motion.

21 Traumatic Asphyxia Occurs when there is a sudden, severe compression of chest which produces a rapid increase in pressure within chest. This injury is scene when a patient is compressed between a vehicle and a solid object such as a wall. The sudden increase in thoracic pressure results in neck vein distention, cyanosis to the face and neck and bleeding into the eyes. If the patient is still trapped when you arrive, leave the patient in the position found until they are assessed by paramedics. Extrication of the patient should involve consultation between all care providers ( fire and paramedics)

All of these vessels are contained in the chest.

22 Laceration of Great Vessels The great vessels include the superior vena cava, inferior vena cava, pulmonary arteries and veins and the aorta. All of these vessels are contained in the chest. When a patient experiences an injury to these vessels fatal hemorrhage within the chest cavity is the general result.

Cardiac Tamponade occurs when blood leaks into the sac surrounding the heart (pericardium). It often occurs due to penetrating trauma.

23 Additional Severe Chest Injuries Pulmonary Contusion is a bruise in the lung tissue. This bruise disrupts the flow through the capillaries around the alveoli, causing the area of the lung to become dysfunctional. Cardiac Tamponade occurs when blood leaks into the sac surrounding the heart (pericardium). It often occurs due to penetrating trauma. Blood leaks from the wound in the heart into the sac, where it gets trapped. Diaphragm Rupture is a tearing of the diaphragm which allows the abdominal organs to protrude upward into the chest. The patient s breathing is affected because the abdominal organs occupy space in the chest and because the torn diaphragm is less able to provide movement that assists with breathing.

24 Management of Chest Injuries When managing a chest injury, always remember the following: Cover all open chest wounds with an occlusive dressing secured on three sides. Ensure that the side left untapped is the lowest side of the dressing in order to ensure drainage from the wound Maintain an open airway and deliver high-flow oxygen. Be aware that the patient may require respiratory support with the BVM All chest trauma patients will require spinal immobilization If a flail chest is evident, immobilize the flail segment. Perform ongoing assessments for the development of a pneumothorax, hemothorax and other respiratory complications.

25 Professional Development & Training Abdominal Trauma

26 Hollow Organs of the Abdomen Right Upper Quadrant Left Upper Quadrant stomach small intestine large intestine bladder Right Lower Quadrant Left Lower Quadrant

27 Solid Organs of the Abdomen liver Right Upper Quadrant Left Upper Quadrant spleen pancreas kidney Right Lower Quadrant Left Lower Quadrant

28 Signs & Symptoms Abdominal organs are susceptible to forces from outside the body, and significant internal injury is possible even with only minor external injuries. Patients can lose large amounts of blood before they begin to show symptoms. Solid organ lacerations are often the result of direct force trauma, such as when the steering wheel crushes the liver after a MVC. Sudden deceleration forces can also impact abdominal organs. When the body comes to a sudden stop, such as in a fall, the organs continue moving and can tear at the point where they connect to the abdominal wall or blood supply. Signs and symptoms may include pain, tachycardia, decreased blood pressure, pale cool & moist skin, firm abdomen on palpation and bruising

29 Blunt Abdominal Wounds Blunt abdominal trauma is a leading cause of mortality among all age groups. Identification of serious abdominal trauma is often challenging; many injuries may not manifest during the primary assessment. Blunt trauma to the abdomen may cause severe bruises of the abdominal wall, laceration of the liver and spleen, rupture of the intestine, rupture or tearing of the kidneys and rupture of the bladder.

Additionally, they may decrease the severity of the third collision which refers to the

30 Seat Belt Injuries When properly applied seatbelts will successfully restrain the passenger and prevent a secondary collision within the vehicle. Additionally, they may decrease the severity of the third collision which refers to the passengers organs movement within the abdominal cavity. If used inappropriately, seat belts may cause deceleration injuries to the abdominal organs.

31 Evisceration Occurs when internal organs or fat protrude through an open wound. Always remember: NEVER try to replace the organs, cover the organs with a moist gauze, then secure with an occlusive dressing secured on all four sides. The organs must be kept warm and moist.

Management of Abdominal Injuries When managing an abdominal injury, always remember the following: Treating abdominal injuries is largely based on recognizing the significance of the mechanism of

32 Management of Abdominal Injuries When managing an abdominal injury, always remember the following: Treating abdominal injuries is largely based on recognizing the significance of the mechanism of injury. Control external bleeding with thin absorbent pads. Cover large wounds that expose internal organs with pads soaked in saline or sterile water. If the injury is penetrating, inspect the patient s back and sides for exit wounds. Maintain an open airway and deliver high-flow oxygen. All abdominal trauma patients will require spinal immobilization

33 Professional Development & Training Patient Transport Equipment

The bariatric stretcher weighs 120 lbs / 54 kg due to the battery and hydraulics.

