SOP-15 Emergency Response

7/30/2019 SOP-15 Emergency Response

1/18

SOP 15 Emergency Response P

OANRPPCSU 14March2011

SOPNo.15

StandingOperatingProcedure(SOP)for

EmergencyResponse

1. PURPOSE. Tooutlinestepstofollowinthecaseofafieldemergency.

2. SCOPE.Includesproceduresforfieldoperations.

3. RESPONSIBLITIES.

a.NaturalResourceManagementSupervisor: ReviewprocedureswithNaturalResource

ManagementStaffduringsafetybriefingstoensureunderstandingandcompliance. Ensure

staffhasreceivedorientationfromMedevacandWildernessFirstAid.

b. NaturalResourceManagementStaff: ExecuteemergencyresponseproceduresinaccordancewithSOP.

c.FailuretocomplywiththisSOPmayresultindisciplinaryaction.

HelicopterwreckagefromcrashDecember2003.

4. PROCEDURES.NewstaffshallreadthisSOPandallattacheddocumentsbeforebeginning

fieldwork.


2/18


a. GeneralConsiderations.

(1)Intheeventofanemergency,staffshouldseektoremaincalm,respondwithalacrity

andcompassion,andcommunicateclearlyandfrequentlywithBase,supervisors,and

otherfirst

responders.

(2)Firstrespondersmayinclude:NRS,EmergencyMedicalTechnicians,Medevac,Range

Control,andHonoluluFireDepartmentStaff.

b. EmergencyProcedures

(1)FollowattachedWilderness1stResponsedocumentsWMAsWildernessFirstAidGuideisanewresource,(scannedandattached)

c. TrainingandGear

RequiredGear SuggestedGear/Training RequiredTraining

FirstAidKit, includingrubbergloves, CPR faceshield, and

flaresormirror,asdetailedin

theFieldworkSOP.

Communcation: radio or cellphone

Emergency Response Forms(seebelow)

Fieldpackwithallstandardgear

Vehicle/largefirstaidkit

MedevacOrientation

CPR WildernessFirstAid

Checklistof

Field

Safety

Sheets

Makesureyouhavethelatestversionofeveryform!

Item Latest

Version

1 FieldPhoneList

V:\NewHireOrientationandTraining\SafetyandFirstAid\

fieldphonelist.exl

3/11/10

2 EmergencyContactList


EmergencyContactSheet.doc

12/16/09

3Field

Wilderness

First

Response


FieldWILDERNESS1stRESPONSE2009.doc

3/17/10

4 PatientInformationFormSOAPA


PatientInformationFormSOAPA.doc

2/10/10


3/18


5 LZlist

V:\Forms\NR_LZ_List_MASTER.pdf

9/30/09

6 FieldSafetyMaps

V:\MapGraphics\FieldSafetyMaps\Koolau\PDFs\_KoolauFieldSafetyMaps.pdf

V:\MapGraphics\FieldSafetyMaps\Waianae\_WaianaeFieldSafetyMaps.pdf

4/09

7Ramik

Label


RamikMiniBarsLabelExp2013.pdf

7/1/09

8 NARSPermit09


NARSPermit09.pdf

4/6/09

LastModified6/6/2011

V:/NewHireOrientationandTraining/SafetyandFirstAid/CurrentForms

d. Practice/FireDrills

(1)SupervisorsshallconductFireDrillswithstaffthreetimesperquarter(minimum),

unlessotherwisespecifiedbytheSeniorNaturalResourceManagementCoordinators.

Otherstaffhavespecificgoalssetforfiredrillcompletionrates. Baseshallconduct

impromptufiredrillswithfieldstaffattheirdiscretion.

(2)FireDrillswillbetrackedviatheFireDrillRecordForm. Theseformswillbefiledand

keptbytheSeniorNaturalResourceManagementCoordinator. Theywillbereviewed

byparticipatingstaffandthePCSUSafetyofficer. Theywillalsobediscussedat

CoordinatorMeetings.

(3)PotentiallyproblematicfindingsofFireDrillswillbeaddressedbysupervisorystaff. If

needed,changestoSOPSandotherdocumentswillbemade.


