Chapter 36 emergency preparedness list,items for emergency bag,wiser emergency response guide,long term food storage company reviews indeed - For Begninners

Copyrights by their respective owners and their use is allowed under the fair use clause of the Copyright Law. BMJ Books is an imprint of BMJ Publishing Group Limited, used under licence by Blackwell Publishing which was acquired by John Wiley & Sons in February 2007. The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
Designations used by companies to distinguish their products are often claimed as trademarks. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. Until recently, training in advanced prehospital care relied on seeking out experts and hassling them for snippets of wisdom, and applying for a post on one of the few existing helicopter emergency medical services. Recent years have seen the modernization and some standardization of practice, an explosion of services able to provide prehospital critical care, and the hard won recognition of the subspecialty of Prehospital Emergency Medicine (PHEM), with dedicated training schemes for PHEM practitioners.
This book covers a comprehensive spectrum of prehospital topics written by the a€?hard-hittersa€™ in the field: specialists at the forefront of civilian and military practice.
The ABC of Prehospital Emergency Medicine began life in 2009 as a collaborative project in response to joint frustrations over the lack of a concise, single resource capable of delivering the essential knowledge and key practical techniques required for effective Prehospital Emergency Medicine (PHEM) practice. Throughout our own training and ongoing practice in PHEM we have been inspired and informed by a number of experienced prehospital practitioners both in the UK and abroad. Over the last 4 years the project has been forced to evolve and grow in response to exciting developments in clinical care and prehospital governance.
We must thank the team at Wiley Blackwell, our supportive (and tolerant) families and our expert team of authors without all of whom this project would never have happened.
The role of the PHEM practitioner or team is to augment the existing prehospital response, not replace it.
An important move forward in the evolution of the field of PHEM in the UK has been its recognition as a new medical subspecialty led by the Intercollegiate Board for Training in prehospital Emergency Medicine (IBTPHEM). The first step in delivering high-quality prehospital care is the timely activation and deployment of prehospital resources.
It is important for the prehospital practitioner to have an understanding of how emergency calls are processed and resources dispatched.
In most developed countries there is a single emergency telephone number that members of the public may dial to contact the emergency services. Emergency calls from telephone and mobile phones pass to operators within designated Operator Assistance Centres (OACs) run by phone providers. Although effective in prioritizing an ambulance service response, AMPDS has been shown to lack the sensitivity and specificity required to select calls that would benefit from enhanced prehospital emergency medicine (PHEM) intervention. The model operated by London Helicopter Emergency Medical Service (HEMS) in the UK represents current best practice for enhanced call prioritization and dispatch.
While the call is being prioritized by the call taker, the dispatcher is responsible for allocating an appropriate resource(s) to the incident.
The ambulance service may deploy its resources to the scene of an incident in a number of different ways: foot, bicycle, motorbike, car, ambulance, helicopter or fixed wing aircraft. Many systems deploy their prehospital practitioners by rapid response vehicle (Figure 2.3). Figure 2.4 Fire tenders protecting the scene in the a€?fend-offa€™ position (Courtesy of Shane Casey). In remote and rural areas, helicopters increase both the range and speed of PHEM team deployment and allow a single team to cover a large geographical area. Helicopter operations within Europe are regulated by the Joint Aviation Regulations Operations Specifications (JAR-OPS).
The HEMS designation is important as it carries with it alleviation from normal weather limits and exemption from certain Rules of Aira€”in particular those relating to congested area overflight and landing. Incidents that do not meet the JAR-OPS definition of HEMS are classified as air ambulance missions and cannot employ the same exemptions.
Deployment by helicopter provides a unique bird's-eye view of the incident scene on approach which may prove beneficial at large or major incidents. Take advantage of the bird's-eye view of the scene afforded by helicopter deploymenta€”assess for hazards, mechanism and casualty locations. Many countries have legislation defining the role of PPE in the workplace and the responsibilities of employers and employees.
In the UK, PPE provision is controlled by the Health and Safety Executive in the Personal Protective Equipment at Work Regulations, 1992.
PPE for prehospital providers is covered by the generic guidance for all industries but specific details regarding the requirements are not nationally or internationally defined. Prehospital providers work in an environment with risks from multiple sources; therefore, different items of personal protective equipment are required.
