Diver Emergency Rescue V1.2

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DIVER EMERGENCY DIVER EMERGENCY RESCUERESCUE

Ocie E. Flournoy EMT-P

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Introduction Introduction

Rescue of the Unconscious DiverIn this session you will learn the proper

method for movement to the chamber

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AgendaAgenda

Proper movement to the stage Maintaining C-Spine and Airway on the stage Methods of extrication from the stage to the

backboard Securing Diver to backboard Moving Diver to Chamber Treatment in the chamber Time limit: 4 minutes

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Overview Overview

CSID

BACKBOARD

COLLAR

HELMET

CHAMBER

STAGE

C-SPINEDIVER

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VocabularyVocabulary

CISDBACK BOARDC-COLLARHEAD STRAPSSHOULDER MANHEADMANDMT

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Anatomy of the spineAnatomy of the spine

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Spinal ImmobilizationSpinal Immobilization

Hold the head– In-line– Neutral position

Prevent movement

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Size the cervical collar

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Spinal ImmobilizationSpinal ImmobilizationApply the cervical collar

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Spinal ImmobilizationSpinal ImmobilizationAlternative to cervical collars

– Blanket or towel rolls

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C-Spine and helmetsC-Spine and helmets

C-spine control MUST be maintained at ALL times

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Immobilization to a SpineboardImmobilization to a Spineboard

Support cervical spine

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Apply cervical collar

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Immobilization to a SpineboardImmobilization to a SpineboardLog roll

– Spine is kept in-line– Person holding the head coordinates the move

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Place padding in the gaps

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Place padding beside the head

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Immobilization with StrapsImmobilization with Straps Secure

– Chest

– Hips

– Legs

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Secure head last– Tape over forehead– Tape over collar

Reassess distal motor and sensory– Note changes

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Immobilization to a SpineboardImmobilization to a SpineboardSpine protectedEasily turned on their side using the boardMoved easily in and out of chamberTransferred easily to

helicopter

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Focus on Neurological TraumaFocus on Neurological Trauma

C-spine injuries Head Injuries

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A Focus on the NeckA Focus on the Neck

Importance of Stabilization

Prevention of further injury

Safe Movement

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Mechanism of InjuryMechanism of Injury

Subsurface explosions

Unsafe acts

Equipment failures

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Injuries to the C-spineInjuries to the C-spine

Types of fracturesTypes of dislocationsAssessment and treatment of injuries

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Fracture/DislocationFracture/Dislocation

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C2 FractureC2 Fracture

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This is Bad!!This is Bad!!

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C-Collar C-Collar

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CSIDCSID

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Long BoardLong Board

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Lifting and MovingLifting and MovingCentral DogmaCentral DogmaLift with your legs not your back (i.e. bend

at the knees)If you need help, call for it

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AirwayAirwayManual ManeuversManual ManeuversJaw Thrust

– Indications: Unconscious/Unresponsive with suspected neck or back trauma

– Contraindications: None

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AirwayAirwayAdjunctsAdjuncts Oropharyngeal Airway (OPA)

– Indications: Unconscious/Unresponsive– Contraindications: Gag Reflex– Technique:

Adults – Insert upside down and then rotate into place

Pediatrics – Insert right side up Nasopharyngeal Airway (NPA)

– Indications: Suspected loss of control of airway

– Contraindications: Facial Trauma– Technique:

Prior to use, apply surgical lubricant Insert into the nare with bevel toward the

septum vertically

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Table 21-7. Primary Emergency Kit. Diagnostic Equipment ‧ Flashlight ‧ Stethoscope ‧ Otoscope (Ophthalmoscope) ‧ Sphygmomanometer (Aneroid type only, case vented for hyperbaric use) ‧ Reflex hammer ‧ Tuning Fork (256 cps) ‧ Sterile safety pins or swab sticks which can be broken for sensory testing ‧ Tongue depressors ‧ Thermometer (non-mercury type, high and low reading preferably) Emergency Treatment Equipment and Medications ‧ Oropharyngeal airways (#4 and #5 Geudel) ‧ Self-Inflating Clear Bag-Mask ventilator with medium adult mask ‧ Suction apparatus ‧ Nonflexible plastic suction tips (Yankauer Suction Tip) ‧ Large-bore needle and catheter (12 or 14 gauge) for relief of tension pneumothorax ‧ Small Penrose drain, Heimlich valve, or other device to provide one-way flow of gas out of the chest ‧ Christmas tree adapter (to connect one-way valve to chest tube) ‧ Adhesive tape (2-inch waterproof) ‧ Elastic-Wrap bandage for a tourniquet (2- and 4-inch) ‧ Tourniquet ‧ Bandage Scissors ‧ Curved Kelly forceps ‧ 10% povidone-iodine swabs or wipes ‧ 1% lidocaine solution ‧ #21 ga. 1½-inch needles on 5 cc syringes ‧ Cravets ‧ 20 cc syringe Emergency Airway Equipment) ‧ Cuffed endotracheal tubes with adapters (7-9.5mm) ‧ Syringe and sterile water for cuff inflation (10 cc) ‧ Malleable stylet (approx. 12" in length) ‧ Laryngoscope blades (McIntosh #3 and #4, Miller #2 and #3) ‧ Sterile lubricant ‧ Soft-rubber suction catheters ‧ #32F and #34F latex rubber nasal airways ‧ 5% or 2% lidocaine ointment ‧ Cuffed endotracheal tubes with adapters (7-9.5mm) ‧ Soft-rubber suction catheters NOTE: One Primary Emergency Kit is required per chamber system (i.e., TRCS requires one).