4/18


WILDERNESS1stRESPONSE

PatientAssessment

ProvidePatientCare

CompleteSOAPAPatientInformationForm

MakeanEvacuationDecision

ContinuallyMonitor

Patient

EvacuatePatient

PatientAssessment

STOP. SizeuptheSceneIdentifyhazardstopatients,rescuers,bystanders:isanyoneinimmediatedanger?

DetermineMechanismofInjury(MOI). Whathappenedandhow?

Establishbodysubstanceisolation. Noteanybodyfluids,useuniversalprecautionstokeepoutofthem

untilhavegloves.

Determinenumberofpatients

InitialAssessment:STOPANDFIX!Identifyselfandtraininglevel,obtainconsent,checkformedicalalerttags

Assessresponsiveness(verbalorpain)

StabilizespineifMOIforspuinal(handonforehead)

AAirway:lookinmouth,clearofobstructions

Breathing:look,listen,feel. Ifunresponsiveandnobreathor


5/18


PertinentHistory:experiencedanythinglikethisbefore?Anyrelatedillnesses?

LastIntake/Output:what,when,howmuch,isitnormalforpatient?

Eventsprecedingindicationsofillness:redundancy

ProvidePatientCare

CompleteSOAPAPatientInformationForm

MakeanEvacuationDecision

1. EvacuationNecessary?

Assessseverityofthesituation:BECONSERVATIVE.

Howurgentisthevictimscondition,andhowvitalisresponsetimetoincreasinginjuryseverity?

Whattypeoftransportisneededaccountingforinjuredpersonsconditionandtheweather?

Isthevictimmobile? Howlongisthehike? Ishelicoptersupportneeded? Whattype?

Medevac(EvergreenHelicopters) 911(AirOne) Commercial

Ship Bell412 McDonnellDouglasMD520N Hughes500

LZsize 30x30ft,ifneedtoland,butMedevacpersonnelcanrappelfromhelicopter

intoa

remote

area.

15x15ftifneedtoland,butrescue

Squadmemberscanrappelfrom

Air1

into

a

remote

area.

15x15ft,andtighter!

Line 250 300 100

SpecialEquipment litter(basketlikestretcherdevice)andharnessedhoist

infraredcamera,rescuenetandlitter

(basketlikestretcherdevice)

N/A

HoursofOperation 247 247 Daylight

Pilot Unknown Unknown (perhapsLincoln) Wellknown

Communication Dialin(phoneorpacmere) Dialin(phoneorpacmere) Direct(helicopterradio)

MedicalResponse Medic,Hospital,Ambulance Hospital,Ambulance.NOMEDIC.

Hospital,Ambulance

NOMEDIC.

2. Ifhelicopterevacuationisnecessary,complete9LineMedevacQuickFax(usedforallhelicopterrescues).

Location

of

Pickup

Site

Lat/Long

PickupSiteFrequency&CallSign PacmereA6:DPWEnv;Heli:141.100

NumberofPatientsbyPrecedence #Urgent,#Priority,#Routine

SpecialEquipment Litter,rescuenet(only911),infraredcamera(only911)

NumberofPatientsbyType #RequireLitter,#Ambulatory(abletowalk)

Number&TypeofWound,Injuryor

Illness

PickupSiteMarking Colorflagging,flare,strobe,glowstick,smoke,mirror.

PatientStatus TELLMEDEVACWEARECIVILIANS.

TerrainDescription:

Size

of

LZ

&

Slope

of

Terrain

Obstacles

WindDirection&Speed,Weather

Howclose

to

patient?

Wires,antennas,ditches,vehicles,etc.

ConverttoLat/LongforMedevacand911onRinoLegendGPSasfollows:1. Takeawaypoint,ormakesureyouhaveawaypointforthepointforwhichyouwantcoordinates.Fig.12. NavigatetotheMainMenuScreenusingthepagebutton(ontherightsideabovethepowerbutton).Fig.23. GotoSetup(thehammer)byusingthejoystick.Fig.2


6/18

SOP 15 Emergency Response Page 98

4. UndertheSetupMenu,gototheUnitsoption (tapemeasure)byusingthejoystick.Fig.35. ThefirstheadingisPositionFormat.BelowitshouldreadUTMUPS.UsethejoysticktohighlightUTMUPSandselectitby

depressingthejoystick.

