hello and welcome to the module 10 video review chapters 40 41 42 43 and 44 so let's just really quick talk a little bit about just culture and this is a system based on our attempt to avoid punitive consequences for everyday actions or mistakes a lot of this is focused around safety but we use it for other things as well and the system really does work pretty well when it's utilized by those who have honesty and integrity um but excellent for safety excellent for Education just really overall a pretty good system driving the ambulance it is important to know that we are still required to follow laws regulations and ordinances sure we have special privileges that we get um when we're responding to emergencies for example you know we get to park close to wherever the emergency is happening in most cases in emergencies we can contraflow or stop at a red light clear the intersection and go through so we we have a few special things that that we're allowed to do um and there is really no reason to justify operating an ambulance unsafely the most important thing is is that you want to be safe and you want the roadway to be safe for the people around youer cars ambulances have laws and regulations um that govern operation so you need to have a drive valid driver's license you need to be responding to an emergency in order for us to have those special privileges we talked about before um and when you're doing these things you need to use your warning devices like emergency lights horns and sirens you need to exercise due regard which essentially says I'm going to ask for the rideway instead of just take it so when you approach a red light for example and you're on your way to an emergency we don't just blow through the red light we slow down we clear the intersection and ask everyone involved on the road I mean not verbally of course uh but we're going to make sure that everyone else has come to a stop and then we are going to proceed through that red light so it's more about an asking permission than a taking permission and um those are important and then there's lots of other systems that provide additional operational guidance lots of ambulance services also use safety driving policies which also help um reduce accidents and just like cars we need to make sure that we maintain control of our ambulance and possibly it's even more important with an ambulance because we could potentially have a patient in the back one of the most common places or actually the most common place for ambulances to be involved in a collision is at intersections and for some reason we just have trouble with this a lot of times there are cars turning and so there's a lane that gets blocked and ambulances will collide with blocked Vehicles pedestrians uh are especially susceptible to being hit by ambulances so just be really careful make sure you clear all your intersections and drive with Excellence it's definitely important to be safe while we're driving but it's also important to be safe when we're not driving so when we're walking around our ambulance responding to accidents and scenes it's important to make sure that we wear our high visibility apparel so that means those super bright yellow vests with the reflective tape and uh velcro and tear Away safety straps it's also easy to forget that roadways are not the only place that we should be wearing these high visibility vests we should also be using them any place where cars or other vehicles travel like um side roads culde saacs also in parking lots a lot of times people forget how important it is to wear these in parking lots people are not paying attention when they're driving home or leaving the grocery store it's super important that we wear these vests so we can give motorists extra time to not notice us should they not be paying attention points for roadway safety don't trust traffic around you don't turn your back to traffic okay make sure that you wear PP and at night turn off vision impairing lights remember when it's foggy don't use your brights buy something without inspecting it first so I would say you probably wouldn't use something without inspecting it first and this applies to the ambulance as well so checking the AC the heating ventilation checking seat belts making sure your radios work that we have supplies and unit cleanliness is super important prior to our shift crucial to make sure that we have uh the basic medical supplies that we need to operate imagine not checking to make sure you have the things that you need to have and showing up to an emergency and realizing that you don't have the tools that you need to save a life so this list here is just a small list of things that are recommended for check off about roadway safety remember we should stay 100 ft from any sort of wreck or burning vehicles and 2,000 ft from Hazmat spills ideally we should be upill up Wind Up Up and Away however you want to put it we need to be far away from those we also need to keep in mind that the wind direction can change so pay attention to that too transport is a valuable tool but knowing when and how to use it is super critical for us to understand we need to know that we will have operational guidelines to ad here too remember this is going to be ideal for patients who need to go to a facility that's far away perhaps there's a prolonged extrication um we do know the Air transport will save time over ground transport for critical patients in a lot of circumstances perhaps your patients in a remote area or ground transport is completely blocked specialty medical skills supplies or equipment may also be available in Air transport that's not available on ground transport in regards to Medical Transport there are some guidelines or some some things we should look out for some good reasons to call for air medical transport and those things would include uh acute stroke head injuries with altered mental status chest or abdominal trauma with signs of respiratory distress or shock any sort of serious mechanism of injury or a patient with penetrating injuries remember also patients who have severe injuries to delicate areas such as the hands feet face and genitals for air medical support we want to remember that we also need to set up a landing zone so avoid power