Download SOP for Emergency Response

Oahu Army Natural and Cultural Resource Management Safety Program 2014
RCUH-PCSU
SOP No. 3
26 August 2013
Standing Operating Procedure (SOP) for
Emergency Response
I. PURPOSE: To outline steps to follow in the case of a field emergency.
II. SCOPE: Includes procedures for field operations.
III. RESPONSIBILITIES:
A. Natural Resource Management Supervisor: Review procedures with
Natural Resource Management Staff during safety briefings to ensure
understanding and compliance. Ensure staff has received orientation
from Medevac and Wilderness First Aid.
B.
Natural Resource Management Staff: Execute emergency response
procedures in accordance with SOP.
C.
Failure to comply with this SOP may result in disciplinary action.
Helicopter wreckage from crash, December 2003
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Oahu Army Natural and Cultural Resource Management Safety Program 2014
IV. PROCEDURES: New staff shall read this SOP and all attached documents before
beginning field work.
A. General Considerations
1. In the event of an emergency, staff should seek to remain calm,
respond with alacrity and compassion, and communicate clearly and
frequently with Base, supervisors, and other first responders.
2. First responders may include: NRS, Emergency Medical Technicians,
Medevac, Range Control, and Honolulu Fire Department Staff.
B.
Emergency Procedures
Follow attached Wilderness 1st Response documents. WMA’s Wilderness First
Aid Guide is a new resource, (scanned and attached).
C.
Training and Gear
Required Gear
Required Training
Suggested Gear/Training
• Field pack with standard • CPR
• Medevac Orientation
gear*
• Wilderness First Aid
• First Aid Kit,
• Communication: radio or
cell phone
• Emergency
Response
Forms (see below)
• Vehicle/large first Aid kit
when camping*
*Detailed in the Fieldwork SOP
Checklist of Field Safety Sheets
Make sure you have the latest version of every form!
Item
1
2
Field Phone List
V:\NewHireOrientationandTraining\SafetyandFirst Aid\
fieldphonelist.exl
Emergency Contact List
V:\NewHireOrientationandTraining\SafetyandFirst Aid\
EmergencyContactSheet.doc
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Latest
Version
3/14/13
3/14/13
Oahu Army Natural and Cultural Resource Management Safety Program 2014
3
Field Wilderness First Response
V:\NewHireOrientationandTraining\SafetyandFirstAid\
FieldWILDERNESS1stRESPONSE2009.doc
4
Patient Information Form SOAPA
V:\NewHireOrientationandTraining\SafetyandFirstAid\
PatientInformationFormSOAPA.doc
5
LZ list
V:\Forms\helicopterrelated\NR_LZ_List_MASTER2.pdf
6
Field Safety Maps
V:\MapGraphics\FieldSafetyMaps\Koolau\PDFs\_KoolauF
ieldSafetyMaps.pdf
V:\MapGraphics\FieldSafetyMaps\Waianae\_WaianaeFie
ldSafetyMaps.pdf
7
Ramik Label (when current)
V:\NewHireOrientationandTraining\SafetyandFirstAid\
RamikMiniBarsLabelExp2013.pdf
8
NARS Permit
V:\NewHireOrientationandTraining\Safetyand FirstAid\
2013NARS SUP final signed.pdf
Last Modified 7/3/2014
V:/New Hire Orientation and Training/Safety and First Aid/Current Forms
3/14/13
2/10/10
9/4/12
4/09
7/1/09
3/8/13
D. Practice/Fire Drills
1. Team Coordinators shall conduct fire drills with staff three times per
quarter (minimum), unless otherwise specified by the Senior Natural
Resource Management Coordinators. Other staff will have specific
goals set for fire drill completion rates. Base shall conduct
impromptu fire drills with field staff at their discretion. Failure to
conduct your quota of fire drills will be included in your annual
performance evaluation and could result in a reduction in your
overall assessment.
2. Fire drills will be tracked via the Fire Drill Record Form. These forms
will be filed and kept by the Senior Natural Resource Management
Coordinator. They will be reviewed by participating staff and the
PCSU Safety officer. They will also be discussed at coordinator
meetings.