The PPE must be designed to allow the wearer to perform the risk-related activity without limitation, but with maximum protection. There are also a number of specialist items of PPE, used by groups of providers with unique risks. Prehospital practitioners should wear head protection for all RTCs involving extrication, when working at height, during civil unrest, working on industrial sites and in any other designated a€?hard hata€™ area.
Eye protection should be worn when there is a risk of injury to the eye from debris, such as during cutting glass or metal at an RTC.
EXCEPTION: Within employee work areas, clearances on common use circulation paths shall be permitted to be decreased by work area equipment provided that the decrease is essential to the function of the work being performed. EXCEPTION: The clear width shall be permitted to be reduced to 32 inches (815 mm) minimum for a length of 24 inches (610 mm) maximum provided that reduced width segments are separated by segments that are 48 inches (1220 mm) long minimum and 36 inches (915 mm) wide minimum. EXCEPTION: Entry doors to hospital patient rooms shall not be required to provide the clearance beyond the latch side of the door.
These forces do not apply to the force required to retract latch bolts or disengage other devices that hold the door or gate in a closed position. EXCEPTION: In assembly areas, aisle ramps adjacent to seating and not serving elements required to be on an accessible route shall not be required to comply with 405. EXCEPTION: Within employee work areas, the required clear width of ramps that are a part of common use circulation paths shall be permitted to be decreased by work area equipment provided that the decrease is essential to the function of the work being performed.
EXCEPTION: Within employee work areas, handrails shall not be required where ramps that are part of common use circulation paths are designed to permit the installation of handrails complying with 505. EXCEPTION: Existing call buttons and existing keypads shall be permitted to be located at 54 inches (1370 mm) maximum above the finish floor, measured to the centerline of the highest operable part. 60 inches (1525 mm) - Other car configurations that provide a turning space complying with 304 with the door closed shall be permitted. EXCEPTION: Where space on an existing car operating panel precludes tactile markings to the left of the controls, markings shall be placed as near to the control as possible. EXCEPTION: In elevator cars with more than one opening, hoistway doors and gates shall be permitted to be of the manual-open, self-close type.
The ADA and other Federal civil rights laws require that accessible features be maintained in working order so that they are accessible to and usable by those people they are intended to benefit. EXCEPTION: Platform lifts serving two landings maximum and having doors or gates on opposite sides shall be permitted to have self-closing manual doors or gates. Blackwell's publishing programme has been merged with Wiley's global Scientific, Technical and Medical business to form Wiley-Blackwell. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose.
No single written resource was available for study, and the preparation for the Diploma in Immediate Medical Care required assimilation of several disparate texts. The need is greater than ever to collate an overview of recommended practice into a single publication. It will guide PHEM trainees, help in postgraduate immediate care exam preparation, and assist any prehospital provider wanting an update in the current state of the art. I am thrilled at its publication, and am heartened that I now have the pleasure of recommending it to my own trainees.
We are grateful that many of these individuals have agreed to share their knowledge and experience more widely by contributing to this text. The most welcome of these has been the formal recognition of PHEM as a subspecialty within the UK and the development of a comprehensive PHEM curriculum. Finally we would like to dedicate this text to the hundreds of prehospital practitioners who have dedicated many hundreds of thousands of hours of their own time to make the speciality what it is today. In the developed world, the provision of prehospital care is usually the responsibility of a regional ambulance or emergency medical service (EMS).
PHEM's evolution has been triggered by the demand to meet new challenges imposed by the regionalization of specialist medical and trauma services. Their function is to provide an additional level of support for those patients with higher acuity illness and injury, both on scene and during transfer. IBTPHEM has produced a curriculum that outlines the knowledge, technical skills and non-technical (behavioural) skills required to provide safe prehospital critical care and safe transfer. Germany) where they are firmly integrated into medical training and the emergency medical services (EMS). This book aims to provide some of the underpinning knowledge required for effective PHEM practice. The emergency number differs from country to country but is typically a three-digit number that can be easily remembered and dialled quickly, e.g. Their function is to determine which emergency service is required and forward the caller details to the appropriate Police, Fire or Ambulance Emergency Control Centre (ECC).
The most common system used within the UK ambulance service is the Advanced Medical Priority Despatch System (AMPDS). In order to identify these cases, an additional tier of enhanced caller interrogation and dispatch criterion is required.
