Emergency response and what to do in an accident

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krisholub
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Emergency response and what to do in an accident

Postby krisholub » Wed Apr 11, 2018 12:20 pm

Inspired by the recent incident at Boulder, I wanted to offer my perspective on what you can do if you find yourself involved in an accident as a bystander or otherwise. I'm mostly going to focus on the logistics side of getting EMS activated and how to manage the situation from an operational perspective, as opposed to specific medical advice. For the latter, I highly recommend taking at least a Wilderness First Aid Course, though Wilderness First Responder training would be ideal if you can commit to the time involved. I'm also going to tailor this largely for Boulder since that's what I'm familiar with, but you can apply the decision tree to other locations as well.

1. First and foremost, do not become a patient yourself. If you get injured, not only is that one less body able to assist in the rescue, but now resources must be divided between two scenes. Make sure you are out of danger, whether that means diving on your wing if a dust devil is ripping through, managing your glider if you are in turbulence/near terrain, or choosing not to topland near the scene unless you are 100% certain you can do so safely.

2. Take a moment to calm and collect yourself. Saving 20 seconds and rushing into action is not going to make a difference when even a simple rescue effort is likely to take an hour or more, but making the right choices and not forgetting a critical action or piece of equipment can save tens of minutes. Take a few deep breaths and get your heart rate down.

3. Determine if EMS needs to be activated. If you aren't sure that the pilot is OK and can't get to them quickly, don't hesitate to call 911. There is no charge for rescue. The only time you will be billed is if you receive medical transport, which you can refuse on scene later if you choose. And if you're sufficiently injured that you are unable to refuse care, the money doesn't matter anyway. If it turns out that the pilot is not in need of assistance, it is not a problem to call 911 back and update them that no response is needed. You will not be penalized, billed, ticketed, or charged in any way - the most that will happen is the Sheriff will come out to collect information for their report.

4. Assuming that EMS needs to be activated, make sure someone is responsible for making that happen. If you're by yourself, that becomes your job. If you have additional bodies available, you can delegate that task. Make sure you explicitly address the person and inform them that they are the point of contact and to do it immediately. Don't rely on "someone call 911". Be prepared to answer the following questions:

a. "Where are you" - You don't have to give exact coordinates right now (more on that later), just give a general location e.g. "On the hill above Wonderland Lake" so the dispatcher knows which agencies to activate. Sometimes 911 will connect you to the City instead of the County office, and they will have to transfer you, so there's no point in giving specifics yet only to repeat yourself.

b. "What is your emergency" - be concise, but explicit. Dispatchers don't know anything about paragliding and talking about collapses is meaningless. A simple "a paraglider has crashed and the pilot is injured" is sufficient.

c. "Is the victim conscious? Is the victim breathing?" Pretty self-explanatory. If you aren't on scene yet, "I don't know" is an acceptable answer. You can also note "they are/are not moving."

d. There will likely be followup questions, including the exact location and specific injures. Stay on the line and answer those as calmly and clearly as possible. Every bit of detail you can provide will assist in getting the right resources to the right location as quickly as possible. When describing location, try to avoid referencing paraglider-specific landmarks such as launches or LZs, as EMS will not be familiar with these locations. Street locations and addresses are ideal if you know them. Use obvious/officially named landmarks, distances, and cardinal directions. If you have GPS coordinates those are great.

Image

This is a rough overview of how you can divide Boulder up, using the ridgeline, the cliff bands, and the water tower as landmarks to identify the best access point. If you are certain of the closest access point, you can also relay that to the Dispatcher. Describe the location in terms of something like, "200 feet below the top of the ridge, on the east side and between the Cliffs and the Water tower" or "300' below the ridge, on the west side, north of the water tower". This is of course site-specific, but the general principle is to use terminology that will be meaningful to non-pilots.

5. Once EMS is enroute, make sure that the point of contact is still accessible in the event that the dispatcher needs to call back for further information. That person needs to stay in cell phone range and make sure their phone is off silent. If you have the bodies available, send someone out to meet EMS and direct them to the scene.

