Truck Drivers Learn a Hard Lesson in Emergency Scene Management

I’m a bit of a car nerd. I like driving them, working on them, racing them, I even like reading about them. Thanks to my father (he used to rally-drive), I learned to do handbrake turns as a teenager before I learned to parallel park. I didn’t ever think there was much of a connection between my fascination with cars and emergency planning, but if you keep your eyes open, you find lessons everywhere.

Emergency Scene Management

The race and camera crews for Boyd Coddington, host of TV’s American Hotrod got stuck heading back to town after a day’s shooting. Unable to dig themselves out, they called for help. About two hours later the wrecker and flatbed trucks in the background arrived. Photos: Ron Christensen

SpeedWeek is an annual event held on the Bonneville Salt Flats near Wendover, Utah. Miles of flat, level and salt-encrusted desert make an ideal racing surface for drivers from all over the world to run time trials and attempt setting land speed records. At the 2007 event, thanks to a rare torrent of rain, the salt surface was especially thin in places and a motor home transporting a racing crew broke through and got stuck. The crew called for help and two trucks arrived. And also got stuck.

Emergency Scene Management

Emergency Scene Management

The motor home crew was sure they would be back underway in minutes. Except that the wreckers weigh about half again as much as the motor home. They broke through the salt and got stuck too. “No problem,” said the wrecker crews. Big Blue would get them all out.

The truck drivers called for help from a third truck nicknamed “Big Blue”. Big Blue arrived and set about freeing the other two trucks.

It got stuck too.

In trying to tow the yellow wrecker out, Big Blue had managed to drag it 100 ft. until the mud was six feet high on driver’s side before getting itself stuck in four feet of mud and as well.

The yellow wrecker, rather than sitting level, was now listing about 40 degrees to the left with its right-hand tires about a foot off the ground

By 10:30pm, the three trucks were mired, in places, six feet deep in the clay-like mud under the salt pan. The motor home hadn’t moved.  All four vehicles wound up spending the night in the desert. In the morning, a fourth wrecker truck (that’s five vehicles altogether for those scoring along at home) arrived and began carefully extricating the other wreckers and the motor home, one by one.

The crews managed to free the flatbed truck and backed it up to free Big Blue, but it broke through the salt and got stuck. Again. This time worse than before.

In a last-ditch attempt to pull the motor home free, the crews hooked the incapacitated Big Blue to the motor home and tried to winch it out. But the boom winch was not aligned with the motor home for a tow, so it was damaged. Under tension, there was no way to unhook the cable and the damaged winch wouldn’t release. Now there was the added hazard of the 1000-foot tow cable pulled taut as a guitar string through the night air about 3 feet off the ground.

The hard lesson the truck drivers learned is one that applies to all responders, whether they are firefighters, policemen, or occupational first aid: always perform a scene assessment as soon as you arrive and before you enter the scene to give aid. Neglecting to do this can result in a situation becoming twice (or three times, or four times…) as bad as before as the responder becomes an addition to the problem rather than contributing to a solution. Utah Salt Flats Racing Association

Headaches, are They All Created Equal?

Clayton Tobin is a BCAS paramedic who also works for us in northern BC. To help his fellow Iridia paramedics out, he put together a summary on assessing and diagnosing headaches. For the benefit of other paramedics and first-aid attendants who read the blog, we decided to share an abridged version of it here.

Industrial Paramedics are in a unique situation where we are assessing patients in remote locations.  A common presenting complaint for these patients is of a headache.  Fortunately, most headaches are benign, but a small percentage of them can be serious. They are cannot-miss headaches, though they may initially have only mild symptoms.

HeadachesThere are two main classifications of headache: primary and secondary. Primary headaches are defined as existing independently from any other medical condition, and account for 90% of all headaches that present for medical assessment.  They’re usually migraines, tension headaches, and cluster headaches. Although they can be severe and debilitating, they are benign. Patients with primary headaches will almost always have a history of similar headaches. If the headache is different from their “normal” headaches or they are having a new onset of a primary headache, you’ll have to consider the possibility of a secondary headache. A secondary headache is one that results from an underlying medical condition. That condition can be something as benign as sinusitis or muscle strain or it can be life threatening.

Carbon monoxide (CO) poisoning, meningitis and subarachnoid hemorrhage (SAH) (bleeding between the membranes that cover the brain) are among the most worrying of serious headaches. A good history is important in catching the CO poisoned patient. It is important to keep this possibility in the back of your mind when you are assessing the headache patient in an industrial setting.

Meningitis is an inflammation of the membranes that cover the central nervous system and is almost always associated with a headache and fever. A stiff neck, confusion and photophobia (light hurts the eyes) are common accompaniments. Patients suspected of meningitis will require assessment by a physician as they can get very sick quickly. Pay special attention to any headache patient with a fever.