34 Ferno 35A Modified Transport Stretcher The Ferno 35A Modified stretcher weighs 81 lbs / 37 kg and has a load limit of 650 lbs / 295kg. The bariatric stretcher weighs 120 lbs / 54 kg due to the battery and hydraulics. The bariatric stretcher has a load limit of 1000 lbs / 453kg. The stretchers have 8 bed positions with 1 being for transport, 2-4 for transfer of the patient, 5-6 for rolling and 7-8 for loading into the ambulance.

35 Pinch Points It is important to remember that the Ferno 35A Modified stretcher has many pinch points that may cause injury to the rescuer. The area s to use caution with are the safety bar release lever on both sides, the stretcher frame that makes contact with undercarriage on both sides and the sidearm release handle on both sides.

Removing and Preparing Stretcher When removing the stretcher from

in the end of the wall mounted locking bar in order to release the

36 Removing and Preparing Stretcher When removing the stretcher from the ambulance ensure the vehicle bumper is raised and secured, push in the end of the wall mounted locking bar in order to release the stretcher and hold on to the upper/lower control handle and remove stretcher from vehicle. While your partner is supporting the stretchers undercarriage lower the frame, release safety bar and remove stretcher.

Removing and Preparing Stretcher Once the stretcher is

37 Removing and Preparing Stretcher Once the stretcher is removed from the ambulance, position the stretcher on a level surface and lock wheels. Lower the stretcher to bed positions 2, 3 or 4 ( approx. knee height of patient ), lower the sidearm on the side the patient will be entering stretcher and ensure the straps are undone.

Preparing to Load the Stretcher Whenever a

As directed by the paramedics, assist them

position 7 and 8, ensure the drop frame is

38 Preparing to Load the Stretcher Whenever a patient is on the stretcher, a paramedic should be the only person operating ANY control handle. As directed by the paramedics, assist them in raising the stretcher to loading position 7 and 8, ensure the drop frame is extended on the stretcher and ensure vehicle bumper is raised and secured. Position the stretchers loading wheels on deck of the ambulance and engage safety hook.

Preparing to Load the Stretcher Prior to loading the stretcher remove

coordinate a smooth lifting motion of the wheels.

39 Preparing to Load the Stretcher Prior to loading the stretcher remove all non-essential equipment and place in ambulance in order to decrease the weight you will be lifting. Get close to the side of the stretcher and communicate in order to coordinate a smooth lifting motion of the wheels. In order to prevent the wheels from dropping while the stretcher is being loaded, DO NOT let go of the undercarriage until all wheels are loaded.

The chair has 6 inch locking wheels on back of chair and 4 inch swivel caster wheels

40 Ferno EZ-Glide Evacuation Chair The Ferno EZ-Glide Chair weighs 33 lbs. / 15 kg and will comfortably hold 500 lbs. / 227 kgs. The chair has 6 inch locking wheels on back of chair and 4 inch swivel caster wheels on front of chair which aid in chairs movement on flat surfaces. The Stair Glide Track feature aids in going down stairs only.

Key Components All handles found on the Ferno

aids the rescuers in moving a patient down a

Additionally, the fold out foot rest gives increased

to engage shoe heels and the plastic buckle strap

41 Key Components All handles found on the Ferno EZ-Glide Chair that perform mechanical functions are coded red and are easily identified. A key feature is the Stair-Glide track system which aids the rescuers in moving a patient down a staircase. Additionally, the fold out foot rest gives increased comfort and safety for patient, provides the ability to engage shoe heels and the plastic buckle strap can be used for securing lower legs to chair. Extension Handle Release Lift Bar Release Chair Lock Release Stair-Glide Track

When ascending a staircase ensure the Stair-Glide is in the closed and locked position.

42 Ascending and Descending Stairs When descending a staircase ensure the Stair-Glide is engaged on two steps for proper operation, allow the Stair-Glide to gently operate as it descends and DO NOT force the chair. When ascending a staircase ensure the Stair-Glide is in the closed and locked position. If space permits utilize four rescuers to carry the patient and always hold handrail for extra support. Always have a spotter gently supporting the person s back who is at the foot end of the chair.

43 EMS Command Coordinator For all questions pertaining to this module, contact your E.M.S. Command Coordinator.

Trauma Overview. Chapter 22

Trauma Overview. Chapter 22 Trauma Overview Chapter 22 Kinematics of Trauma Injuries are the leading cause of death among children and young adults. Kinematics introduces the basic physical concepts that dictate how injuries occur