6. Send in a hasty team to the scene. If you have the people available, this can be done in parallel while calling 911. Make sure the hasty team has some sort of communications, ideally both radio and phone. Send in a medical and tree rescue kit if any are available. If this is a back country rescue, make sure everyone responding has everything they might need for an extended stay, especially including headlamps, water, and sufficient warm layers. If it's very back country with the possibility of an overnight stay, consider bringing fire-starting capabilities.

7. Assess the patient. If there are any immediate safety concerns such as them being dragged, address those first. Disconnect their wing and ball it off out of the way if you can, but avoid moving the patient first and foremost. It is likely better to keep them in their harness for now, as that is a good way to keep them immobilized. This is where medical training comes into play, but here's a crash course on the very basics to provide a meaningful assessment and initial life-saving efforts.

a. ABCs'. In descending order of importance, check that the person has an open Airway (nothing obstructing their mouth, including their tongue). Look up the jaw-thrust maneuver on youtube for further explanation. Breathing Verify that they are breathing on their own, or use rescue breathing (from CPR) if they are not. Circulation Check for a pulse if you know how to find one. Look for any major bleeding and control it with direct pressure and keep the pressure on until help arrives. Superficial bleeding can be ignored.

b. Level of consciousness. In descending order there is: Responsive (actively reacts to you), Visual (looks at you), Verbal (responds to your voice), and Pain (reacts to something like pinching their earlobe or firmly rubbing their sternum (breastbone) with a knuckle. If they are capable of talking to you, use these 4 questions, referred to as Person, Place, Time, and Event: "What is your name?" Where are you?" "What year is it?" "Do you remember what happened?". Give them 3 words to remember - I like using a Color, number, and animal, such as "Red,4, Bird" but it doesn't matter. The words should be simple and easy to remember, the only purpose of them is to periodically ask the patient if they remember them, as a rough way to assess their cognition.

c. Identify any major injuries. Use anything you can see or feel, as well as what the patient tells you hurts.

Once you have your assessment complete, relay that information to 911 or to the person who is maintaining contact with them. If you don't have any further tasks to attend to, have someone start taking vital measurements. Use a stopwatch and count the patient's number of breaths in 30 seconds and measure their pulse for an additional 30 seconds, and multiply each of those numbers by 2 to get breaths and beats/min. If you're bad at math, just measure each for 1 minute. Write those numbers down along with the time, and take new measurements every 10-15 min. Have that data available to give to EMS when they arrive. The exact numbers are useful, but seeing the relative change over time is what's really important.

8. Wait. This is the hard part. Unfortunately other than controlling bleeding and keeping them still until help arrives, there isn't a lot you can do with no equipment and no training. Do what you can to keep them comfortable. Have someone stand infront of them to provide shade, put layers on top of them if they are cold, unzip jackets if they are overheating, etc. Do not give them any pain medications and avoid food or water unless you're really deep in the backcountry and they can reliably take it without choking. Once you've addressed the immediate concerns, now is a good time to direct additional bodies to pack gear up. If applicable, consider taking pictures of the equipment as-is for later investigation. If the accident becomes a fatality, leave everything where it is for the authorities to conduct their investigation.

9. Once EMS arrives, don't take it personally if you're ignored or told to go away. Bystanders can be an additional liability to themselves and the rescue time and can unintentionally get in the way. Step back and ask someone who isn't busy for direction. They might use your help if they are resource-limited, but there is a great chance they'll just have you hike out.

10. Follow up. Take of yourselves psychologically. Don't hesitate to reach out for help if you are having trouble coping, even if it's days or weeks later. Victim's advocates are available to be called at the scene if you need to talk to someone, but often it's helpful just to talk to other people and debrief with "beer therapy."