lines tall trees Towers any other obstructions to the flight path make sure that it the landing zone is clear of obstacles obstructions make sure it's flat flee of free of debris and at least 150 ft from any sort of vehicles make sure that during the day it's 60 ft x 60 ft and at night it's 100 ft by 100 ft pay attention to wind direction and Mark Each corner of the landing area two quick things to remember okay make sure we don't approach by the tail rotor and remember that the main rotor blades May dip down to as low as 4T off the ground just generally it's a good idea to just not approach a helicopter until a pilot or a crew member has motioned you to proceed to make sure and approach helicopters from downhill Direction not from uphill let's switch gears and talk about Hazmat so hazardous material is any sort of material or substance that could pose a threat or unreasonable risk to life health or property if not controlled um so essentially anytime that I eat ice cream because I'm lactose intolerant that would make me um a hazardous material um the principal dangers of this are toxicity flammability and reactivity do has defined or classified nine classes of hazardous materials which include explosives gases flammable liquids and combustible liquids flammable solids spontaneously combustible and dangerous when wet oxidizer and organic peroxides poison or poison inhalation Hazard radioactive substances corrosive substances and miscellaneous sort of vessel that carries a Hazmat substance must have a placard on it for identification purposes here you'll see the number 1866 which is is the United Nations code or number for this Hazmat material 704 Hazmat classification this is another way we can identify hazardous materials and how dangerous they are so you'll see in that diamond we have four different colors and different numbers so essentially the lower the number it goes from 0 to four the lower the number the less hazardous the substance is where four is like the most hazardous so the blue square or diamond is for health hazards red is flammability yellow is instability and then white identifies specialty or special hazards so how do we identify Hazmat one of the ways we can identify Hazmat materials is using our senses but I really don't recommend this um mean you could use your nose to smell and identif a hazardous substance but depending on how Hazard it is you may only be able to detect it once um so look out for visual Clues like wavy colored Vapors froster container leaks weird odors and typically if you smell or see something weird Retreat from the area especially in uh areas like plants or industrial sites rescue can be dangerous and really no one should be attempting Hazmat rescue unless they've had training if this happens and you stumble into a Hazmat rescue request help locate yourself in bystanders uphill upwind upstream and away from danger and allow the people who were trained to do the rescues to do this rescue time that there's a has mat situation be aware that there might be a need for decontamination uh be familiar with your local procedures so unless you're specifically tryed to do this again um don't worry about this 60 to 90% of decontaminants are removed with clothing and try to avoid cross contamination and emergencies we have different areas that we identify and inside each of those areas we perform specific functions so the center area is called the hot or the contamination Zone this is where most of the Hazmat uh exposure is located and no one should be in the hot contamination Zone except for those who have the proper PPE to be there uh the surrounding area is the warm or the control Zone um you still need to have PPE for this um but this is where decontamination is going to happen um and then the cold and the safe zone is essentially where treatment is going to happen remember we don't want to allow contaminated patients to leave the warm Zone into the cold Zone unless they have been decontaminated because then that contaminates the cold zone or the safe Zone that radiation emergencies are part of pmat there are specific guidelines for these types of emergencies um if an RSO cannot come to the site of a radiation emergency remember we can place the patient in a body bag up to their neck uh cover their hair with a cap or a towel and then wipe their face with wipes place them in a plastic bag for disposal at the hospital remember these the substance that you wipe from the face could potentially be radioactive so make sure you let the hospital know that you may have radioactive waste inside of a bag and they'll know where that needs to go specifically remember time distance and shielding are critical in reducing exposure in radiation emergencies remember your priorities the safety of Rescuers uh of yourself and patients is the priority um make sure that you you're doing patient care and make sure that the right proper decontamination procedures are followed here you'll see some radiation Hazard labels radioactive white one is going to be the least amount of radioactivity or hazardous radioactivity level um yellow 2 and yellow 3 just increase the likelihood of injury and the amount of radiation radiation exposure can cause radiation sickness which essentially comes from large amounts of radiation so symptoms can start from a few hours to days following the exposure and depending on how much the patient was exposed to can last a few days to even seven or eight weeks typically we'll know how bad a reaction they're going to have how bad their symptoms are going to be by based off of how quick the symptoms present themselves so if they start vomiting very very quickly after exposure the likelihood of having a positive outcome has been greatly reduced victims of radiation generally are not contagious they're not infectious and typically won't endanger you you're at risk of becoming contaminated if the person still has particles on their skin or clothing however so keep an eye on those signs and symptoms which include hair loss Burns and generalized skin lesions with radiation emergencies make sure you have protection okay um and factors that determine your exposure level uh will vary based on the amount and type of shielding that you use the strength of the radiation