SAH presents as a severe, “thunderclap” (sudden onset) headache. Patients will often say things like, “this is by far the worst headache of my life”. They come usually during physical exertion or other activity that increases pressure in the head. Two thirds of all SAH are caused by the rupturing of an aneurysm Loss of consciousness or buckling of the knees is not uncommon, and they can often develop neck stiffness, low back pain, bilateral leg pain or increased intracranial pressure leading to confusion or coma. Sentinel headaches will warn of SAH 30%-50% of the time. These warning headaches can present as more mild or benign ones and are often misdiagnosed. Patients will often ignore these headaches as over-the-counter analgesia can relieve the pain. Sentinel headaches are characterized by a sudden severe pain often brought on by bending, lifting or even coughing as increased blood pressure in the cerebral artery causes a small leak in the aneurysm. A full-blown SAH can occur a few hours to a few months after a sentinel headache (2 weeks is the median time span). A patient suspected of having a sentinel headache or SAH will need a diagnostic CT scan or lumbar puncture to determine if there is blood in their cerebral spinal fluid.

Because some causes of secondary headaches are catastrophic, a thorough assessment must be done for all headache patients. This includes a complete set of vital signs including blood pressure and especially a temperature and a neurological assessment. It is important to obtain a good history including the onset (sudden?), severity (“worst headache in my life”?) and quality (“different from normal headache”?) of the pain and its precipitating events. Palpate the face and head. The location of the pain (i.e. unilateral or bilateral) may also be useful. Note whether or not anything makes the pain worse (tenderness over the temples as in temporal arteritis) or better (lying down as in spontaneous intracranial hypotension). Is there a stiff neck? What are the associated symptoms?

Headaches are most often benign and can easily be dismissed, but a limited few of them are caused by a cannot-miss condition. In the setting of industry we often get the worker coming in who is just looking for a Tylenol. With a thorough assessment we can significantly reduce our chances of missing the rare, cannot-miss headaches.

Flooding from Hurricane Tomas Bolsters a Cholera Outbreak in Haiti

A cholera outbreak in the Artibonite province of Haiti has killed over 500 people and infected over 7000 more in the last three weeks. Cholera is a bacterial infection of the small intestine transmitted through the ingestion of tainted water or food. The main source of the disease at the moment is the Artibonite River, which generations of rural Haitians have used for almost everything. “Before the cholera we drank from the river and the canals all the time,” said Solomon Pierre, who lives in a farming hamlet near L’Estere. “Now we try not to.”

With a large part of Haiti’s infrastructure destroyed by the earthquake in January, even more of the region’s population are forced to turn to the river and its tributaries as a primary source of drinking and washing water. Nine months after the earthquake, urban centres still look like war zones and almost 1.3 million people are still living in makeshift huts fashioned from plastic tarps. Aid workers wielding megaphones drive around telling people how important it is to use soap.

Cholera Outbreak

Port-au-Prince, Haiti: January 13, 2010

Cholera Outbreak

Until now, a cholera case hadn’t been seen in Haiti in 50 years. While we may never definitively know the cause of this outbreak, the US Centers for Disease Control have determined that the strain in Haiti is a South Asian one that may have crossed the Pacific with peacekeeping or aid workers

Physicians working in Haiti say it isn’t feasible to expect people to not wash or bathe in the waters because there are no alternatives. “We know there may be cholera in there, but sometimes it is all we have to drink,” said Alienne Cilencrieux, another resident. “If we have Clorox, we pour some in and drink it. It tastes bad. Or we dig in the ground until we find water and drink that.” In some places, people get water from hoses placed on the sidewalk by hotels or aid organizations. They wash themselves in plastic buckets then empty the buckets next to their tents where the water washes down the street or evaporates.

Cholera Outbreak

A funeral procession in Port-au-Prince, October 16. The earthquake, disease and flooding combined with the country’s poverty have left Haiti a long ways from returning to self-sufficiency. After nine months and the efforts of over 10 000 aid organizations, there is no sign that a better Haiti is being built.

While Hurricane Thomas spared the battered island a full-on landfall, it did bring significant flooding to the area. Several rivers burst their banks leaving many tent cities covered in up to two feet of standing flood waters. Epidemiologists fear the flooding could provide the outbreak with the means to become an epidemic. Spiegel Online

AED Shopping Tips

When buying an automated external defibrillator (AED), choosing a model can be a daunting task. When evaluating a defibrillator, you don’t need an exhaustive background in electronics or cardiac medicine, but with a growing number of manufacturers and a plethora of models and features, how can you know which type of AED will suit your needs?