3. Potentially problematic findings of fire drills will be addressed by
supervisory staff. If needed, changes to SOPS and other documents
will be made.
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4. Safety Observations are also completed by OANRP staff. These
observation sheets are written record of the programs commitment
to ensure safe practices are used and safety considered regularly.
Supervisors determine the required number of observations to be
completed by staff.
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WILDERNESS 1st RESPONSE
Patient Assessment
Provide Patient Care
Complete SOAPA Patient Information Form
Make an Evacuation Decision
Continually Monitor Patient
Evacuate Patient
Patient Assessment
 STOP. Size-up the Scene.
•
•
•
Identify hazards to patients, rescuers, bystanders: is anyone in immediate
danger?
Determine Mechanism of Injury (MOI). What happened and how?
Establish body substance isolation. Note any body fluids, use universal
precautions to keep out of them until have gloves. Determine number of
patients.
 Initial Assessment: STOP AND FIX!
•
•
•
Identify self and training level, obtain consent, check for medical alert tags.
Assess responsiveness (verbal or pain).
Stabilize spine if MOI for spinal (hand on forehead).
• Airway: look in mouth, clear of obstructions.
• Breathing: look, listen, feel. If unresponsive and no breath or <12 breath/min,
ADMINISTER RESCUE BREATHING (1 breath/5 sec).
• Circulation: check pulse in wrist/neck, if none, ADMINISTER CPR. Check for
bleeding; control/treat shock.
• Disability: maintain stabilization of spine unless patient has no significant
MOI.
• Environment/Expose: assess/treat environmental hazards, identify potential
life-threatening wounds.
 Focused Exam and History
1. Head to Toe Body Check: If major spinal injury suspected, don’t roll. In case of
unsuspected spinal injury, roll patient on side to check vertebrae, using proper
technique to keep head and neck stabilized.
2. Vital Signs
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• Note time vital signs taken. Take at regular intervals, dependent on patient’s
condition.
• Level of Responsiveness (LOR):
a. AVPU – A = awake, go to A&O scale below; V = verbal, response to verbal
stimulus; P = pain, responds to pain (such as a pinch to the underarm); U =
unresponsive.
b. A&O scale for all Awake on AUPU; 4 questions: identity, location, time,
event (A&Ox1-4). Retain memory starting from identity going to event.
Responsiveness Best to Worst: A&Ox4, 3, 2, 1, Alert, Verbal, Pain,
Unresponsive.
• Heart: Rate, Rhythm, Quality: normal rate range between 50-100 beats/min.
• Respiratory: Rate, Rhythm, Quality: normal rate range between 12-20
breaths/min.
• Skin: Color, Temperature, Moisture (SCTM): normal is pink, warm, and dry.
• Pupils: Pupils Equal Round and Responsive to Light (PERRL).
• Temp: Touch test
• Patient History (SAMPLE):
• Symptoms
• Allergies: what are they, has patient been exposed, what were past exposures
like?
• Medications: what are they, why taking; legal, recreational, herbal, vitamins?
• Pertinent History: experienced anything like this before? Any related illnesses?
• Last Intake/Output: what, when, how much, is it normal for patient?
• Events preceding indications of illness: redundancy?
 Provide Patient Care
 Complete SOAPA Patient Information Form
 Make an Evacuation Decision
1. Evacuation Necessary?
• Assess severity of the situation: BE CONSERVATIVE.
a. How urgent is the victim’s condition, and how vital is response time to
increasing injury severity?
b. What type of transport is needed accounting for injured person’s condition and
the weather?
c. Is the victim mobile? How long is the hike? Is helicopter support needed?
What type?
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Ship
LZ size
Line
Special
Equipment
Medevac (Evergreen
Helicopters)
Bell 412
30x30ft, if need to land, b
Medevac personnel can
rappel from helicopter
into a remote area.
250’
litter (basket-like
stretcher device) and
harnessed hoist
24-7
Hours of
Operation
Pilot
Unknown
Communicatio Dial-in (phone or
pacmere)
911 (Air One)
Commercial
McDonnell-Douglas MD 520N
15x15ft if need to land, but
rescue Squad members can
rappel from Air-1 into a
remote area.