source so are the alpha beta gamma rays distance from the radiation the type of radiation how long you are exposed and the amount of your body that was exposed to the radiation lots of factors so the creation of a lot of illicit drugs falls under Hazmat as well because if you think about it a lot of these circumstances where people are operating clandestine drug facilities they are just dumping chemicals into sometimes a bathtub or a bucket and that's going to produce noxious fumes so it's very dangerous so um keep that in mind um when you enter these scenes things like phosphorus sodium hydroxide and hydr ammonia and hydrochloric acid can be present um these things can produce gases like phosphine which is extremely toxic and even in small amounts is incredibly dangerous um as harmless as marijuana can can be remember too that in large marijuana growing operations often times there's large amounts of fertilizer storage and with large amounts of fertilizer um increases a um a likelihood or a risk of um a big accident or explosion let's talk about MCI so mass casualty event incident is any event that places excessive Demand on your local system and typically involves three or more patients so does that mean if you have five patients that you have an MCI not necessarily anytime that you have less resources then you have emergencies you can consider or classify that as an MCI so remember it's better to call too many people than not enough and be familiar with your local disaster plans ahead of time m is a system we use for managing mcis it provides a consistent approach um the IC System is part of Nims and it provides for flexibility and stability if we all do a project together and we do that project the same way every time it allows that project to be much more organized and we can finish projects quickly together when we know what our job is and how to do it and that's what Nims allows us to do in Nims you have different branches which will be your command system um which will have sections underneath them like finance and administration Logistics operations and planning and under each one of those are are different workers with different jobs assigned to help um fix the situation at hand is a chart just illustrating how that layout would work obviously incident command is at the top and people report to incident command but if you look for example under operation section you'll see Hazmat police fire and EMS you don't see a diamond for each one of those that that links itself to instant command if you have too many people talking to the instant command things get crazy communication becomes difficult so the people underneath those diamonds report to the diamonds and then the diamond report to the rectangles it allows communication to be quick easy and organized okay here is uh the EMS Branch Organization for any major incident obviously there's an Incident Commander at the top and uh flowing downwards um we divide them up into subcategories and then the subcategories have Personnel working for them as well remember for Nims responsibilities of the units may include triaging treatment transport staging and morg units anything to function properly in an MCI we need to know how to triage people and very simply put this is defined as our ability to place a priority on patients in order for us to ascertain who needs to be treated first triage is done by the first EMS crew and is conducted at the incident site they get a colored tag um that shows where their classification is and they're removed from the incident site they go to the triage unit where they are triaged again to be familiar with the start triage system it's a system that uses colors to identify priority it's used for anyone old older than 8 years of age or who weighs more than 100 lb each patient should be triaged in less than 30 seconds we're going to look at their respiratory status profusion and mental status remember the pneumonic RPM first category easy it's green if you can walk you're green it doesn't matter if you have someone walking towards you that uh is missing an arm has a glass Shard stuck through their eye and a briefcase that says $1 million for the first person who helps me um there's still a green tag because they're able to walk you'll see the start tree Arch system um this functions like and if then chart so um respirations if yes then we'll perform this action if no then we perform this action um and that will help you decide what what color your patient is you'll start from the top and move your way down towards the bottom is what we use for children um remember we're going to assess them based on RPMs as well uh and this is for anyone who appears to be a child system is very similar to uh start triage remember the colors are going to be different here they're labeled um red brown green and black um and essentially all we do is follow the chart from top to bottom um and that will help us to determine the priority of our pediatric patients here is a visual that just shows the different color tags example of what they would look like and some of the priorities that would make them fit in these categories um pause your video here if you'd like to read more or see more about that information mass destruction um of course I only hope that we never have to deal with this um but remember there's different types of weapons of mass destruction the pneumonic Seaburn will help you remember chemical biological radiological nuclear and explosive use the B pneumonic and that stands for biological nuclear incendiary chemical or or explosive explosives and incendiary devices are the most common types of weapons of mass destruction this includes explosives um which we all know what explosives are fuel is ignited the air pressure around it rapidly changes and it produces a shock wave um in all directions and it can cause blast injuries have improvised explosive devices um often these are created from easily obtained products um so think about the Boston Marathon the explosive devices there were created from pressure cookers and they had put nails and shrapnel in them Vehicles can become improvised explosive devices remember car truck bombs um commonly used an explosive called ammonium nitrate and fuel oil explosives that have