These things take experience to get good at, and it's worth practicing what you would do in a simulated emergency. Don't worry about getting it all perfect. The most important part is staying calm, not making the situation worse, and getting help on the way. If you can do those things, you've done at least 80% of your job.

jjhildebrand1
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Re: Emergency response and what to do in an accident

Postby jjhildebrand1 » Wed Apr 11, 2018 2:43 pm

Great information and food for thought, Kris. Others, definitely dive into this one! One extra tidbit for those that are trained in basic CPR/AED and First Aid: it can be scary to help but be confident that if you do, you're protected by Good Samaritan laws, which all 50 states have enacted. Here's the basics of that law:
All 50 states have enacted Good Samaritan laws that give legal protection to people who willingly give emergency care to an ill or injured person without accepting anything in return. To be considered a "Good Samaritan" you must act in good faith, not be deliberately negligent or reckless, act with in the scope of your training, and not abandon the person after starting care.
, ) jake

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Mike Jobin
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Re: Emergency response and what to do in an accident

Postby Mike Jobin » Wed Apr 11, 2018 5:12 pm

Really great write up Kris!

When something tragic like this happens it is hard to understand your purpose in the situation, even with training. Sometimes there is no one but the first responder and sometimes there are too many people involved. If you are first, for sure you will have too much to do. Prioritizing your efforts is the most difficult in my experience. I only have a few things to add to your thorough post above:

5. Once EMS is enroute, make sure that the point of contact is still accessible in the event that the dispatcher needs to call back for further information. That person needs to stay in cell phone range and make sure their phone is off silent. If you have the bodies available, send someone out to meet EMS and direct them to the scene.


At the Owens valley nationals in 2015, Jason had crashed on the first day and I was flying over afterwards. There were 4-6 pilots that arrived before me and I was confused as to what I could do to help. I realized what that was and decided not to land close to the accident, but rather i flew down the dirt roads and find the correct route back. I landed and waited for the rescue vehicle to guide them. I would not have been effective any other way in that situation(other than helping with lifting and any other manual labor).

Another way is to simply provide shade for the injured person. Many times the temperature is quite high and just a little bit of extra comfort is a big thing. Most Emt's have not had a problem with that in my experience.

One other thing to add is something I had to do once... sometimes the injured person is on a hill an has problems staying still. providing a way for them to be stationary is really important until rescue arrives. In my case I sat lower on the hill and used my body to stop the person from moving.

Kris, We don't usually give out knick names these days but I would say your'e the new "rescue ranger"

rossco
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Re: Emergency response and what to do in an accident

Postby rossco » Wed Apr 11, 2018 6:27 pm

Indeed an excellent write up Kris. You have opened up a topic that needs to be discussed.

You don't know me, but I've been there and done that once or twice. Ask Jobin. Nice to see someone picking up the baton.

AVPU scale
A Alert
V responds to verbal commands
P responds to Pain (i.e., sternal rub)
U Unresponsive

A,A & O x4 Awake, Alert and Oriented x 4 items (person, place, time, and event)

A couple of items to follow up on if so desired:

Medical kits:
Individual-- consider an IFAK (Goggle it) with a couple of additions to suit your needs, such as a SAM splint and space blanket. Not some stupid bag from IKEA with band aids and cough drops. If you need it, this is trauma, not a comfort kit.

Group-- At minimum, an entry level BLS bag in someone's truck who is omnipresent at the flying site. AND the knowledge to use it. WFR is an excellent starting point.

Tree Rescue
Individual-- At minimum, a descender, webbing to tie off, and 75 ft of 6 mil accessory cord and THE KNOWLEDGE TO USE IT.

Group-- at your discretion and skill/knowledge level. I used to carry 200' of 10 mm static line, locking biners, webbing, pulleys, ascenders, H2O, headlamp, MREs, tree saw, space blanket, and poncho liner in a go backpack in my vehicle. In this sitch, without the knowledge and expertise, it may be best to have the patient secure themselves and await tech rescue if there are no injuries.

Seek out and find anyone who has medical experience in the flying community. ER nurses, docs, EMTs, Medics, FFs. Get that conversation going. see who is there a lot and so on.

Respectfully,
Rosco


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