A dedicated HEMS dispatch desk within the Ambulance Control Centre is manned by an operational HEMS paramedic. Most modern CAD systems have an integral automatic vehicle location system (AVLS) which will automatically populate a list of the nearest available resources. The decision to deploy a particular asset will be determined by the distance the asset is from the incident, the accessibility by road, known congestion and the required skill set of the responders. Land-based deployment is not restricted by weather or daylight hours in the same way that helicopter deployment is. A daily vehicle check is important and should include fuel and oil levels, water coolant, screen wash, electrics, lights and tyres (tread depth, inflation and damage).
If activation occurs while the vehicle is mobile, the driver should pull over at the next safe opportunity before further details of the incident are taken.
Helicopters have also shown proven benefit in the urban setting where congestion may limit rapid deployment by road (Figure 2.5). HEMS crew membera€”an individual who has been specifically trained and assigned to the HEMS flight to provide medical assistance to the patient and assist the pilot during a mission with such roles as navigation or radio management. Medical passengera€”an individual who is carried during a HEMS flight whose primary roll is patient care. A landing site twice the diameter of the rotor blades is required and should be flat, free of debris and clear of any wires. The National Trauma Triage Protocol: can this tool predict which patients with trauma will benefit from helicopter transport? Do pre-hospital trauma alert criteria predict the severity of injury and a need for an emergent surgical intervention? Validity of helicopter emergency medical services dispatch criteria for traumatic injuries: a systematic review. First aid and basic life support training always starts with the premise that the rescuer should only approach a casualty if it is safe to do so.
The primary need to control hazards and reduce risks to health and safety are highlighted in all these documents.
These define PPE as a€?all equipment which is intended to be worn or held by a person at work and which protects him against one or more risks to his health or safetya€™. In the UK, responsibility is devolved to NHS trusts, and in the USA, Emergency Medical Services Authorities for each state produce guidance documents.


Gloves, masks, eye protection, sleeve protectors and aprons guard against blood-borne pathogens and reduce transmission of infection to and from patients. Clearly, for PPE to function properly the user must be trained in how to don, wear, remove and adjust their PPE, in addition to knowledge of its limitations, how it should be stored, cared for, maintained and disposed of. Eye protection also protects against the risk of infection from splashes of body fluid or blood and respiratory secretions during airway management.
The provisions of Chapter 4 shall apply where required by Chapter 2 or where referenced by a requirement in this document. Where the accessible route makes a 180 degree turn around an element which is less than 48 inches (1220 mm) wide, clear width shall be 42 inches (1065 mm) minimum approaching the turn, 48 inches (1220 mm) minimum at the turn and 42 inches (1065 mm) minimum leaving the turn. An accessible route with a clear width less than 60 inches (1525 mm) shall provide passing spaces at intervals of 200 feet (61 m) maximum.
Where handrails are provided along walking surfaces with running slopes not steeper than 1:20 they shall comply with 505.
Security personnel must have sole control of doors that are eligible for the Exception at 404.1. Manual doors and doorways and manual gates intended for user passage shall comply with 404.2. Door closers and door stops shall be permitted to be 78 inches (1980 mm) minimum above the finish floor or ground. Maneuvering clearances for forward approach shall be provided when any obstruction within 18 inches (455 mm) of the latch side of a doorway projects more than 8 inches (205 mm) beyond the face of the door, measured perpendicular to the face of the door or gate. A door can be recessed due to wall thickness or because of the placement of casework and other fixed elements adjacent to the doorway.
The distance between two hinged or pivoted doors in series and gates in series shall be 48 inches (1220 mm) minimum plus the width of doors or gates swinging into the space. Handles, pulls, latches, locks, and other operable parts on doors and gates shall comply with 309.4. Existing locks shall be permitted in any location at existing glazed doors without stiles, existing overhead rolling doors or grilles, and similar existing doors or grilles that are designed with locks that are activated only at the top or bottom rail.
Access gates in barrier walls and fences protecting pools, spas, and hot tubs shall be permitted to have operable parts of the release of latch on self-latching devices at 54 inches (1370 mm) maximum above the finish floor or ground provided the self-latching devices are not also self-locking devices and operated by means of a key, electronic opener, or integral combination lock.
Door hardware that can be operated with a closed fist or a loose grip accommodates the greatest range of users. Door closers and gate closers shall be adjusted so that from an open position of 90 degrees, the time required to move the door to a position of 12 degrees from the latch is 5 seconds minimum.
Door and gate spring hinges shall be adjusted so that from the open position of 70 degrees, the door or gate shall move to the closed position in 1.5 seconds minimum. Fire doors shall have a minimum opening force allowable by the appropriate administrative authority.
