Management of USAR Entrapped Trauma Patients
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In this episode we look at the variable patient presentations USAR docs and paramedics encounter when rescuing individuals from a collapsed structure. Joe points out that these patients vary based on the amount of time that has passed since the initial disaster situation. If you’re responding to the early hours after a collapse, your approach is more immediate life threats such as hemorrhage management or opening and maintaining an airway.
Many hours or even days later, rescuers are less likely to encounter survivors with active life threats and are more likely to encounter threats associated with the entrapment itself. Crush injuries, particulate inhalation, and other less acute factors.
Also on the show were our disaster weather expert Kyle Nelson and our emergency management expert Becky DePodwin. Our episode was hosted by Sam Bradley and Jamie Davis.
Scroll down for Podcast Discussion Summary
Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well.
Podcast Discussion Summary
Managing Trauma in Urban Search
Jamie introduces the topic for this episode of the Disaster Podcast, focusing on managing various types of trauma during urban search and rescue (USAR) operations. The discussion will cover best practices for assessing and treating patients in trapped situations, such as in collapsed structures following earthquakes.
Sam mentions that crush injuries will be a particular point of interest, and the group plans to discuss the order of treatment priorities for trapped patients. Kyle is expected to contribute scenarios, possibly relating to avalanche rescue. The hosts also briefly discuss the current weather in Colorado, noting the variability typical of March.
Managing Patients in Complex Situations
In the meeting, Jamie and Joe discussed the management of patients in complex situations, such as a rescue operation following a collapsed structure due to an earthquake. The discussion focused on the different types of patients expected to be encountered, how they are managed, and the timeline of their treatment.
Joe highlighted the importance of understanding and sorting out the timeline of the event and the patient’s condition, which can significantly impact the priorities and management of the patient’s care. The conversation also touched on the challenges and considerations in remote or wilderness medicine settings, emphasizing the importance of considering the time factor in treating patients.
Factors to Consider in Treating Exposed Patients
In the meeting, Joe discussed the various factors that need to be considered in treating patients who have been exposed to adverse conditions for extended periods. He highlighted the potential for significant fluid loss, exposure to elements, and a higher likelihood of hypothermia and hyperthermia. Joe also pointed out the potential for metabolic derangements, such as hypoglycemia, due to lack of food intake.
Joe emphasized the need to consider crush syndrome and its impact on patients, particularly during extraction. Furthermore, Joe noted the potential for respiratory injury and the impact of prolonged exposure to dust, spores, and other toxic substances on the patient’s airway and immune system. He also touched on the possibility of neurologic changes due to head injuries or other factors.
IV Access in Confined Spaces
Jamie and Joe discussed the practicality of initiating intravenous (IV) access during rescues in confined spaces. Joe explained that as the situation becomes more critical, interventions like IV access become higher priority to prevent dehydration. He detailed the challenges of finding a vein in a dehydrated patient and the need for alternative methods like intraosseous access.
Joe also discussed the importance of maintaining IV flow during the rescue process, using pressure bags, IV pumps, and packaging the IV line to protect it during patient movement. He emphasized the need for careful patient movement to avoid injury and the potential fragility of the patient due to prolonged exposure.
Crush Injuries and Fluid Therapy
Joe discussed the importance of fluids in treating crush injuries, which are common in major disasters like earthquakes. He explained that these injuries occur when tissues are crushed, causing toxins like potassium to build up, affecting the patient’s nerves and cardiovascular system.
The treatment involves specific medications and dilution with fluids to restore the patient back to their pre-injury state. Joe also mentioned that extrication can cause bleeding and fluid loss, which can negatively impact the patient. He emphasized the need for rescuers to understand disease processes to treat patients effectively before, during, and after extrication.
Rhabdo Management and Patient Monitoring
Joe emphasized the importance of managing Rhabdo, a significant concern in patients, both before, during, and after extrication. He highlighted the need for aggressive pain management due to the uncomfortable and anxiety-provoking nature of the process.
Kyle raised concerns about pain management and monitoring patients, particularly those with nerve damage or other factors affecting sensation. Joe agreed, stressing the need for continuous monitoring of patients’ responses to interventions, especially in cases of crush injuries and Rhabdo. He also discussed the challenges of patient packaging to accommodate necessary monitoring equipment while still allowing for safe and efficient extrication.
Rescuing Patients in Disaster Situations
In the meeting, Joe shared his insights on the challenges of rescuing patients in disaster situations, emphasizing the importance of a tailored and customized approach. Jamie and Sam expressed their appreciation for Joe’s expertise and suggested that the team from Paragon Medical Education Group could provide specific and focused training for rescuers in their jurisdiction.
The team also discussed the importance of considering practical issues when rescuing patients, such as packaging and moving them in a restricted environment. The conversation ended with plans for future episodes and the suggestion for the community to share their ideas and experiences.
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