BASIC RESCUE TECHNIQUE AND EMERGENCY RESPONSE

INTRODUCTION

Road safety is a significant worldwide health issue. Poor road safety causes one of the greatest inequities in the world today. More than a million people – the vast majority in the poorest countries of the world – are being killed each year, often because unsuitable vehicles are being driven on unsuitable roads by poorly trained drivers and who would want to go on hard drugs to take more turns in an attempt to make more gain. At the inquest into the world’s first road traffic death in England in 1896, the coroner was reported to have said “this must never happen again”.

Despite significant improvements in road safety in several countries over the past few decades, 1.2million people are killed every year in road traffic crashes around the world. This represents an average of 3242 persons dying each day around the world.  Nine out of ten deaths occur in developing countries – most of them among pedestrians, bicyclists, motorcyclists who are on stimulants and passengers of public transport, and more than half of them youth between 15 and 44 years old.Up to 50 million people are injured, many suffering life-long disability.These are the forgotten victims of road crashes.

Yet road traffic-related deaths and injuries attract little attention from the world’s media. They occur one by one, in a series of personal tragedies.

SYSTEMS APPROACH

A systems approach to road accident rescue can be described as a sequence of inter-related events that will enable achievement of a safe, effective and efficient rescue.

To effectively perform the road accident rescue role of providing lifesaving support to trapped and injured persons and subsequently their extrication, personnel should possess a knowledge of:

a.       the systems approach to road accident rescue;

b.       basic first aid;

c.       other agency roles and resources;

d.       the importance of scene integrity;

e.       the basic construction of motor vehicles;

f.       relevant equipment;

g.       the techniques employed to effect extrication; and

h.       critical incident stress and the importance of effective operational and emotional debriefing.

THE PSYCHOLOGY OF RESCUE

People tend to react differently to danger, but the most general responses are anxiety and fear, perhaps the most powerful of all emotions. It must be remembered that it is not just the casualty who faces the danger. Even if the main danger has struck and passed, additional dangers are still often present. The biggest difference between the casualty and the rescuer is that the rescuer is better able to cope with, or handle the situation. This is because the rescuer has the knowledge and the resources to minimize risk and to remedy the situation.

It is normal to be anxious and feel fear in the face of danger. These are emotional reactions common to both casualty and rescuer. Many other emotional responses may develop during a rescue situation—pity, disgust, contempt, pride, concern and many more. These are often exaggerated beyond all reason by the urgency and pressures of the situation, thus lowering the efficiency of the overall operation.

The rescuer must be aware of the psychological needs of accident casualties, not just their physical needs, and be prepared to meet those psychological needs.

RESCUE WORKERS

An event requiring rescue operations will usually create three categories of rescue workers.

GROUP 1—SURVIVORS

a.       The immediate reaction of survivors of road accidents, once they have discovered they are not seriously injured is to help others. They usually do not know what to do, but they feel they should do something to assist. The situation where untrained survivors, possibly in some state of shock, attempt to render assistance is a concern.

b.       These good intentions could aggravate the conditions of those being ‘helped' to the point where loss of life may be greater than it should be. These same individuals could also be a hindrance, in the way of, and interrupting the functioning of trained rescue teams.

Nevertheless, uninjured and slightly injured survivors could well be the only hope of survival for many casualties eg if toxic gases, dangerous chemicals, fire or danger of fire exists at the site of the accident. The first group to commence rescue work at an accident site usually consists of those survivors still physically capable of doing so.

The potential for good is enormous but the danger inherent in utilizing untrained personnel is equally serious.

GROUP 2—UNTRAINED PERSONNEL

a.       The second wave of rescue workers is drawn from people either witnessing the event or from the vicinity of the event, drawn to the site by curiosity and, for many, a desire to assist the casualties. Although not quite as emotionally involved as the survivors, the danger inherent in utilizing untrained personnel is still a factor which must be considered. On the positive side, they often bring necessary resources with them and can be very effective if they can be brought under control and properly supervised.

b.       Unfortunately, a large number of the ‘curious' are just that. They have no desire to help, but just look. They get in the way, shout advice and generally add to the excitement at the site, the very thing that is least needed.

GROUP 3—TRAINED PERSONNEL

The last group to arrive at the scene are the trained rescuers e.g. Ambulance, Police, Fire etc. It takes some time for various emergency services to mobilize and arrive at the scene. The quicker they can arrive the less time there will have been for the first two groups to aggravate the situation and create more dangers to surviving casualties and to themselves. Well trained teams will effectively utilize the resources available, to efficiently carry out the necessary tasks.

PERSONAL TRAITS OF THE RESCUER

Rescue work is not an easy task, nor is it glamorous. Certainly not all people are suited to such work. Physical fitness, personality, emotional stability and availability are all factors involved in determining one's suitability.