The maximum force pertains to the continuous application of force necessary to fully open a door, not the initial force needed to overcome the inertia of the door. Swinging door and gate surfaces within 10 inches (255 mm) of the finish floor or ground measured vertically shall have a smooth surface on the push side extending the full width of the door or gate. Tempered glass doors without stiles and having a bottom rail or shoe with the top leading edge tapered at 60 degrees minimum from the horizontal shall not be required to meet the 10 inch (255 mm) bottom smooth surface height requirement. Doors, gates, and side lights adjacent to doors or gates, containing one or more glazing panels that permit viewing through the panels shall have the bottom of at least one glazed panel located 43 inches (1090 mm) maximum above the finish floor. Doorways shall provide a clear opening of 32 inches (815 mm) minimum in power-on and power-off mode. Where doors and gates without standby power are a part of a means of egress, the clear break out opening at swinging or sliding doors and gates shall be 32 inches (815 mm) minimum when operated in emergency mode. The clear width of a ramp run and, where handrails are provided, the clear width between handrails shall be 36 inches (915 mm) minimum. Ramps that do not have level landings at changes in direction can create a compound slope that will not meet the requirements of this document. The landing clear width shall be at least as wide as the widest ramp run leading to the landing. Ramps that change direction between runs at landings shall have a clear landing 60 inches (1525 mm) minimum by 60 inches (1525 mm) minimum. Ramp runs with a rise greater than 6 inches (150 mm) shall have handrails complying with 505.
Ramps not subject to the exception to 405.5 shall be designed to maintain a 36 inch (915 mm) minimum clear width when handrails are installed.
Edge protection shall not be required on ramps that are not required to have handrails and have sides complying with 406.3. Edge protection shall not be required on the sides of ramp landings serving an adjoining ramp run or stairway. Edge protection shall not be required on the sides of ramp landings having a vertical drop-off of A? inch (13 mm) maximum within 10 inches (255 mm) horizontally of the minimum landing area specified in 405.7. The floor or ground surface of the ramp run or landing shall extend 12 inches (305 mm) minimum beyond the inside face of a handrail complying with 505. The extended surface prevents wheelchair casters and crutch tips from slipping off the ramp surface. A curb or barrier shall be provided that prevents the passage of a 4 inch (100 mm) diameter sphere, where any portion of the sphere is within 4 inches (100 mm) of the finish floor or ground surface.
Counter slopes of adjoining gutters and road surfaces immediately adjacent to the curb ramp shall not be steeper than 1:20. Curb ramps and the flared sides of curb ramps shall be located so that they do not project into vehicular traffic lanes, parking spaces, or parking access aisles. Diagonal or corner type curb ramps with returned curbs or other well-defined edges shall have the edges parallel to the direction of pedestrian flow.
Raised islands in crossings shall be cut through level with the street or have curb ramps at both sides. Call buttons and keypads shall be located within one of the reach ranges specified in 308, measured to the centerline of the highest operable part.
The clear floor or ground space required at elevator call buttons must remain free of obstructions including ashtrays, plants, and other decorative elements that prevent wheelchair users and others from reaching the call buttons. The call button that designates the up direction shall be located above the call button that designates the down direction. A destination-oriented elevatorA system provides lobby controls enabling passengers to select floor stops, lobby indicators designating which elevator to use, and a car indicator designating the floors at which the car will stop.
Call buttons shall have visible signals to indicate when each call is registered and when each call is answered. A visible and audible signal shall be provided at each hoistway entrance to indicate which car is answering a call and the car's direction of travel. In existing elevators, a signal indicating the direction of car travel shall not be required. Visible signal fixtures shall be centered at 72 inches (1830 mm) minimum above the finish floor or ground.
Destination-oriented elevatorsA shall be permitted to have signals visible from the floor area adjacent to the hoistway entrance. Audible signals shall sound once for the up direction and twice for the down direction, or shall have verbal annunciators that indicate the direction of elevator car travel. Existing elevators shall not be required to comply with the requirements for frequency and dB range of audible signals. Each destination-oriented elevatorA in a bank of elevators shall have audible and visible means for differentiation. Destination-oriented elevatorsA shall provide tactile car identification complying with 703.2 on both jambs of the hoistway immediately below the floor designation.
