What To Do Until The Ambulance Arrives Health Services at Metro Jail Dilemma Nurses receive little or no education on how to respond to emergencies On-the-job training may or may not be sufficient Our solution at Salt Lake Metro Jail: Hired a nurse supervisor with EMS background Budget for purchasing emergency response equipment Training, inservices, education, skills review Legal Issues Duty To Act The Good Samaritan Act Implied consent Refusal competency Deliberate Indifference Needs Assessment Equipment available with proper use BLS for healthcare providers BLS Instructors on staff Basic first aid review Hemorrhage control Splinting Spinal Immobilization Etc Skills assessment and reinforcement ACLS Certification in community classes Incident Command System (ICS) Instruction provided to educate health services staff of their role during an incident Reinforces the need for security first, then health care after involving the sworn staff Scene Safety Situations where medical assistance may be justifiably delayed until the situation is deemed safe: - hostile environment (forced cells, riots, etc) - drug overdoses / psychiatric patients - environmental disasters - haz-mat situations - manmade hazards, fire, smoke, etc 1
Scene Safety Don t Become The Second Victim Infectious Disease Hepatitis Spread by blood and body fluids Estimated that 50 to 60% of incarcerated individuals are hepatitis C positive. HIV Infectious Disease Spread through contact with blood / body fluids: dirty needles, sexual contact, etc. Huge financial impact on correctional institutions (medications are expensive)! Virus isn t as hardy as Hepatitis Body substance isolation Universal Precautions Body Substance Isolation Gloves Gown Mask Goggles CPR Mask Infectious Disease Precautions Reinforce that handwashing is the number one way to reduce the spread of infectious disease and improve personal protection Placed dispensers of an alcohol-based hand cleanser for easy access to facilitate elimination of cross contamination and improve personal protection Prevent Infections The likelihood of catching an infectious disease is negligible when properly protected Reinforce Body Substance Isolation (BSI) or universal precautions with every patient Infectious Disease Trauma Bags: Gown, Face shield, Gloves, shoe covers, biohazard bag 2
Model for Education Basic EMT curriculum Utilization of similar equipment Skill sheets utilized for nurses during skill review Available from the internet or your state EMS office Uniqueness of Corrections Secured perimeter Security set-up Controlled access Access for health services Munitions Equipment Emergency Supplies Rescue Rigs Rescue rigs are in the designated exam rooms. Ambulance gurney C-collar, backboard and spider straps Oxygen and airway equipment AED Jump-kit with supplies. Jump Kit First Aid (Jump) Kit Gloves Faceshield Oropharyngeal airways Nasopharyngeal airways Barrier devices NTG, ASA Dressings Bandaging material I.V. Supplies Glasgow Coma Score Splinting supplies Emergency OB 3
Priorities for the First Responder Survey the scene rescuer safety Identify incident commander Body substance isolation Jump kit Assess and treat the patient Appropriate disposition: Infirmary, Hospital, mental health, remain in assigned area Documentation Priorities of Patient Assessment Introduction Stay calm Airway, Breathing, Circulation (ABCs) Implement spinal precautions if necessary Control severe bleeding Head to toe assessment for injuries or problems. Obtain a history Airway Breathing Airway opened Patient on back Head-tilt chin-lift Jaw-thrust Manual cervical spine stabilization if indicated If there is no barrier device, the staff are instructed to NOT provide rescue ventilations Barrier Devices Circulation Check for pulse External blood loss must be controlled to prevent shock Arterial vs venous bleeding Bleeding cessation - direct pressure & elevation - pressure point - tourniquet (last resort) 4
SAMPLE Medical Responses Signs/Symptoms Allergies Medications Pertinent medical history/prior surgeries Last oral intake Events leading up to the incident Respiratory Distress Chest pain Seizures Myocardial Infarction Cardiac Arrest Stroke Diabetes Allergic Reactions Anaphylaxis Psychological issues Mental health referrals Drug/Alcohol withdrawals Obstetrical emergencies Environmental Trauma Examples of education Myocardial Infarction Rapid defibrillation with an AED is a critical link in the chain of survival An AED is present in each pod, processing and mental health Rules of the AED Turn the machine on Only the patient gets defibrillated Stoke Three simple questions Ask the person to smile. Ask the person to raise both of their arms. Ask the person to speak a simple sentence. ABC s, O 2 application Call 9-1-1 Prepare the patient for EMS transport Impaled Objects Do not remove impaled objects ABC s Secure in place Gunshot Wounds / Stabbings Your safety is the first priority secure the scene. 5
Pregnancy Delivering a Baby Abortion Ectopic Pregnancy Trauma Abruptio Placenta Placenta Previa Pregnancy-Induced Hypertension (PIH) Prolapsed Cord Breech Birth Munitions of Salt Lake Metro Jail Pepperball Water O/C Smoke grenade Stinger grenade 40 mm Rubber Body with180.320inch Dia Pellets Effective to 50 Foot Radius Stinger Grenade 40 mm Diameter 40mm/1.600in Velocity: 325 fps Ecchymosis, Edema Fractures Sprains & Strains Potential Injuries Abrasions & Laceration 6
Potential Injuries (Con t) Penetrating Injuries Blunt Force Trauma- Head & Neck Factures of Jaw, Facial Bones, Skull, and Neck. Airway Occlusion 2 nd to Swelling and Crush Injury Closed Head Injuries Eye Injuries Lacerations & Dental Injury Penetrating Injuries Blunt Force Trauma- Chest Fractures of Ribs, Flail chest Hemothorax Pneumothorax Pulmonary Contusions Cardiac Tamponade Penetrating Injuries Blunt Force Trauma- Extremities Fractures Strain and Sprains Compartment Syndrome Rhabdomyolysis Hyperkalemia Penetration Injuries Compartment Syndrome Evaluation Nurse completes initial evaluation and initiates appropriate treatment All persons struck by any munitions are scheduled with a physician to be seen in less than 24 hours 7
Conclusion Resources Annual skills review Stretcher mechanics AED LifePak 12 capabilities and functions Splinting Spinal immobilization Emergency childbirth Bag-valve-mask ventilations Etc Local EMS agencies Fire department Ambulance agencies Air medical companies Offer a tour Usually willing to provide education Equipment compatible with the transporting agencies Example: Gave local ambulance a check for six backboards Any patient sent out on a backboard is replaced from the ambulance at the time the patient is being loaded for transport LifePak vs Zoll Success Administration bought into the concept Initially, the nurse educator was also the primary person in charge of the emergency Support, practice and positive reinforcement has improved the confidence of line staff Line staff are the medical incident commanders and the nurse educator provides support Summary Health services staff can be successful Improved patient care delivery Decreasing liability www.wellcon.net 8