different effects and where you are pro in your proximity to the explosion will determine what type of injuries you might sustain so the first is called primary the second is secondary and then tertiary quinary and quinary uh the explosion is primary secondary effects result from flying debris tertiary effects are injuries produced by the propulsion of your your body and then quinary effects include burn crush and uh inhalation um quinary effects include environmental exposure so uh radioactivity fuels and metals and things like that be cautious of secondary undetonated devices um most of the time these are going to call Burns cause Burns so remember use your rule of nines pay attention to area breathing and address your burned areas agents are dispersed um in a variety of ways including aerosol devices this is an important key term to remember uh the word is volatility and the definition of this is its tendency or its ability to evaporate and create a vapor that's volatility and agents that don't evaporate are called persistent pause your slide here to read about the different chemical agents that we're about to talk about nerve agents are very powerful and easily made and essentially they overstimulate the muscles smooth muscles and glands and nerves causing us problems problems can include respiratory failure paralysis of respiratory muscles lots of Airway secretions um we want to remember the pneumonic slud so that salivation lacrimation urination defecation gastric distress imis and we left one off which is called meiosis and meiosis is the constriction or extreme constriction of pupils nerve agents will include monitoring ABC uh we do have medications that can help which are atropine and prid doxine which are antidotes um if there are seizure seizures uh benzos can be used to eliminate those another type of chemical agent is a vesicant which causes blistering burning and tissue damage agents include sulfur nitrogen mustards Lite and fos Gene oxine vesicant we're going to look for burning redness blistering and necrosis stinging tearing and development of ulcers in the eyes shortness of breath wheezing edema nausea vomiting and fatigue see care for ve vesicant should include irrigation uh managing any chemical burns rber dry sterile dressings um blite is an arsenic based agent has an antidote called Di caol iide has a bitter almond smell and it disrupts the ability of our cells to use oxygen it can be inhaled and ingested and with high dose death can occur in as little as 6 to 8 minutes very dangerous we look for anxiety weakness dizziness nausea muscle trem trembling tachicardia tachypnea apnea seizures uh coma pale cyanotic or sometimes even normal colored skin Cyanide by managing the airway breathing and oxygenation there are antidotes available so nitrites and sodium thos sulfate and hydroxocobalamin as well sometimes these are hard to come by though pulmonary agents which include phosphene and other hallogen compounds and nitrogen oxygen compounds and these act primarily to cause lung injury lary agent exposure look for tearing and runny nose throat irritation dpia wheezing coughing crackle Strider and secretions these agents include managing Airway and breathing being prepared to suction administer oxygen and then beta 2 Agonist such as albuterol can be given for wheezing activate ALS for this and you definitely should be prepared to manage the airway toxic industrial chemicals and the way that we treat and approach them will depend on the agent involved and there are far too many to go over individually for nuclear weapons and radiation there are three mechanisms of death primarily radiation blast injuries and thermal Burns radiation is defined as energy released from radioactive atoms which pass through and change the structure of the molecules in our cells exposure is radiation injuries that occur during or shortly after detonation and then of course after detonation there is what's called Fallout which is radioactive dust and particles that can be life-threatening to people far from the epicenter of the detonation nuclear weapons cause blast injuries rapid heating of air uh rapidly expanding gas cloud um the injuries are the same as those from conventional explosives and the wind blasts can reach up to 160 m hour so um remember 160 m hour is pretty powerful so expect objects to be thrown for great distances burns are the the type of injury that caused the most deaths from nuclear explosion heating is a short duration but it's very intense and eyes can be damaged from the intense lights are it's conventional explosive devices that have radioactive materials in them um these pose are risk of widespread radiation illness and contamination of the environment around it radiologic exposure devices differ from Dirty bombs because they do not use an explosive to disseminate uh radiation nuclear weapons and radiation remember most destruction and death is nearest the center of the blast there is less death and injury the further you are from the blast so we want to identify the time after exposure that the patient complains of any R radiation related signs and symptoms because the closer the symptom is to the exposure typically the worse off the patient is going to be we'll look for are going to be nausea fatigue Mala which is just essentially a general feeling of illness uh and clotting disorders you might see vomiting loss of appetite diarrhea fluid loss rening of the skin rapid onset of incapacitation cardiovascular collapse confusion confusion and burning sensation it's definitely not something that you want to to go through emergency medical care for nuclear weapons and radiation includes protecting yourself and patients from further radioactive exposure so use necessary PPE and remember if you are not trained in radiation rescue or intimately familiar with the risks of radiation exposure probably best to leave this to a radiation safety officer um you are potentially could suffer thermal and blast injuries so manage Airways breathing and oxygenation iodine tablets can help protect against long-term effects of radiation so that ends our module tin review I hope that you learned something and of course if you have any questions make sure to reach out to your local instructor thanks