The device shall be activated by sensing an obstruction passing through the opening at 5 inches (125 mm) nominal and 29 inches (735 mm) nominal above the finish floor. The device shall not require physical contact to be activated, although contact is permitted to occur before the door reverses. For cars with in-car lanterns, T shall be permitted to begin when the signal is visible from the point 60 inches (1525 mm) directly in front of the farthest hall call button and the audible signal is sounded.
The level of illumination at the car controls, platform, car threshold and car landing sill shall be 5 foot candles (54 lux) minimum. Where the elevator panel serves more than 16 openings and a parallel approach is provided, buttons with floor designations shall be permitted to be 54 inches (1370 mm) maximum above the finish floor. In existing elevators, car control buttons with floor designations shall be permitted to be located 54 inches (1370 mm) maximum above the finish floor where a parallel approach is provided. Emergency control buttons shall have their centerlines 35 inches (890 mm) minimum above the finish floor. Emergency controls, including the emergency alarm, shall be grouped at the bottom of the panel. Raised character and braille designations shall be placed immediately to the left of the control button to which the designations apply. Buttons with floor designations shall be provided with visible indicators to show that a call has been registered.
Keypads shall be identified by characters complying with 703.5 and shall be centered on the corresponding keypad button. As the car passes a floor and when a car stops at a floor served by the elevator, the corresponding character shall illuminate. In destination-oriented elevators, a display shall be provided in the car with visible indicators to show car destinations. The signal shall be an automatic verbal annunciator which announces the floor at which the car is about to stop.
The verbal annunciator shall be 10 dB minimum above ambient, but shall not exceed 80 dB, measured at the annunciator. Elevator cars shall provide a clear width 42 inches (1065 mm) minimum and a clear depth 54 inches (1370 mm) minimum. Cars that provide a clear width 51 inches (1295 mm) minimum shall be permitted to provide a clear depth 51 inches (1295 mm) minimum provided that car doors provide a clear opening 36 inches (915 mm) wide minimum. Existing elevator cars shall be permitted to provide a clear width 36 inches (915 mm) minimum, clear depth 54 inches (1370 mm) minimum, and a net clear platform area 15 square feet (1.4 mA?) minimum. Elevator cars shall provide a clear floor space of 36 inches (915 mm) minimum by 48 inches (1220 mm) minimum and shall comply with 305. If the telephone or device is in a closed compartment, the compartment door hardware shall comply with 309.
Inclined stairway chairlifts and inclined and vertical platform lifts are available for short-distance vertical transportation.
Building owners are reminded that the ASME A18 Safety Standard for Platform Lifts and Stairway Chairlifts requires routine maintenance and inspections. The clearance between the platform sill and the edge of any runway landing shall be 1 inch (32 mm) maximum. Our expert authors represent the wide range of healthcare practitioners to which we hope this text is both accessible and useful.
It is our hope that this text will serve as a useful educational tool for PHEM trainees, as well as a useful revision aid for the seasoned prehospital practitioner. A number of agencies may operate in support of the ambulance service including private ambulance companies, rescue organizations (e.g. Many of the critically injured or unwell patients that prove to benefit most from these new systems of care are paradoxically those less likely to tolerate extended transfer without advanced critical care support. In doing so they are also well placed to educate and enhance the skills of the prehospital providers they work alongside.
In Australasia, geography has been the driving force behind the development of retrieval medicine as a specialization. This process requires efficient call handling, robust call prioritization and intelligent tasking of resources. In the UK this information is passed electronically in the form of Caller Line Identification (CLI) via a system called Enhanced Information Service for Emergency Calls (EISEC). They are responsible for scanning all the incoming cases and identifying those that would benefit from enhanced intervention. The choice of resource will depend on the location, mechanism of injury, number of patients involved and the perceived severity of injury. PHEM practitioners deployed to augment the ambulance service response will usually deploy by land vehicle or by helicopter.


They are ideal for operations in built-up urban areas as they are not limited by the need for an appropriate-sized landing site. Medical equipment should be appropriately restrained and a lockable box available for CD storage.
Their use may be restricted by poor weather conditions, onset of darkness or the lack of an appropriate landing site. No specific training other than a pre-flight briefing is required, but they must be accompanied by a HEMS crew member. Take-off and landing are the most hazardous periods of a HEMS flight therefore talking should be kept to a minimum during these phases unless a hazard is being noted.
Healthcare providers working in the prehospital environment have an obligation to treat patients and if the risk cannot be completely removed it must be mitigated.