300’
infrared camera, rescue net and
litter (basket-like stretcher
device)
24-7
Hughes 500
15x15 ft., and
tighter!
Unknown (perhaps Lincoln)
Dial-in (phone or pacmere)
Well-known
Direct
(helicopter
radio)
Hospital,
Ambulance.
NO MEDIC.
Entire Island
Medical
Response
Medic, Hospital,
Ambulance
Hospital, Ambulance.
NO MEDIC.
Jurisdiction
Only active on Army
Ranges
Entire Island
100’
N/A
Daylight
2. If helicopter evacuation is necessary, complete 9 Line Medevac QuickFax (used for
all helicopter rescues).
Location of Pickup Site
Pickup Site Frequency & Call
Sign
Number of Patients by
Precedence
Special Equipment
Number of Patients by Type
Number & Type of Wound,
Injury or Illness
Pickup Site Marking
Patient Status
Terrain Description:
-Size of LZ & Slope of Terrain
-Obstacles
-Wind Direction & Speed,
Weather
Lat/Long
Pacmere A-6: DPW Env; Heli: 141.100
# Urgent, # Priority, # Routine
Litter, rescue net (only 911), infrared camera (only 911)
# Require Litter, # Ambulatory (able to walk)
Color flagging, flare, strobe, glowstick, smoke, mirror.
TELL MEDEVAC WE ARE CIVILIANS.
How close to patient?
Wires, antennas, ditches, vehicles, etc.
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Convert to Lat/Long for Medevac and 911 on Rino Legend GPS as follows:
1. Take a waypoint, or make sure you have a waypoint for the point for which you
want coordinates. Fig.1.
2. Navigate to the Main Menu Screen using the page button (on the right side
above the power button). Fig.2.
3. Go to Setup (the hammer) by using the joystick. Fig.2.
4. Under the Setup Menu, go to the Units option (tape measure) by using the
joystick. Fig.3.
5. The first heading is “Position Format.” Below it should read UTM UPS. Use the
joystick to highlight UTM UPS and select it by depressing the joystick.
6. Scroll Down with the joystick and select hddd.mm’ss.s”.
7. Navigate back to the Main Menu (Fig .2) by using the page button and
select the Find Option.
8. Choose “Waypoints” then “nearest.” Pick your waypoint from the list.
9. In the “Location” box, you should have the coordinates in the Lat/Long format.
3. Contact help.
CALL BASEYARD. East Range: 656-7641, 656-7741, 656-8341. West Range: 655-9175
Pacmere Ch. A-6.
•
•
Provide responder with info on SOAPA Form/9 Line Medevac QuickFax (used for
all helicopter rescues).
Coordinate rescue calls with baseyard:
Medevac (Evergreen
Helicopters)
Office calls Schofield Firing Desk
Phone 655-1434; Fax 655-1433
Schofield Firing Desk needs to
call Medevac before they can
fly.
Office sends Helicopter Quick
Fax and calls Medevac
Fax 656-1855 and Phone 6561849
911 (Air One)
Office calls 911 and
provides them with
same info as on
Helicopter Quick Fax.
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Commercial
Office calls commercial
helicopter companies
provides them with same
info as on Helicopter Quick
Fax.
Airborne Aviation; Alan
(808)927-5486m, Steve
(808) 429-6315, Jim (808)
281-4198 , Susie (808) 4422122, Howard 233-9735
K&S/Paradise Tropical
Helicopters 284-3288
Josh 741-4354; Cal 808-8959612
Windward Aviation 808-
Oahu Army Natural and Cultural Resource Management Safety Program 2014
877-3368
Pacific Helicopters
1-800-953-5552, 808-8719771
Lincoln Ishii 542-0506
Continually Monitor Patient
Evacuate the Patient
 If helicopter support is needed, prepare Landing Zone or Drop Zone.
If LZ site is nearby and large enough for Bell 412 landing (30x30ft), or McDonnellDouglas MD 520N & Hughes 500 landing (15x15ft):
• clear trees and shrubs.
• mark LZ in inverted Y formation (point into wind).