The following traits are desirable:

a. Interest—Rescuers must have a genuine interest in rescue work.

b. Motivation—Rescuers must be prepared to continually undergo training to maintain a professional standard.

c. Dependability—Lives of casualties and team members rely upon dependability.

d. Initiative—The nature of rescue operations is such that it is often impossible to closely supervise each team member. Each must be able to see what needs doing, and complete the tasks at hand.

e. Versatility—Each situation is unique. An individual must apply a wide range of skills and knowledge to new situations.

f. Cooperation—Rescue work is a team effort.

g. Physical Fitness—Rescue work is physically demanding and often continues for long periods. Physical limitations must be recognized by the rescuer and taken into consideration.

h. Leadership Qualities—Required by all rescuers at various times and to varying degrees. Through capable leadership by trained rescuers, many more untrained personnel may be utilised.

i. Control Over Fears (Phobias)—It is important that rescuers are aware of their limitations. Part of this knowledge consists of being aware of phobias. It is vital that the leader of a rescue team is aware of any phobias among team members.

Note: Some phobias which could seriously affect a rescuer, and which may be identified in training are:

(1) haemophobia (fear of the sight of blood);

(2) acrophobia (fear of heights);

(3) claustrophobia (fear of confined spaces); and

(4) hydrophobia (fear of water)

j. Good Dress and Bearing—Appearance should instil confidence in others.

PROTECTIVE EQUIPMENT

Safety is the responsibility of every member. Protective equipment should be worn during all training and operational incidents. The recommended minimum issue of equipment is:

a. helmet

b. overalls/coat;

c. work gloves;

d. boots;

e. eye protection;

f. ear protection; and

g. disposable gloves.

EMERGENCY CARE

FIRST AID

PRIORITIES

First aid priorities are:

1. dangers;

2. airway maintenance;

3. breathing restoration;

4. circulation restoration;

5. haemorrhage control;

6. crush injury management;

7. fracture immobilisation; and

8. communicable diseases.

Problems with airway, breathing and circulation are all separate problems dealt with individually. However, they must also be considered collectively as part of a total package. Any casualty may need management of only one or possibly all three of these areas.

BREATHING

If the casualty has a blockage of the airway, this must be cleared. If breathing has stopped, the rescuer must breathe for the casualty after first clearing the airway (ie Expired Air Resuscitation/EAR).

HEARTBEAT

If the casualty's heart has stopped beating, artificial circulation must be provided (External Cardiac Compression/ECC).

BLEEDING

Since body functions depend on an adequate and uninterrupted supply of blood, any opening in the circulatory system through which blood may be lost should be considered dangerous.

Severe or continued bleeding may lead to collapse and death.

The rescuer must be able to recognise, and if possible, control and manage

a haemorrhage.

COMPRESSION AND SPINAL INJURY

It is important that rescue personnel be able to recognize:

a.       a trapped casualty suffering a compression (crush) injury and to have an understanding of the techniques in releasing the compressive force and the management of the possible resulting syndrome (if this situation is not understood and correctly managed, it can lead to death of the casualty; and

b.       an injury situation involving suspected spinal damage and implement appropriate handling techniques).

FIRST AID PRIORITIES

In a medical emergency it is necessary to have an action plan, one that will work every time, regardless of the type of incident. The following action plan is called

DRABC each letter stands for something the rescuer must do, and the sequence in which it will be done.

The following chart sets out the DRABC action plan, comprising:

D—Danger R—Response A—Airway B—Breathing C—circulation the chart also shows the order of priority and the appropriate time for the control of bleeding and the care of the unconscious casualty.

All first aid management begins with DRABC

EMERGENCY CARE ACTION PLAN

·         Check for danger to:                yourself;                the casualty;                and bystanders. ·         Act only if safe to do so: Do not become the next casualty. Remove danger from the casualty, or if                       necessary the casualty from danger. Warn bystanders of any danger and ask them to keep a safe distance. If unsafe, wait for expert assistance to arrive	D—Danger
·         Check for response: Gently shake and shout loudly. If the casualty responds, check and control serious external bleeding. If no response, proceed with ABC.	R—Response
·         Firstly place casualty on side, then: open the mouth; clear if needed; and keep the airway open (head tilt and jaw support).	A—Airway
·         Look, listen and feel: Is the lower chest or the abdomen rising and falling? Can you hear breathing sounds? Can you feel breathing?	B—Breathing
·         Then: if the casualty is breathing but not responding place onto side; or if the casualty is not breathing, start expired air resuscitation (EAR).
·         Check the carotid neck pulse: If present, continue EAR. If absent, start cardiopulmonary resuscitation (CPR). Note: These procedures apply to a casualty outside of a vehicle. Considerable improvisations may have to be implemented for the casualty trapped inside a vehicle.	C—Circulation

HAEMORRHAGE CONTROL

Bleeding may be external, internal or both. When bleeding occurs internally, treat for shock and elevate the lower extremities if possible. This casualty must be transferred to a medical facility as quickly as possible, since surgical procedures may be required to stop the bleeding.

