Skill

Individual procedures and skills used in SkillGuides and scenarios

Applies an occlusive dressing and tape according to local protocol if sucking chest wonds is present.

Assesses respirations for the following: Rhythm, Depth, Effort, Noise

Attach the regulator/flow meter to the valve stem using the two pin-indexing holes and make sure that the washer is in place over the larger hole, do not overtighten.

Continue until the flange rests against the skin. If you feel any resistance or obstruction, remove the airway and insert it into the other nostril.

Counts number of breaths for 30 seconds and multiply by tow for respirations per minute determines if patient is breathing within normal limits (12–20 adult) (14–24 child) (20-30 infant).

Crosses torso straps over the patient’s shoulders and secures to board; pads behind the patient’s head, filling voids; secures the patient’s head to the board using two cravats (forehead and chin).

Determines the number of lifters available for positioning:

Determines scene is safe

Draws the two ends together over the symphysis pubis, compressing the greater trochanters of the femur.

Executes the lift. Another rescuer slides the device into place starting at the pt.'s feet. Lower the patient as a unit.

Explains the commands, procedures, and hand positions for the lift, including distance patient is to be lifted.

Exposes and assesses the injury to determine the location and proximity to hip or knee joint; checks for bleeding and treats bleeding if present.

Folds a sheet lengthwise 12-18" wide and places it on a backboard where the pelvis will be positioned.

Forms general impression—evaluates any extrication issues for each patient(s); considers c-spine stabilization/immobilization.

Gently advance the airway. If using the left nare, insert the nasopharyngeal airway until resistance is met. Then rotate the nasopharyngeal airway 180 into position. This rotation is not required if using the right nostril.

Gently moves the patient’s head so that the eyes are looking forward; the patient’s nose and chin are aligned with the sternum.

Gloves should be turned inside out, with the second glove serving as a container for the first glove.

Using Dominant hand, grasp exterial or the opposite glove at the wrist, ensuring that you do not contaminate you skin.

Hold the adjunct against the side of the face with the flange adjacent to the corner of the patient’s mouth. Size the airway by measuring from the patient’s earlobe to the corner of the mouth or from the corner of the mouth to the angle of the jaw.

If bleeding continues, remove dressing and apply a hemostatic bandage. (if authorized)

If bleeding continues despite direct pressure and hemostatic bandage, verbalizes application of a tourniquet and mark forehead.

If SEVERE signs/symptoms exists– Administers 3 atropine & 3 2-PAM CL injections in rapid succession.

If pt. has suspected spinal injury, then do not use this lifting technique.

Insert the lubricated airway into the larger nostril with the curvature following the floor of the nose. If you are using the right nare, the bevel should face the septum. If using the left nare, insert the airway with the tip of the airway pointing upward, which will allow the bevel to face the septum.

Introduces self, obtains permission to help/treat.

Keeps the patient's knees slightly flexed, and pads under the legs/knees with a rolled-up blanket.

Log rolls patient on to backboard maintaining spinal alighment; positions patient so that the buttocks are positioned on the sheet 1-2" above the top of the iliac creast.

Looks for chest rise and fall (On unresponsive patient, places hand on patient’s chest or listen at mouth for respirations).

Lowers the patient into a supine position on the long board, securing the patient and the short board to the long board in the usual fashion.

Manually stabilizes the head/cervical spine, kneeling next to the patient; establishes in-line stabilization.

Moves the patient to a long board by placing the long board next to the patient’s buttocks; lifts the patient onto the long board, maintaining C-spine stabilization.

Observes patient for excessive salivation (pneumonic SLUDGE - DUMBELS)

Open the patient’s mouth with the cross-finger technique. Hold the airway upside down with your other hand. Insert the airway with the tip facing the roof of the mouth and slide it in until it is half way into the mouth.

Palpates entire chest checking for tenderness/deformities

Peel the glove off of you hand, turning it inside out as you remove it.

Placed ungloved fingers inside the cuff of the gloved hand, making sure you do not touch exterior of gloved hand.

Place the removed glove in the palm of your gloved dominant hand.

Places one cravat around each shoulder (over and under the armpit); ensures thatthe cravat is not directly over the fracture site and that front of cravat has wide band.

Places board behind the patient’s back, aligning the top of the device with the top of the patient’s head.

Places hands on either side of the patient’s head with the palms adjacent to the ears, the fingers supporting the jaw and the back of the head.

Positions hands underneath the patient to lift at points of body mass (shoulders, kips). Rescuer at head directs lift.

Position the lifters and have them form a bridge over the patient, head-to-shoulder, shoulder-to-shoulder.

Gently pulls the ends of the sheet tight.

Readjusts occlusive dressing tape according to local protocol.

Rescuer #1 directs the roll, ensuring that all rescuers are ready to roll the patient toward them as a unit.

Rescuer #1 stabilizes injured area of leg/ankle by placing one hand on front of ankle and one hand on back of the ankle, holding this position firmly as the boot is removed.

Rescuer #2 assesses CMS, kneels beside the patient’s shoulder/upper chest, and grasps the patient’s shoulder/hip.

Rescuer #2 ensures that the patient is centered on the backboard; if needed, the patient is recentered on the board using axial movements.

Rescuer #2 firmly grasps ankle hitch with one hand and places other hand under the calf and moves the injured leg in a coordinated fashion with Rescuer #1 to straighten leg into anatomical alignment using manual traction; maintains traction as Rescuer #1 releases manual stabilization.

Rescuer #2 gently removes boot by sliding heel away from foot, followed by the toe portion; monitors patient for indications of excessive pain; stops or modifies procedures as appropriate.

Rescuer #2 removes the chin strap and places one hand at the patient’s occiput (base of helmet) and the other at the patient’s chin to ensure head/C-spine immobilization.

Rescuer #2 slides backboard into position, tilting the backboard, and then palpates the patient’s spine for any injuries.

Rescuer #3 connects ankle strap if needed and turns crank/knob, gradually replacing manual traction with mechanical traction.

Rescuer #3 positions backboard beside the patient and kneels at the patient’s hips; grasps the patient’s hips, overlapping hands with Rescuer #2 and above the knee.

Rescuer #3 prepares traction splint and adjusts to proper size according to manufacturer’s instructions; rescuer uses uninjured leg to measure splint.

Rescuer #4 kneels beside the patient’s knee/lower leg; grasps the patient’s upper thigh, overlapping with Rescuer #3.

Rescuers #2 and #3 stand next to the patient, one on either side; Rescuer #2 stands on the right side of the patient, places one hand on the patient’s elbow and the other under the patient’s armpit and grasps the backboard slot above the patient’s shoulder. Rescuer #3 does the same on the other side of the patient.

Rotate the airway 180°. Insert the airway until the flange rests on the patient’s lips.

Secures the patient to the backboard, ensuring that the backboard straps do not go over or put stress on the injured area.

Size the airway. Place the flange against the nostril, and the end should touch the patient’s lower earlobe. Coat the tip and the entire length with a water-based lubricant.

Starting at the wrist, fold glove over and peel it back, turning it inside out as you remove the glove.

Ties the two ends using an overhand knot, or wraps the two sheets ends around each other before securing the ends with one or two nylon cable ties.

Tightens cravats so that the position of the shoulders is the same as if the patientwere sitting normally (shoulders should not be pulled all the way back).

Using an oxygen wrench or valve stem on the top of the cylinder, turn the valve counterclockwise to slowly "crack" the cylinder for 1 second.