• mark LZ with flagging, brightly colored clothing, etc. but tie securely.
If LZ is not available, clear DZ large enough for litter or rescue net, but not vital:
• mark DZ with flagging, brightly colored clothing, etc., tie in tree if need.
• Guide Helicopter to Site.
• Communicate to pilot o’clock or compass relation to site from pilot’s viewpoint and
employ light source as constant site indicator. At night, use only glows sticks for
NVG operations.
 If helicopter support is not needed, assist the victim to the nearest medical facility.
After Hours Considerations
If an accident happens during off-hours (night, weekends) when base is not normally
operational, it is a priority to either open base, or create a secondary base. Notify a
coworker who can: open the baseyard, be a point of contact for all responders, assist
with emergency calls, help determine necessary level of response. The severity of the
emergency should determine the level of base support needed in an off-hours
emergency.
Calling priority by position:
Priority
1
1
1
Name
Joby Rohrer
Dan Sailer
Kapua Kawelo
Personal Cell
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Home
Work Cell
295-2556
222-7917
864-1014
Oahu Army Natural and Cultural Resource Management Safety Program 2014
2
2
2
2
2
3
3
3
3
3
Jane Beachy
Matt Burt
Vince Costello
Matt Keir
Julia Gustine Lee
Mike Walker
Kaleo Wong
295-3378
N/A
224-9296
366-7149
285-2526
N/A
352-7145
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Will Weaver
Michelle Mansker
265-1724
864-1005
Calling priority by position: Senior Coordinators (JR, DKS), Federal Biologist (KK), senior
staff (JB, MB, VC, MK, JG), NRMCs/SNRMS (MW, DF, KWong, KP, WW). The Federal
Natural Resource Manager (MM) should always be notified as well. If none of these
employees are available, contact other techs or support staff. See the Emergency
Contact Sheet.
Calling priority by distance from baseyard:
Location
Mililani
Mililani
Mililani
Waialua
Name
Scott Heintzman/
Taylor McCarthy
Chad Koide
Will Weaver
Michelle Akamine
Waialua
Waialua
Mike Walker
Kim Welch
Personal Cell
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Home
N/A
Work Cell
N/A
N/A
N/A
N/A
N/A
265-1724
388-6216
N/A
224-8671
285-2108
Oahu Army Natural and Cultural Resource Management Safety Program 2014
Secondary Focused Spinal Assessment (FSA)
Appropriate when MOI indicates possible spine impact.
REQUIREMENTS for spinal assessment:
• In wilderness (>1 hour from medical assistance)
• Full assessment already completed
Patient must pass ALL 5 of the following:
1. A&Ox 3 or 4
• 4 questions: identity, location, time, event.
2. Sober, no narcotics or alcohol
3. No distracting injuries (when touched with pressure, patient can feel)
4. Normal Circulation, Sensation, Motion (CSM) in all extremities; can move figure
and toes against resistance, can differentiate between sharp (poking with sharp
stick) and dull (touch with cloth) on all 4 extremities with eyes closed
5. No pain/tenderness on spine
Signs/Symptoms of Spinal Injury
• Pain, tenderness, obvious injury or deformity along vertebral column
• Altered distal sensations: numbness, tingling, unusual hot/cold sensations
• Diminished circulation, sensation, motion
• Weakness or paralysis
• Respiratory difficulty
• Incontinence or uncontrolled erection
• Shock
• Nausea
• Skin color flushed from accident site down
If fail FSA or have any above Signs/Symptoms, ASSUME SPINAL INJURY
Treatment
•
•
•
•
•
•
•
•
Stabilize spine and head manually.
Check CSMs in extremities.
Establish neutral alignment of spine (natural prone position, body parts in line).
Apply cervical collar, if available.
Secure body, and head onto a backboard, if available.
• If collar or backboard not available, keep neck alignment stable with gear,
clothes, etc.
Recheck CSMs in extremities.
Anticipate shock.
EVACUATE
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CPR
REQUIREMENTS for CPR:
• Unresponsive patient with no pulse.
• DON’T begin CPR if patient is alive, has injuries incompatible with life, has an
obviously lethal injury, has rigor mortis or lividity, or has a well-defined DNR (Do
Not Resuscitate).
