Disability and environment dangers

Facilitator: Greg + Charis
Medics:
Patients: Carry pt.
Time: 30 mins; 1150-1220
Actual time:
Learning Objectives:
Materials:

The 30-hour shift: When Disability and Environment become life-threatening

Facilitator says

After scene assessment, approach stuff like LOR and MOI, and ABC assessment you have 2 more letters, D and E. This is back in the realm of MOI for c-spine, where you are preventing a potential injury instead of a known injury. But remember, prevention is where lazy medics thrive.

Disability,

for the purpose of initial assessment, means "a person is less able to perceive or move away from life-threatening danger than she normally is." If she lost mobility aids (walker, crutches) or perception aids (glasses, hearing aid), has lost her ability to be as oriented or alert as she normally is, or has sustained a musculoskeletal injury, she's gonna need the scene made safe around her or assistance exiting it. With her consent, it is your job to help her get to safety and any necessary further care.

Environment

is back to your scene assessment, but with an eye to long-term threats -- if you have to weigh the risks and benefits and shelter in place for a while or evacuate.

Facilitator says

So far in this training, you:

  • Controlled a scene with a privacy circle.

  • Delegated tasks.

  • Considered your exits and evacuation route

  • Investigated what resources are locally available

  • Held someone in c-spine immobilization.

  • Helped a person roll so she could vomit safely.

  • Walked into a warm restaurant or bar to get out of the cold with someone.

  • Helped someone lie down and insulated her body when she had shock signs.

  • Called 911.

  • Flagged a cab.

  • Spread calm and helped ground someone who was temporarily disabled by panic.

Those are all D and E level interventions.

Facilitator says

In an unsafe scene, blindness and musculoskeletal injuries may be life threats.

  • Some people have impairments that predate the action, and want help getting to a safe scene.

  • Some people are injured in ways that make it difficult or dangerous for them to move without assistance.

  • Some tactice (like lockdowns) temporarily disable the blockader, and their support crew may have to attend to the effect of weather, dehydration, achy muscles, hunger, regular medication, and other needs

Facilitator asks

What can make the scene unsafe to a person who has suffered an action-related disability? Good answers:

  • Weather and environment (more Sunday).

  • Crowds.

  • Cars and other vehicles.

  • Police.

  • Media.

Assessment and response

Empower and accompany

Facilitator says

When the disability is not an emergency, and the environment is safe, problem-solve with the person and then hang out until the problem is solved:

  • Hang out at the trailhead or the main fire until the person's brother brings her spare glasses.

  • Hang out in a coffeeshop along the march route with the person until a cab comes to take the person home.

  • Hang out at the action first aid station while the drunk guy who fell off the park bench and hit his head sleeps. Wake him up every hour for 24 hours to check vital signs for evidence of brain swelling, as directed by the nurse at the first aid station.

Protect and wait for back-up

Facilitator says

When the person has to stay in place until an ambulance arrives (or the blockade is broken), protect the person from the environment:

  • Protect with privacy circle.

  • Pad under the person to prevent heat loss through the ground, or burns from hot pavemement -- the person will lose heat if the ground is cooler than their body (under 100 F)

  • Cover with warm clothing, emergency blankets, sleeping bags, hat.

  • Shade the person from the sun and wind.

  • Hold cervical spine stabilization.

  • Describe what is going on to the person -- even if he has a lowered level of responsiveness (LOR) -- so he can stay situationally aware.

Assist with evacuation to safety

Facilitator says

When the person can move on her own or with easy assistance, offer assistance:

  • In bad weather: walk with the person to a better environment (coffeeshop, library, etc.).

  • If the person can't see because of pepper spray, walk her to a safe area and do eye flush (Sunday afternoon).

  • For leg, ankle and foot injuries: walking assist to a safe environment, and then splint and plan for next steps.

Skills Drill: Evacuation

Facilitator says

The last skill this morning is evacuation of a person who needs assistance to move. If a person is unable to move unassisted, your best bet is to shelter in place, but if the scene cannot be made safe, it's your choice to evacuate. Evacuation is dangerous. You can get knee injuries, back injuries, you can drop the person, and you are less mobile and less able to avoid danger yourself until the evacuation is complete.

During an evacuation you have to be especially attuned to scene safety and especially able to de-escalate and negotiate your way to safety.

  • Delegate bystanders to clear a path for you if necessary.

  • Be very careful not to hurt your back ("Look out for Number One" -- if it will hurt you, don't do it. This is not about strength or ability, it is about safety).

  • Better to underestimate what you can carry, than to overestimate and end up in a tight spot.

  • When walking, go sideways, "clicking heels together."

Practice

Get into your groups of 3.

Trainer buddy pair (with volunteer) slowly demonstrate

single walking assist, double walking assist, and chair carry.

  • Decide lead buddy for the carry.

  • Chin up.

  • "We are going to stand 'stand.' I will say '1-2-3-stand.' " "Is anyone not ready?" ("anyone" includes the pt).

  • Communicate verbally to each other about hazards.

  • "Set down on 'down.' I will say '1-2-3-down.' " "Is anyone not ready?"

Students practice

single walking assist, double walking assist, and chair carry.

Break-Out: Backcountry Evacuation

Facilitator says

Imagine that here at Feral, this dude Skink's foot was crushed under a rock while he was hiking alone. He called for help, then extracted himself and crawled painfully to camp. You arrived to find his ankle deformed by the crush wound and oozing blood (but not bleeding freely). Bone was visible, and the wound was contaminated with debris.

Students

break into groups and quickly decide your priorities for Skink, your evacuation plan (including who would help you), where you would take him, and how long you expect it will take to get to definitive care.

Debrief

Preparedness line

\"How much time do you think the evacuation will take?\"1

Facilitator asks

one person from each group to report-back one piece of their plan.

  1. Give students a range like 30 minutes -- all day.↩