Where changes to working practices alone are insufficient to protect employees from exposure to the hazard, PPE should be provided to lessen the risk. The regulations also govern assessment of suitability, maintenance, storage, instruction in and use of PPE.
The US Food and Drug Administration regulates the safety and efficacy of some forms of PPE, and the UK Health and Safety Executive provides quality assurance via the CE marking system (Table 3.2).
In contrast helmets, boots and high-visibility clothing protect the wearer from injury, e.g.
Goggles, protective glasses (Figure 3.2), visors and full face splash guards are all available.
All components of an accessible route shall comply with the applicable requirements of Chapter 4. It would not be acceptable for security personnel to operate the doors for people with disabilities while allowing others to have independent access. Clear openings of doorways with swinging doors shall be measured between the face of the door and the stop, with the door open 90 degrees. Maneuvering clearances shall extend the full width of the doorway and the required latch side or hinge side clearance.
Operable parts of such hardware shall be 34 inches (865 mm) minimum and 48 inches (1220 mm) maximum above the finish floor or ground. Hardware that requires simultaneous hand and finger movements require greater dexterity and coordination, and is not recommended. It does not apply to the force required to retract bolts or to disengage other devices used to keep the door in a closed position. The minimum clear width for automatic door systems in a doorway shall be based on the clear opening provided by all leaves in the open position.
The clear floor space adjacent to the control shall be located beyond the arc of the door swing.
Changes in level other than the running slope and cross slope are not permitted on ramp runs.
The adjacent surfaces at transitions at curb ramps to walks, gutters, and streets shall be at the same level. Curb ramps at marked crossings shall be wholly contained within the markings, excluding any flared sides.
The bottom of diagonal curb ramps shall have a clear space 48 inches (1220 mm) minimum outside active traffic lanes of the roadway. Each curb ramp shall have a level area 48 inches (1220 mm) long minimum by 36 inches (915 mm) wide minimum at the top of the curb ramp in the part of the island intersected by the crossings. Building owners should note that the ASME Safety Code for Elevators and Escalators requires routine maintenance and inspections. The height of the clear floor or ground space is considered to be a volume from the floor to 80 inches (2030 mm) above the floor. Responding cars are programmed for maximum efficiency by reducing the number of stops any passenger experiences.
Where in-car signals are provided, they shall be visible from the floor area adjacent to the hall call buttons. Tactile symbols and characters shall be provided adjacent to the device and shall comply with 703.2. Car doors shall be positioned at the narrow ends of cars and shall provide 32 inches (815 mm) minimum clear width.
Platform lifts shall not be attendant-operated and shall provide unassisted entry and exit from the lift. Because an accessible route requires an 80 inch (2030 mm) vertical clearance, care should be taken in selecting lifts as they may not be equally suitable for use by people using wheelchairs and people standing. Isolated or temporary interruptions in service due to maintenance or repairs may be unavoidable; however, failure to take prompt action to effect repairs could constitute a violation of Federal laws and these requirements. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. As a result, there is a need to provide a body of prehospital practitioners capable of providing advanced clinical assessment and critical care intervention at the scene of an incident, together with safe critical care retrieval to an appropriate centre of care. Prehospital practitioners may deploy to scene using a variety of different transport modalities.
In the 1990s the European Union added 112 as the Global System for Mobile Communications (GSM)-approved common emergency telephone number.
The data then appears automatically as an incident on the dispatchers computer-aided dispatch (CAD) screen in the ECC (Figure 2.1). AMPDS uses a structured questiona€“answer logic tree to allocate a dispatch priority: Reda€”Category A (immediately life threatening), Amber - Category B (urgent call), or Greena€”Category C (routine call). A set of evidence-based criteria known to be associated with severe injury are used to trigger the a€?immediate dispatcha€™ of the helicopter or car-based team (Box 2.1). Over short distances they also offer similar response times to helicopters because of the additional time taken by helicopters for take-off and landing. The vehicle should have visual and audible warning devices, as well as high-visibility markings.
Progression to scene should be made rapidly but safely with the full use of visible and audible warning devices. Once landing is complete, exit from the aircraft between the 2 and 10 o'clock position after gaining the pilots permission by a thumb up signal (Figure 2.6).
Personal protective equipment (PPE) is the term used to describe those items worn or used to reduce risk where it cannot be entirely avoided. In the USA, the Occupational Health and Safety Administration publish similar guidelines (Table 3.1).
