Captain Rom Duckworth Discusses Coordinating Extrication & EMS at FDIC 2016
As rescue technicians race to develop new tools to keep pace with vehicle design, the challenge is to remember that tools and technology are based on the vehicle, but strategy and tactics are based on the patient. Fire captain and paramedic Rom Duckworth highlighted this point during his presentation “Coordinating Extrication and EMS” delivered Friday at FDIC 2016 in Indianapolis.
Citing concepts of damage control extrication, Capt. Duckworth proposed coordinating EMS and extrication through a five-step approach.
1) Ahead of Time: Duckworth told attendees that the challenge of coordinating responders from numerous different agencies is a difficult one with a simple solution. “Clearly define roles and expectations, then practice as you expect to play,” Duckworth said. In a discussion with attendees concerning the challenges of different EMS systems Duckworth said, “Are EMS agency providers told to stay away from the extrication hot zone during the rescue? OK, but ensure that a qualified rescue tech is equipped and designated as the inside medical provider or IMP.” If ambulance crews are expected to enter the vehicle being extricated, ensure that they are properly trained and protected to do so ahead of time. Challenges occur with any change, but coordination is critical for both the safety of rescuers and operational effectiveness.”
2) Arrival on Scene: Duckworth endorsed the idea that every responder should perform a personal size-up to identify dangers on scene and understand their roles in the extrication operation. He said that “personal accountability is at the center of the concepts of group situational awareness and crew resource management.”
3) Access to the Patient: Attendees agreed that it can be tempting to jump in right away, but Duckworth cautioned that the IMP must first check 360-degrees around the vehicle(s) plus inside, over and under to mitigate any immediate hazards within their capability. Once in contact with the patient(s), Duckworth emphasized that the IMP was the key not only to patient care, but also to successful extrication strategy and tactics.
4) Actions of Emergency Care: Promoting concepts from Tactical Combat Casualty Care (TCCC), Duckworth encouraged attendees to prioritize immediate life threats such as massive hemorrhage, airway difficulties, respiratory emergencies, circulation problems, and head injury (MARCH).
5) After the Call–Follow up and prep for the next call: Duckworth cautioned that after the last patient has been extricated, a number of issues remain to be dealt with. His list included:
- Pictures
- Pain/pathogens
- Post Traumatic Stress Disorder
- Preview/review of the Call
- Practice of lessons learned
Wrapping up the program, Capt. Duckworth stressed that information learned in the classroom is only worthwhile if put into action with a system of regular review and improvement. “The best providers take a look back after each call and ask, “˜What can we improve?’ In this way coordinating EMS and rescue can make a good crew into a truly great extrication team.”