2 components of CPR:
• Rescue Breathing (pulse, no breath)
• Chest Compressions (no pulse, no breath)
Initial STOP & FIX Assessment, conduct ABCs:
• Airway: look in mouth, clear of obstructions.
• Head Tilt/Chin Lift: standard method
• Jaw Thrust: good if fear spinal injury, but need to use pressure to maintain.
• Breathing: look, listen, feel. If no breathing, administer 2 breaths, and check
pulse
• Circulation: check pulse,
If have pulse, continue rescue breathing:
1 breath every 5 seconds
If no pulse, add chest compressions:
30 compressions, 1 breath x 2, check for pulse
Continue until achieve success, become exhausted, dangerous conditions develop, turn
over to higher level of care, or declared dead by doctor. In wilderness, greater than 30min
without signs of life, assume dead.
Wound Management
Evacuate:
• Animal bites
• Deep or highly contaminated wounds, high risk of infection
• Wounds opening to fractures or joint spaces
• Infected wounds
• Wounds with severe blood loss
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Heat Illness
Heat Stroke = EVACUATION
Heat Exhaustion
Shock caused by
dehydration
Heat Stroke
Causes irreversible
liver, kidney,
nervous system
damage
Signs/Symptoms
Dizziness, fainting
Weakness
Headache
Mild confusion
Nausea
Loss of appetite
Difficulty breathing
Rapid onset of confusion, irrational behavior
Loss of coordination
Loss of conciousness
Increased HR, RR
Skin hot, red, dry (no sweating)
Treatment
Move patient out of direct sun, away from heat
Oral rehydration: electrolytes, lightly salted water
Spray with water; fan
Move patient out of direct sun, away from heat
Oral rehydration if concious enough to drink
Spray with water; fan aggressively
Ice packs to neck, groin, armpits
Massage extremities to increase circulation
Monitor vital signs
EVACUATE
Hypothermia
Alcohol intoxication can reduce shivering and complicate diagnosis and treatment of
hypothermia.
Severe hypothermia = EVACUATION
Signs/Symptoms
Treatment
Alert
Prevent further heat loss
Vital signs normal
Employ rewarming techniques
Mild
Vigorous shivering
No alcohol, tobacco consumption
Vital signs depressed
In addition to above:
LOC altered
Monitor vital signs
Moderate to Lack of response to painful EVACUATE
or verbal stimuli
Severe
Lack of shivering
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Rewarming Techniques
Shivering
Dry clothes
Insulate patient from ground
Cover with vapor barrier
Move to warm envionment
Mild exercise
Warm, sweet drinks if patient can hold own cup
Heat application to underarms, neck, groin,
sides of chest wall
Oahu Army Natural and Cultural Resource Management Safety Program 2014
Shock
Inadequate perfusion of body cells with oxygenated blood
Shock is always a secondary condition caused by an underlying problem with:
pipes, pump, fluid, or obstruction.
Signs/Symptoms
•
•
•
•
•
•
•
•
•
Weak, rapid pulse (over 120bpm)
RR increasing, shallow
Skin pale, cold, clammy, bluish
Capillary refill slow (nail beds)
Nausea, vomiting
Restless behavior
Dry mouth, severe thirst
Visible blood loss, pooling
Internal blood loss, swelling
Treatment
•
•
•
•
•
•
•
Treat underlying problem
Place head downhill or elevate feet 12” off ground
Insulate from cold ground
Keep patient warm
Monitor vital signs
Reassure, calm patient
Sips of water
Evacuate if
•
•
•
No improvement with treatment
Significant vital sign changes when stand
Condition untreatable in field (internal bleeding
Head Injury
Duration of Signs/Symptoms determines severity of injury: mild = quick recovery, severe =
quick decline.