They should have clear labelling of the wearer's job title and an integrated visor, the standard of which is separately regulated. Eyewear should include side protection and should fit over prescription glasses if necessary.
Openings more than 24 inches (610 mm) deep shall provide a clear opening of 36 inches (915 mm) minimum. Where sliding doors are in the fully open position, operating hardware shall be exposed and usable from both sides. Curvilinear ramps with small radii also can create compound cross slopes and cannot, by their nature, meet the requirements for accessible routes. The landing clear width shall be at least as wide as the curb ramp, excluding flared sides, leading to the landing.
Diagonal curb ramps provided at marked crossings shall provide the 48 inches (1220 mm) minimum clear space within the markings. Each 48 inch (1220 mm) minimum by 36 inch (915 mm) minimum area shall be oriented so that the 48 inch (1220 mm) minimum length is in the direction of the running slope of the curb ramp it serves. Recessed ashtrays should not be placed near elevator call buttons so that persons who are blind or visually impaired do not inadvertently contact them or their contents as they reach for the call buttons.
If a lift does not provide 80 inch (2030 mm) vertical clearance, it cannot be considered part of an accessible route in new construction.
It is sold on the understanding that the publisher is not engaged in rendering professional services. In most continents the enhanced skill set required to provide this level of care falls outside that deliverable by the ambulance service or its supporting bodies, and therefore requires the deployment of specially trained physician-led teams. Greater Sydney Area HEMS) have recognized the commonality between PHEM and retrieval medicine and have moved towards delivering a combined model that provides both interfacility secondary transfer and primary prehospital retrieval. The choice of modality will be determined by the system in which they work and by the nature and location of the incident. While this automatic data transfer occurs, the caller is connected to a call taker at the ECC who will begin the process of call prioritization. The use of non-clinical dispatchers in this role is associated with high rates of over-triage.
Certain other cases undergo direct caller interrogation by the paramedic to assess whether enhanced intervention would be beneficial (Box 2.2). In recent years, healthcare-associated infections and chemical, biological, radiation and nuclear (CBRN) hazards have highlighted the importance of PPE for the safety of both the patient and the practitioner. Modern helmets are lightweight for comfort, with an adjustable headband and chin strap to ensure good fit (Figure 3.1). There shall be no projections into the required clear opening width lower than 34 inches (865 mm) above the finish floor or ground. A level landing is needed at the accessible door to permit maneuvering and simultaneously door operation. Diagonal curb ramps with flared sides shall have a segment of curb 24 inches (610 mm) long minimum located on each side of the curb ramp and within the marked crossing.
The 48 inch (1220 mm) minimum by 36 inch (915 mm) minimum areas and the accessible route shall be permitted to overlap. The audible signal and verbal annunciator shall be 10 dB minimum above ambient, but shall not exceed 80 dB, measured at the hall call button.
If professional advice or other expert assistance is required, the services of a competent professional should be sought. The experiences of many of these systems has helped mould the new PHEM subspecialty within the UK. AMPDS incorporates protocolized pre-arrival first aid instructions that are relayed by the call taker to the caller while they await the emergency response. Incident details are sent directly to vehicle-mounted data terminals with integrated satellite navigation systems that will automatically plot the route to the incident. If the prehospital practitioner is first on scene at a road traffic accident, the fend-off position may be used to protect the incident scene (Figure 2.4).
Projections into the clear opening width between 34 inches (865 mm) and 80 inches (2030 mm) above the finish floor or ground shall not exceed 4 inches (100 mm).
In addition, each injury and injury mechanism is allocated a unique AMPDS code for audit purposes.
The clinical knowledge and experience of the HEMS paramedic is critical in ensuring rapid and accurate identification and prioritization of these cases. Alternative modes of dispatch include activation via a base telephone landline, mobile phone or pager system.
The vehicle should be positioned approximately 50 meters back from the incident and positioned to afford maximum use of rear visual devices and reflective high-visibility markings.
Care should be taken on sloping ground to avoid walking into the rotor disc by exiting downhill from the aircraft. The front wheels should be turned in a safe direction to reduce the risk of the vehicle being pushed into the incident if another vehicle collides with it.
Keys should left in the ignition and the engine left running to prevent the battery draining flat. Once parked in a fend-off position, no one should return to the vehicle unless absolutely necessary.




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