6. ScrollDownwiththejoystickandselecthdddmmss.s7. NavigatebacktotheMainMenu(Fig.2)byusingthepagebuttonand

selecttheFindOption.

8. ChooseWaypointsthennearest.Pickyourwaypointfromthelist.9. IntheLocationbox,youshouldhavethecoordinatesintheLat/Longformat.

3.Contacthelp

CALLBASEYARD. EastRange:6567641,6567741,6568341.WestRange:6559175PacmereCh.A6ProvideresponderwithinfoonSOAPAForm/9LineMedevacQuickFax(usedforallhelicopterrescues).

Coordinaterescuecallswithbaseyard:

Medevac(EvergreenHelicopters) 911(AirOne) Commercial

OfficecallsSchofieldFiringDesk

Phone6551434;Fax6551433

SchofieldFiringDeskneedstocall

Medevacbeforetheycanfly

Officecalls911andprovides

themwithsameinfoason

HelicopterQuickFax.

Officecallscommercialhelicopter

companiesprovidesthemwith

sameinfoasonHelicopterQuick

Fax.

Officesends

Helicopter

Quick

Fax

and

callsMedevac

Fax6561855andPhone6561849

AlfredPena,BaseManager/LeadPilot,

cell3759192

PacificHelicopters

18009535552,8088719771

Howard4791492

LincolnIshii5420506

JoeAllen:TBD

K&S/ParadiseTropicalHelicopters

2843288

Josh7414354;Cal8088959612

WindwardAviation8088773368

AirborneAviation;Jim(808)281

4198,(808)

878

1088,

Susie

(808)

4422122

ContinuallyMonitorPatient

EvacuatethePatient

Ifhelicoptersupportisneeded,prepareLandingZoneorDropZoneIfLZsiteisnearbyandlargeenoughforBell412landing(30x30ft),orMcDonnellDouglasMD520N&Hugh

500landing(15x15ft):

cleartreesandshrubsmarkLZininvertedYformation(pointintowind).markLZwithflagging,brightlycoloredclothing,etc.buttiesecurely

IfLZisnotavailable,clearDZlargeenoughforlitterorrescuenet,butnotvital

markDZwithflagging,brightlycoloredclothing,etc.,tieintreeifneedGuideHelicoptertoSite

Communicatetopilotoclockorcompassrelationtositefrompilotsviewpointandemploylightsouasconstantsiteindicator. Atnight,useonlyglowssticksforNVGoperations

Ifhelicoptersupportisnotneeded,assistthevictimtothenearestmedicalfacility


7/18

Page99hasbeenremovedasitcontainspersonalinformationregardingemployees


8/18


SecondaryFocusedSpinalAssessment(FSA)AppropriatewhenMOIindicatespossiblespineimpact

REQUIREMENTSforspinalassessment:

Inwilderness(>1hourfrommedicalassistance) FullassessmentalreadycompletedPatientmustpassALL5ofthefollowing:

1. A&Ox3or4.4questions:identity,location,time,event

2. Sober,nonarcoticsoralcohol3. Nodistractinginjuries(whentouchedwithpressure,patientcanfeel)

4. NormalCirculation,Sensation,Motion(CSM)inallextremities;canmovefigureandtoesagainst

resistance,candifferentiatebetweensharp(poking

with

sharpe

stick)

and

dull

(touch

with

cloth)

on

all

4extremitieswitheyesclosed

5. Nopain/tendernessonspineSigns/SymptomsofSpinalInjury Pain,tenderness,obviousinjuryordeformityalongvertebralcolumn

Altereddistalsensations:numbness,tingling,unusualhot/coldsensations

Diminishedcirculation,sensation,motion Weaknessorparalysis Respiratorydifficulty Incontinenceoruncontrollederection Shock Nausea SkincolorflushedfromaccidentsitedownIffailFSAorhaveanyaboveSigns/Symptoms,

ASSUMESPINALINJURY

Treatment Stabilizespineandheadmanually CheckCSMsinextremities Establishneutralalignmentofspine(naturalproneposition,

body

parts

in

line)

Applycervicalcollar,ifavailable Securebody,andheadontoabackboard,ifavailable Ifcollarorbackboardnotavailable,keepneckalignmentstablewithgear,clothes,etc.