Keep in mind that all defibrillators do one fundamental thing: they deliver an electric shock that resets the heart’s natural pacemaker and converts an irregular, unstable heart rhythm to a sustainable one. To accomplish this, all AED’s possess three basic elements: a battery that provides energy for the cardiac shock; a main unit that analyzes heart rhythms and generates the electrical charge; and the electrodes, or pads, that deliver the shock to the patient.

These similarities lead some to believe that all AED’s are the same, but there are differences. The features that distinguish defibrillators are component quality, user interface, and innovations in technology.

AED Shopping Tips

Components

Getting to know a few simple details will quickly determine the overall quality of an AED:

  • Better quality AEDs use medical-grade, lithium-ion batteries and do not rely on any secondary source of power to run self-checks or power the unit.
  • Many units use a diagram to show the proper placement for electrodes and the polarity (positive or negative) of each.  The best public-use AED’s simplify this process and use non-polarized electrodes that can be placed interchangeably.
  • Most Health-Canada approved AEDs have been drop tested to just over a meter and are designed to survive rough treatment.

A product specification associated with durability of any electronic equipment is the IPX rating.  The IP Code is an International (or Ingress) Protection Rating and is expressed as IP followed by a two-digit number. The first digit indicates the level of protection against particles such as dust or dirt; the second gives the level of protection from water. The higher the number, the greater the resistance. Every AED has an IP Code which can usually be found in the user’s manual.

Usability

The most visible features that differentiate AED’s are those that indicated ease of use and quality of performance.  As public access defibrillation programs become more commonplace, simplicity in design and use become paramount.  There are a few factors to consider when purchasing an AED:

  • How many buttons (if any) do I have to push for a shock?
  • Are there voice prompts and a display to guide me during a rescue?
  • Will the unit’s prompts assist me with delivering CPR to the victim?

Many units run daily, weekly and monthly self checks.  It is important to purchase a unit that checks issues such as the presence of electrodes, pad connectivity, battery life and wire conductivity as they increase the potential life of your unit.

Time spent remembering or figuring out how an AED works and how to apply the pads can make the difference between a save and a non-save when using a defibrillator.  Features that limit this time are invaluable.

Technology

The most important component of an AED’s design is the technology used to deliver a shock.

There are two methods of shock delivery:  fixed energy and escalating energy. With fixed energy, a shock is delivered once at a given level measured in joules (J), and then subsequently redelivered until there is a correction in the heart’s rhythm. With escalating energy, if the first shock is unsuccessful, the AED progressively increases the energy of subsequent shocks until reaching the maximum allowable number of joules and redelivers shocks at that level.

When purchasing an AED, it is important to find a unit that is not only capable of escalating the shock energy, but of doing so beyond 200J. While an initial shock of 200J is usually successful in an out-of-hospital environment, there are exceptions and escalation above 200J is necessary to maintain success for multi-shock patients. In cases of sudden cardiac arrest (SCA), refibrillation is not just common, it is expected… as long as the AED is up to the task.

***

There are some costs associated with buying and setting up an AED. Making an informed purchase decision ensures that the hard-earned money you to spend will give a potential SCA victim the very best chance of survival.

Disaster planning: Raising awareness and fear mongering

I was having dinner with a friend over the weekend and, as the discussion rambled over barbecued ribs and coleslaw, we got to talking about disasters terrorist attacks. You know, light sort of dinner banter. By the time we were at our coffees, the discussion had shifted to what we do at Iridia:

“Do you make money at that?”

“Sure. You know, not Microsoft money, but some.” I then explained to him some of the ways we help people prepare for the worst.

So you guys are, like, part of that whole Industry of Fear.”

“Pardon?”

“Well, like in Bowling for Columbine: you need people to be scared of things, like H1N1 or terrorists, or they don’t hire your company, right?”

He raised a good point.

That isn’t how we work; we are not out to scare people.  We want to raise awareness and help people to be prepared. But when you’re trying to prepare people for scary things, really, what’s the difference?

The difference is in the choices we make. We can make a decision before we face danger, whether or not to expose ourselves to the prospect of that danger. Usually our choice is no; sometimes it’s yes. Driving over the speed limit is dangerous, but husbands sometimes speed to the hospital when their pregnant wives go into labour. Rock climbing can be dangerous, but it sure is fun. These are choices we make.

Disaster planning

Adventure is where we find most of the value in life. (photo: James Sullivan)

We won’t tell you never to expose yourself to risk because we know that there are times in your life when you’ll have to. There are times in your life when you decide, “Yes, I’m going to take this risk and accept the consequences because the issue at hand is that important.” Police and firefighters do it all the time. Or you might decide that a measure of risk is something you can live with, like people who make their homes in places subject to extreme weather. Our job is to help people to identify these risks beforehand so they can be aware that they’re making a choice and be prepared for the consequences if danger comes.

We don’t want you to fear the rain, we just want to show you how and when it might fall so you know when to take an umbrella.