Arctic health: Extraction of chopper pilot

EXTRACTION OF CHOPPER PILOT

PHASES

  1. Size up the situation
  2. Hazard control and safety considerations
  3. Gaining entry
  4. Administering immediate life-saving care
  5. Rapid accessing
  6. Controlled release management
  7. Packaging and removal of casualties

SIZE-UP THE SITUATION

  • Type of aircraft and extent of damage
  • Number of injured and types of injuries
  • Hazards

CONTROL OF HAZARDS

The safety of rescuers, victims and bystanders must be ensured. Hazards include jet fuel spills (wash away or cover with foam) , instability of craft (secure craft), environmental hazards (adapt according to challenge). Have an outer and inner circle approach where the outer circle is the whole accident scene and the inner circle is the vehicle and its’ entrapped

GAINING ENTRY

This is the creation of a passageway. it can be gained via the doors, windows or front windshield (Always first stabilise the vehicle)

IMMEDIATE LIFE-SAVING CARE  (MARCH Acronymn)

M = Massive haemorrhage

A = Airway

R = Respiratory

C = Circulation

H = Hypothermia / Head injury

(This primary survey is slightly different than the ABC primary survey in that it places major importance to haemorrhage which must be stopped immediately, and addresses hypothermia and head injuries during the primary survey)

M= MASSIVE HAEMORRHAGE (“MARCH)

Use 4cm wide tourniquet with wind-lass 2 cm proximal to wound and wind until distal pulse disappears. If no improvement, second tourniquet adjacent and proximal to the first. Remove within 2 hours. If on for more than 6 hours, don’t remove. There is the risk of potassium, lactae, myoglobin and toxin release into the circulation. Keep limb cool, not frozen. Release atourniquet, ; never remove; risk of a re-bleed. Junctional bleeds in axillae and inguinal areas need specialised tourniquets.

Give 1 gram tranexamic acid in 100 ml saline within 1 hour.

RESPIRATORY (“MARCH”)

Treat tension pneumothaoraxes via needle decompression

CIRCULATION (“MARCH”)

Lrge volume resusciattion elads to “blow-out” of clot, with re-bleed. Maintain systolic of 80-90mmHg. head injuries: maintain systolic at 90-95 mmHg. Best outcomes in order: whole blood from “walking blood banks” (fellow flight members); packed RBCs-blood components; packed RBCs-plasma-platelets; PRBCs -plasma; plasma; PRBCs; colloids; Ringers or Plasmalyte

1 liter Rigers gives 250ml intravascular volume expansion

 

CONTROLLED RELEASE MANAGEMENT

Old “Grab and handle” approach is not sufficient. CRM is the dismantling of vehicle in order to extract the pilot and others. It incorporates making space for extraction and monitoring equipment and stabilising vehicle from causing further damage to rescuers and victims

CHOPPER DAMAGE AND ASSOCIATED INJURIES

Front end damage leads to dash-in, door compression and broken windshield (Injuires include fractures of lower extremities, abdominal injuries, head injuries, c-spine and chest injuries

Broadside damage leads to helicopter doors crashed inwards and dash displacement (Injuries include blunt trauma to the trunk, spinal injury, dislocated and fractured shoulder, pelvic fractures, head injuries, lung contusions)

Rear-end damage leads to compression of doors, breaking of seats, broken windshield from inside-out (Injuries include c-spine, head and face injuries, L-spine injuries and chest trauma)

Roll-over accidents can lead to fuel spills

Falling into water can lead to drowning due to the capsizing of the craft upside-down (due to weight of rotor and roof engine)

Any accident can be associated with crushing injuries, inhalation problems due to inhalation of jet fuel fumes and unconsciousness

Note

  • Always discuss a preplan
  • Determine the inner and outer circle on arrival
  • Wear PPE
  • Control the spectators, safeguard the scene and get lighting if needed

SOME TERMINOLOGY AT EXTRACTION

ACTION CIRCLE

Zone around the damaged craft established early in the extraction, with a diameter of 5 meters

BLANKET ROLL

Rolled up blanket to immobilise C-spine while victim is lying on spine board

BODY POSITIONING

The position that the rescuer must be in, in order to work effectively and safely

BROAD BASED COMMAND More than one task is performed simultaneously during the extraction leading to more speedy outcomes

CARGO COMPARTMENT

The area in the craft that carries cargo

C-SPINE IMMOBILISATION

C-spine is placed in a neutral position and manually maintained with no movement

CIRCLE SURVEY

Rescuers conduct a walk-around the crash site so that the whole accident site is observed prior to extraction

COMMAND

This is the person in charge of the accident scene

DISPLACEMENT

This is the relocation of a door by force beyond its normal range in order to gain access to a casualty

EXTRACTION

Means to remove from danger. It is used to describe the procedures used to cut away, and displce wreckage in order to remove casualties trapped in the craft

“FREEZE”

An internationally accepted alarm call by any rescuer who notices imment danger when it is of such degree that everybody should stop working

Full PPE

Includes hand, foot, head, body protection

GOLDEN HOUR

This is the first hour after an accident. The prognoses of the injured improve if the can receive treatment and be extracted within that hour. Nowdays there is also focus on the “golden ten minutes”

HAZARDOUS MATERIALS

Those materials that are flammable, explosive, toxic, carcinogenic or environmentla polluting. Also called “Hazmat”

HOSELINE

A hose that carries water under pressure to the accident scene

INCIDENT COMMAND

SOP to control the emergency scene through a chain of command

KENDRICK EXTRACTION DEVICE

A specilaised device that protects the c-spine when extracting a victim from an akward position. It has a semi-rigid harness, body and head straps, and neck pad

LONG BACKBOARD

A rigid board that was designed for easy use by sliding it under the victim in order to prevent further spinal collumn injury

NARROW BASED COMMAND

A command concept where multiple emergency rescuers only perform one task at a time

RAPID PATIENT REMOVAL

A procedure for the quick removal of a casualty during extraction due to the patient’s deteriorating condition or dangerous environmental factors e.g fire

SHALL indicates a mandatory requirement

SHORT SPINEBOARD

A shorter version of the long spineboard. It is used to immobilise the injured casualty in the sitting position

STABILISATION OF CRAFT

immobilisation of craft in which victim is trapped

STAGING AREA

A designated area away from the extraction scene where additional apparatus and personnel are kept in reserve until needed on the scene

STRADDLE SLIDE

A method of placing a prone or supine patient on a spine board by sliding the board under the patient

STRADDLE LIFT

A method of placing a prone or supine patient on a long spine board by lifting the patient and sliding the longboard under the patient

TEAM APPROACH

A modern tactical approach where firemen and emergency health care workers practice as a team in extricating a casualty from a craft

TRIAGE

Means “to sort”. A system of categorising and sorting casualties according to severity and injury

TRIAGE SECTOR

The command designation for persons assigned to determine the priority of treatment and transportation of injured patients on an accident scene