RecheckCSMsinextremities Anticipateshock EVACUATE

CPRREQUIREMENTSforCPR

Unresponsive

patient

with

no

pulse.

DONTbeginCPRifpatientisalive,hasinjuriesincompatiblewithlife,hasanobviouslylethal

injury,hasrigormortisorlividity,orhasawell

definedDNR(DoNotResuscitate)

2componentsofCPR:

RescueBreathing(pulse,nobreath) ChestCompressions(nopulse,nobreath)InitialSTOP&FIXAssessment,conductABCs.

Airway:lookinmouth,clearofobstructions.HeadTilt/ChinLift:standardmethod

JawThrust:goodiffearspinalinjury,butneedto

usepressuretomaintain.

Breathing:look,listen,feel. Ifnobreathing,administer2breaths,andcheckpulse

Circulation:checkpulse,Ifhavepulse,continuerescuebreathing.

1breathevery5seconds

Ifnopulse,addchestcompressions.

30compressions,

1

breath

x

2,

check

for

pulse.

Continueuntilachievesuccess,becomeexhausted,

dangerousconditionsdevelop,turnovertohigher

levelofcare,ordeclareddeadbydoctor. In

wilderness,greaterthan30minwithoutsignsoflife

assumedead.

____________________________________

WoundManagement

Evacuate: Animalbites Deeporhighlycontaminatedwounds,highriskofinfectio Woundsopeningtofracturesorjointspaces Infectedwounds Woundswithseverebloodloss


9/18


HeatIllnessHeatStroke=EVACUATION

Signs/Symptoms Treatment

Dizziness, fainting Move patient out of direct sun, away from heat

Heat Exhaustion Weakness Oral rehydration: electrolytes, lightly salted water

Shock caused by Headache Spray with water; fandehydration Mild confusion

Nausea

Loss of appetite

Difficulty breathing

Rapid onset of confusion, irrational behavior Move patient out of direct sun, away from heat

Heat Stroke Loss of coordination Oral rehydration if concious enough to drink

Causes irreversible Loss of conciousness Spray with water; fan aggressively

liver, kidney, Increased HR, RR Ice packs to neck, groin, armpits

nervous system Skin hot, red, dry (no sweating) Massage extremities to increase circulation

damage Monitor vital signs

EVACUATE

__________________________________________________________________________________________

HypothermiaAlcoholintoxicationcanreduceshiveringandcomplicatediagnosisandtreatmentofhypothermia

Severehypothermia=EVACUATIONSigns/Symptoms Treatment Rewarming Techniques

Alert Prevent further heat loss Shivering

Vital signs normal Employ rewarming techniques Dry clothes

Vigorous shivering No alcohol, tobacco consumption Insulate patient from ground

Vital signs depressed In addition to above: Cover with vapor barrier

LOC altered Monitor vital signs Move to warm envionment

Lack of response to painful EVACUATE Mild exercise

or verbal stimuli Warm, sweet drinks if patient can hold own cupLack of shivering Heat application to underarms, neck, groin,

sides of chest wall

Mild

Moderate to

Severe

__________________________________________________________________________________________

ShockInadequateperfusionofbodycellswithoxygenatedblood

Shockisalwaysasecondaryconditioncausedbyanunderlying

problemwith:

pipes,pump,fluid,orobstruction

Signs/Symptoms Weak,rapidpulse(over120bpm) RRincreasing,shallow Skinpale,cold,clammy,bluish Capillaryrefillslow(nailbeds) Nausea,vomiting Restlessbehavior Drymouth,severethirst Visiblebloodloss,pooling

Internalbloodloss,swelling

Treatment Treatunderlyingproblem Placeheaddownhillorelevatefeet12offground Insulatefromcoldground Keeppatientwarm Monitorvitalsigns Reassure,calmpatient SipsofwaterEvacuateif Noimprovementwithtreatment Significantvitalsignchangeswhenstand Conditionuntreatableinfield(internalbleeding)


10/18


HeadInjuryDurationofSigns/Symptomsdeterminesseverityofinjury:mild=quickrecovery,severe=quickdecline.

