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Patient management in the technical rescue environment

Medical Director Jeremy Cushman encourages BLS providers to develop medical preplans for technical rescue scenarios they may encounter


Ninety-five percent of critical medical care necessary in the technical rescue environment falls within the scope of the BLS provider, yet many of the most simple and effective interventions to improve patients’ survival are either forgotten or never learned.

Jeremy Cushman, MD, MS, EMT-P, FACEP, associate professor and chief, Division of Prehospital Medicine, University of Rochester; EMS medical director, City of Rochester and Monroe County, N.Y., presented a session called, “Don’t Forget the Patient! Pearls and Pitfalls of Patient Management in the Technical Rescue Environment,” at EMS World Expo 2017.

Cushman shared these essential medical management considerations for patients encountered across all technical rescue disciplines as well as pearls to help keep our responders safe, primarily: develop a medical preplan for different scenarios you may encounter.

Dr. Cushman noted there are obvious priorities during a trench or collapse rescue. (Photo/City of Asheville)
Dr. Cushman noted there are obvious priorities during a trench or collapse rescue. (Photo/City of Asheville)

Memorable quotes on the technical rescue environment

Here are some of the most memorable quotes from Cushman on patient management:

“Are they trapped or are they inconvenienced? Trapped means tissue is crushed.”

“In the technical rescue environment, identify one person whose sole responsibility is to watch. Ideally to have a conversation, but it can be done remotely.”

“There are some really cool toys out there. We always have to remember how long is it going to take and how will it impact my rescue. Think about anatomic splinting.”

“Want your team to take your drills seriously? Make them rescue your kids.”

Top takeaways on technical rescue

Cushman offered the following tips and strategies for evaluating and treating during technical rescues, guiding attendees to start with an assessment of probable condition, rescue urgency and medical needs.

1. The importance of regulating body temperature is underestimated

Cushman noted one of the many lessons we learned across the Iraq and Afganistan environment is that, “Every victim of trauma begins losing body temperature almost immediately.” In any trauma environment, regulating body temperature should be front of mind. The following strategies can help:

  • Increase ambient temp
  • Insulate and cover casualty
  • Place hot packs in armpits and groin
  • Warmed IV solutions
  • Warming blankets
  • Remove patient from cold environment

He showed a picture of military medics treating a soldier who had been placed inside a body bag to keep him warm.

2. Don’t forget to protect the patient during a technical rescue

Cushman showed a photo of a patient whose car was underneath a tractor trailer truck. The team found the smallest firefighter on the crew, and sent her in to treat the patient, in full PPE, with ear, eye and face protection. The patient, however, had nothing. Remember the essentials of patient PPE, Cushman noted:

  • Eye protection
  • Hearing protection
  • Injury protection
  • Thermal protection

His team packs and brings patient go bags with the following on every rescue:

  • Harness
  • Helmet
  • Ear protection
  • Mask
  • Eye protection
  • Blanket

3. Pause and assess during trench/collapse rescue

Cushman noted there are obvious priorities during a trench or collapse rescue:

  • Clear head and chest first
  • Temperature control
  • Removal
  • Spine/fracture management

However, he noted it’s important to assess and weigh the risks and benefits before taking extreme measures. Pulling too hard can lead to dislocations. And a C-Spine may not be appropriate if it prohibits a timely rescue.

4. The technical rescue environment has unique rehab challenges

Technical rescue can take time. Just as it’s important to regulate patient temperature, pay attention to the effects of the environment on the rescue team. Turnout gear increases temperatures 10 degrees – in the sun, it increases another 10 degrees. And don’t forget about cold stress. Manual dexterity decreases by 10-20 percent once finger temperature drops below 60 degrees. Tactile sensitivity severely decreases when skin temperatures drop below 43 degrees.

Additionally, in a complex technical rescue, nobody wants to leave for rehab. “We all want to be in the fight the whole time,” Cushman said. And in some districts, there may only be 2-3 qualified technical rescue personnel, so rotation is impossible. In these cases, bring rehab to the team, Cushman advised.

Bring water to the crew, and do a face-to-face assessment. Look in their eyes for fatigue. Keep everyone on scene safe.

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