TYPES OF EXTERNAL BLEEDING

Bleeding is classified according to its source:

• Arterial

• Venous bleeding

• Capillary bleeding

Arterial bleeding is characterized by the flow of bright red blood that issues from the wound in distinctive spurts.

Venous bleeding is characterized by a steady flow of blood that appears to be dark red. Although it may be profuse, it is much easier to control than arterial bleeding.

Capillary bleeding is characterized by the slow oozing of blood, usually from minor wounds such as abrasions. It is easily controlled. Normally the threat of contamination may be more dangerous than blood loss.

CONTROL AND MANAGEMENT

There are very few situations in which external bleeding cannot be controlled. Since this is one of the most common conditions that rescuers will encounter, they should be thoroughly familiar with the techniques of control.

Severe external bleeding from sometimes gruesome wounds taxes the presence of mind and self-control. The ability to think clearly, act calmly and keep a tight rein on emotions is most important. The methods of controlling external bleeding will be discussed in the order of priority.

DIRECT PRESSURE

The most effective method of controlling external bleeding is by pressure applied directly over the wound and then elevation of the site if possible. This should then be followed by the application of a suitable dressing pad and bandage.

PRESSURE POINTS

If bleeding cannot be controlled using direct pressure in conjunction with elevation, especially when an extremity is involved, pressure on a strategic pressure point may be required.

A pressure point is a site where the main artery to the injury lies near the surface of the skin and directly over a bone.

CONSTRICTIVE BANDAGE

If direct pressure and the use of pressure points do not effectively control external bleeding, a constrictive bandage should be used, but only as a last resort. Such situations are rare and usually involve traumatic amputations. If a constrictive bandage is applied to a limb, it must only be removed by a medical officer.

REMEMBER

A constrictive bandage must be at least 3cms in width and should be used only to control life threatening bleeding that cannot be controlled by other means.

Even then it should be used only with the complete understanding that it may mean the loss of the limb to which it is applied.

NOTE

External bleeding from the ear canal must not be stopped under any circumstances.

Given this situation the blood and or clear fluid should be allowed to drain freely from the ear.

SPINAL INJURY

In vehicle accidents, spinal injuries are often overshadowed by more obvious and gruesome injuries like fractures, lacerations to the face and body and chest injuries.

Poorly trained rescue personnel often have trouble in identifying spinal injuries and if they do find a spinal injury, it is usually after the more obvious wounds have been treated and the casualty has been moved. By this time any spinal injury caused during the accident will have been made worse, and the casualty may now have permanent and irreparable damage.

For this reason it is vital that the rescuer be able to recognize a spinal injury and be able to immobilize the spine quickly and correctly, since correct immobilization may mean the difference between complete recovery, a life long paralysis, or even death.

RECOGNITION

For any person who has been involved in a motor vehicle accident, the rescuer should assume a spinal injury if that person:

a. is unconscious or has a significant head injury;

b. complains of pain in the neck;

c. complains of numbness, tingling, or ‘pins and needles', in any limb or limbs;

d. complains of inability to move, or decreased strength in any limb or limbs;

e. complains of electric shock sensation on movement;

f. has obvious deformity of the spine; or g. is paralyzed

MANAGEMENT

The most important thing to remember is the ‘ABC’ (i.e. Airway, Breathing,

Circulation) of first aid, resuscitation being the primary function. If an injury to the neck or back is suspected, the spinal column must be immobilized. It is most important not to move the spine prior to immobilization. If it is moved, spinal cord damage may occur due to pieces of bone compressing the spinal cord.

NOTE

All casualties with neck pain, injury or deformity should be managed as follows.

• The head and neck supported by hand until other support can be

arranged; this is most important if the casualty is found in a sitting

position, as when trapped in a motor vehicle.

• The application of a cervical collar if available, or a rolled up towel

placed gently around the neck (like a scarf) for support.

• The securing of a short or long back board for support prior to being

moved.

5. SUMMARY

• ABC

• Immobilize.

• Lift casualty in position found.

• Don't move casualty unnecessarily.

6. WARNING

If you don't think about a spinal cord injury

YOU WILL MISS IT!!

CONCLUSION

The effectiveness of any rescue mission depends largely on knowledge and skills in basic first aid techniques and emergency response, it is therefore important for rescuers in FRSC to have at least a proper training in Basic life Support (BLS) to ensure that we save lives, reduce severity of injuries and promote recovery.

Thank you