Lossofconsciousness=EVACUATION

Signs/Symptoms Time Treatment

A&Ox3 or 4 Quick recovery, Monitor LOC for decreaseNausea within .5 to 2 hrs Monitor vital signs

Mild Vomiting Monitor for signs of severe injury

Dizziness Withhold pain medication

Headache Sleep allowed, wake up every 2 hrs for 8hrs

Repetitive questions Monitor LOC for decrease

Moderate A&Ox2 or 3 (short term memory loss) Monitor vital signs

Prolonged headache and dizziness Sleep allowed, wake up hourly

Altered mental state (combative) If no improvement after 4 hrs, EVACUATE

Low HR Quick loss of Monitor vital signs

Irregular RR function No sleep

A&Ox1 or 2, decreasing EVACUATE

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


11/18

SOP 15 Emergency Response........................................................................................................................................Page 103

PatientInformationFormSOAPA

Name________________________________________Date______________Age________SexM/F

Subjective(accordingtopatient)ChiefComplaint_____________________________________________________________________

____________________________________________________________________________________

MechanismofInjury(MOI)/HistoryofPresentIllness(HPI)_______________________________

____________________________________________________________________________________

ObjectivePatientExam(descriptionofhowpatientfound,resultsofheadtotoeexam)

____________________________________________________________________________________

____________________________________________________________________________________

VitalSigns

Time

LevelofResponsiveness:

A&Ox41,Alert,Verbal,

HeartRate

RespiratoryRate

Skin:Color,

Temperature,

Moisture

Pupils:Equal,Round,

ResponsivetoLight

Temperature

History(SAMPLE)

Symptoms___________________________________________________________________________

____________________________________________________________________________________

Allergies____________________________________________________________________________

Medications__________________________________________________________________________

Pertinentmedicalhistory_______________________________________________________________Lastintake/output_____________________________________________________________________Eventsleadingtoaccident/illness_____________________________________________________________________________________________________________________________________________

Assessment(problemlist)____________________________________________________________________________________

____________________________________________________________________________________


12/18


Plan(planforeachproblemonassessmentlist)____________________________________________________________________________________

____________________________________________________________________________________

AnticipatedProblems____________________________________________________________________________________

____________________________________________________________________________________Base,thisIS/ISNOTafiredrill. IhaveaMILD/MODERATE/SEVERE situationinvolving

_____________________________(name/callsign) at__________________________(management

unit). Evacuationwillberequiredvia_______________________________(ambulance/heli/hike).

Herearetheincidentdetails:Ihavea______(age)yearold______(sex),whosechiefcomplaintis

_________________________________________________________(injury/illness)asaresultof

_______________________________________________________(MOI/HPI).

Patient

was

found

_______________________________________________________(position/location/time)andis

currently____________________________________________(status)and___________(LOC).

Examreveals______________________________________(assessment). Patientvitalsignsat

_________(time)are_____________________________________(HR/RR/SCTM/PERRL/Temp)with

ahistory

of

__________________________________________________________

(SAMPLE).

Evacuationwillrequire_____________________________________________________(gear)at

____________________________________________________(location). Anticipatedproblems

include____________________________________________________________________________.

9LineMedevacQuickFaxInfo:

1Location

of

Pickup

Site

(Lat/Long,

UTM):4

Special

Equipment

(litter,

hoist):

2 RadioSiteFrequency:141.100

CallSignofResponder:

7 PickupSiteMarking(flagging,flare,etc):

3 NumberofPatientsbyPrecedence:

#Urgent:____ #Priority:____

9

aSizeofLZandSlopeofTerrain:


13/18


#Routine:____

5 NumberofPatientsbyType:

#Litter:_____ #

Ambulatory:_____

9

bObstacles(wire,antennae,ditch,

vehicle,etc):

8 NumberofPatientsbyStatus

#Civilian:_____ #Military:_____

9

c

Weather,WindDirection&Speed:

6Patient

&

Type

of

Wound/Injury/Illness:

Patient1:

Patient2:

Patient3:

OANRPBase

POC:

Phone:6567641/6567741

Fax:6567471

OtherDirections/Instructions:


14/18



15/18



16/18



17/18



18/18


Documents

SOP-15 Emergency Response