Loss of consciousness = EVACUATION
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Signs/Symptoms
A&Ox3 or 4
Nausea
Mild
Vomiting
Dizziness
Headache
Repetitive questions
Moderate A&Ox2 or 3 (short term memory loss)
Prolonged headache and dizziness
Altered mental state (combative)
Low HR
Irregular RR
A&Ox1 or 2, decreasing
Loss of conciousness
Increasing headache
Severe
Uncontrollable or protracted vomiting
Amnesia
Unequal pupil size
Seizure
Bruises below eyes or behind ears
Fluid (pink/clear) in ears, eyes, nose, scalp
Fracture, depression, or soft skull
2014
Time
Treatment
Quick recovery, Monitor LOC for decrease
within .5 to 2 hrs Monitor vital signs
Monitor for signs of severe injury
Withhold pain medication
Sleep allowed, wake up every 2 hrs for 8hrs
Monitor LOC for decrease
Monitor vital signs
Sleep allowed, wake up hourly
If no improvement after 4 hrs, EVACUATE
Quick loss of
Monitor vital signs
function
No sleep
EVACUATE
Radio Narrative
(Note: this does not replace the SOAPA note.)
GENERAL INFORMATION
Base, this is
NOT a fire drill
Situation is
Mild
Injured party is/are
Name/Call Sign(s)
a fire drill
Moder
ate
General MU
Specific Spot /
Coordinates (any
format)
Location is
Evacuation is
required
Evacuation method
PATIENT INFORMATION
Patient is a
Severe
Hike
Age
73
NOT required
Truck
Helicopter
Male
Female
Oahu Army Natural and Cultural Resource Management Safety Program
2014
year-old
Physical exam reveals
Describe injury/illness
as a result of
mechanism of injury
A(Ox1-4), V, P, U
and is currently
Vital signs at
A(Ox1-4), V, P, U
Position
Patient was found
Time
are
HR
RR
Skin
Allergies
Yes
Allergen
Pertinent Medication
(only report if necessary)
Yes
Medication
Pertinent Medical History
(only report medical
history if pertinent to
current emergency)
Rev. 2014-05-05
74
PERRL
Temp
No
No
Oahu Army Natural and Cultural Resource Management Safety Program
2014
Patient Information Form – SOAPA
Name______________________________________
Age________ Sex M / F
Date____________________
Subjective (what the patient tells you)
Chief Complaint __________________________________________________________
________________________________________________________________________
Mechanism of Injury (MOI)/History of Present Illness (HPI) _______________________
________________________________________________________________________
________________________________________________________________________
History (SAMPLE)
Symptoms ___________________________________________________________
Allergies _____________________________________________________________
Medications __________________________________________________________
Pertinent medical history _______________________________________________
____________________________________________________________________
Last intake/output ____________________________________________________
Events leading to accident/illness _________________________________________
____________________________________________________________________
Objective (what you observe about the patient)
Patient Exam (description of how patient found, results of head-to-toe exam)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Vital Signs
Time
LoC: Alert and
Oriented x __ (1-name,
2-where, 3-when, 4-what),
Verbal, Pain, or
Unresponsive
Heart Rate (HR)
Respiratory Rate
(RR)
Skin Color,
Temperature,
Moisture
Pupils: Equal,
Round, Responsive
to Light (PERRL)
Body Temperature
Assessment (list what is wrong with patient)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Plan (plan for each problem on assessment list)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Anticipated Problems (weather, worsening medical condition, evacuation logistics, etc.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
9-Line Medevac QuickFax Info:
1
Location of Pickup
Site (Lat/Long, UTM):
4
Special Equipment
(litter, hoist):
2
Radio Site Frequency:
141.100
Call Sign of
Responder:
Number of Patients
by Precedence:
#Urgent:____
#Priority:____
#Routine:____
Number of Patients
by Type:
# Litter:_____ #
Ambulatory:_____
Number of Patients
by Status
# Civilian:_____ #
Military:_____
Patient & Type of
Wound/Injury/Illness:
Patient 1:
7
Pickup Site Marking
(flagging, flare, etc):
9a
Size of LZ and Slope
of Terrain:
9b
Obstacles (wire,
antennae, ditch,
vehicle, etc):
9c
Weather, Wind
Direction & Speed:
3
5
8
6
OANRP Base POC:
Phone: 656-7641/
656-7741
Fax: 656-7471
Other
Directions/Instructions:
Patient 2:
Patient 3:
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