Level 1 Medical kitLevel 1 Medical kit

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Table 21-8. Secondary Emergency Kit. Emergency Airway Equipment) ‧ Cuffed endotracheal tubes with adapters (7-9.5mm) ‧ Syringe and sterile water for cuff inflation (10 cc) ‧ Malleable stylet (approx. 12" in length) ‧ Laryngoscope blades (McIntosh #3 and #4, Miller #2 and #3) ‧ Sterile lubricant ‧ Soft-rubber suction catheters ‧ #32F and #34F latex rubber nasal airways ‧ 5% or 2% lidocaine ointment #11 scalpel blade and handle ‧ 5% or 2% lidocaine ointment Intravenous Infusion Therapy ‧ Catheter and needle unit, intravenous (16- and 18-gauge - 4 ea) ‧ Intravenous infusion sets (4) ‧ Intravenous infusion extension sets with injection ports (2) ‧ 3-way stopcocks ‧ Lactated Ringer’s Solution (3 ea. 1 - liter bag) ‧ Normal saline (2 ea. 1 - liter bag) Miscellaneous ‧ Nasogastric tube ‧ Urinary catheterization set with collection bag (Foley type) ‧ Straight and curved hemostats (2 ea) ‧ Blunt straight surgical scissors ‧ Syringes (2, 5, 10 and 30 cc) ‧ Sterile needles (18-, 20-, and 22- gauge) ‧ Wound closure instrument tray ‧ Needle driver ‧ Assorted suture material (with and without needles) ‧ Assorted scalpel blades and handle ‧ Surgical soap ‧ Sterile towels ‧ Sterile gloves (6-8) ‧ Gauze roller bandage, 1-inch and 2-inch, sterile ‧ 10% povidone-iodine swabs or wipes ‧ Cotton Balls ‧ Gauze pads, sterile, 4-inch by 4-inch ‧ Band aids ‧ Splints


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NOTE 1: Only commands having recompression chambers with a Medical Officer or ACLS trained Diving Medical Technician/Independent Duty Corpsman assigned shall maintain a portable monitor-defibrillator and those drugs required by the American Heart Association for ACLS. NOTE 2: Whenever possible, preloaded syringe injection sets should be obtained to avoid the need to vent multidose vials or prevent implosion of ampules. Sufficient quantities should be maintained to treat one injured diver. NOTE 3: One Secondary Emergency Kit is required per chamber system (i.e., TRCS requires one). NOTE 4: A portable oxygen supply with an E cylinder (approximately 669 liters of oxygen) is recommended whenever possible in the event the patient needs to be transported to another facility.


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Splinting & Spinal Immobilization Splinting & Spinal Immobilization Backboard & Cervical CollarBackboard & Cervical Collar

Standing Take Down:– Hold manual c-spine stabilization– Check PMS x 4– Place backboard behind the patient – Two people on either side facing the patient assist with spinal

control and cut “Bailout” straps– Lower the patient back to the Long board – Size and apply a c-collar– Place straps on the body– Place the head blocks– Secure head to the board– Recheck PMS x 4

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General OverviewGeneral Overview

Spinal Cord Injury is damage to the spinal cord that results in a loss of function such as mobility or feeling. Frequent causes of damage are trauma and disease.

Spinal Cord is the major bundle of nerves that carry impulses to/from the brain to the rest of the body.

Spinal Cord is surrounded by rings of bone-vertebra. They function to protect the spinal cord.

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PrognosisPrognosis Patients with a complete cord injury have a less than 5% chance of

recovery. If complete paralysis persists at 72 hours after injury, recovery is essentially zero.

The prognosis is much better for the incomplete cord syndromes. If some sensory function is preserved, the chance that the patient

will eventually be able walk is greater than 50%. Ultimately, 90% of patients with SCI return to their homes and

regain independence. In the early 1900s, the mortality rate 1 year after injury in patients

with complete lesions approached 100%. Much of the improvement since then can be attributed to the introduction of antibiotics to treat pneumonia and urinary tract infection.

Currently, the 5-year survival rate for patients with a traumatic quadriplegia exceeds 90%. The hospital mortality rate for isolated acute SCI is low.

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From stage to deckFrom stage to deck

Maintain Spinal Immobilization

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Removing the helmetRemoving the helmet

Maintain C-Spine control from below

Pass control to Headman

Cut neck dam

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Applying the collarApplying the collar

Properly size collar Do not allow collar

to be placed over chin

Maintain airway

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Securing the headSecuring the head

Use headlocks Place both head

straps

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Prepare to movePrepare to move

Assure head is secure Recheck straps Properly position

crew Lift only on

command from headman

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Trial RunTrial Run

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SummarySummary

You have been instructed in the approved method of emergency Unconscious Diver Below rescue

This skill must be practiced frequently for maximum effect

Your feed back on this course is very helpful in refining the process.

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Where to Get More InformationWhere to Get More Information

First responder courseBTLS courseU.S. Navy Dive ManualSuperior Offshore in-house training

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QuestionsQuestions

Documents

Diver Emergency Rescue V1.2