EMS World

OCT 2015

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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CASE REVIEW 14 OCTOBER 2015 | EMSWORLD.com Victim Identifcation and Tracking The victim tracking function of the trans- port sector manages victim identification and all necessary documentation of victim tracking. This facilitates the work of fire (and other) investigators and communication with family and relief workers. Once the incident documentation is complete, it is ideal, for case review and risk management purposes, for the responsible EMS and/or fire agency to collect and track all scene documents, patient care reports and worksheets. These are filed in an appropriately protected area for medical documentation. In incidents where patients can identify themselves, accounting for victims may be as simple as tracking them by name on scene and then gathering patient care reports from the EMS transport agencies or hospi- tals where patients were transported. But in other incidents—where serious illness or inju- ry has occurred, where patients are not easy to identify, or where conditions like severe weather or scene hazards don't allow effec- tive on-scene operations—the identification and tracking of patients may require much more effort by EMS providers. There will still be a responsibility at the scene to identify as many patients as possible. The identifica- tion and tracking function for EMS is typi- cally assigned to a single individual, but in large operations it may require more people, including law enforcement personnel. Typical data elements include patient name, triage condition (and maybe the major injury or illness), transport unit, trans- port destination and approximate time of transport. In some cases there are significant time differences as an incident unfolds or victims are found or extricated. This informa- tion eventually needs to be assembled at a single point. In some incidents, personnel at hospitals receiving patients may assist in tracking functions and identifying patients who left the scene without a name. Law enforcement may have additional roles. Many hospitals and other receiving cen- ters (e.g., evacuation areas) may assist in identifying persons affected by large inci- dents or those where evacuations have occurred. In many of those incidents, the EMS system is bypassed, and a complete accounting for victims and evacuees has to be organized by the hospital or public health. EMS would be accountable for those who use the EMS system for transport. Victim Tracking in Diferent Incident Types Several scenarios require victim tracking by fire/EMS agencies, with different challenges, responsibilities and outcomes. There are incidents where persons must be actively sought. These occur when there are life threats present and all persons who are at risk must be located—for instance, in buildings where there are fires or toxins such as carbon monoxide present. All per- sons must be found and moved away from danger. Certain toxins, like botulism, may produce sudden incapacitation, and persons with potential exposure must be located and evaluated. Large vehicle catastrophes— commercial plane crashes, bus accidents, "whiteout" multiple-vehicle crashes, over- turned or incapacitated passenger ships, train crashes—must have all victims found and removed. These incidents can produce scenes where it is very difficult to find all vic - tims, because the number of persons in the vehicles may not be known. An active-shooter incident, where law enforcement may be searching for one or multiple perpetrators, may also be an active-tracking incident. When shootings have occurred in schools, theaters, malls, courthouses and office buildings, it has been necessary to find and treat victims while scenes were still hot. This type of incident can be difficult for victim tracking, most of which may have to occur after the incident, in concert with criminal investigators. Incidents of any type in school or busi- EMERGENCY ASSESSMENT PATIENTS 1–2 PATIENTS 3–4 PATIENTS 5–6 PATIENTS 7–9 PATIENTS 10–12 Airway Open but burned Open, not burned Open Breathing Absent Absent In respiratory distress Wheezing Circulation Pulseless Pulseless Rapid pulse, perfusing well Perfusing well Disability No signs of life Both in PEA rhythm Altered level of consciousness No disability Exposure of Other Major Problems Extensive burns Minor burns Injuries including burns, bruises, cuts Injuries from breaking windows Injured FFs with minor burns and sprains Special Issues Left in place in house Two young boys, look similar CO levels high CO levels high, one refusing transport Will be seen at urgent care center Triage Class 2 patients 2 patients 2 patients 3 patients 3 patients Organizing Patient Assessment Many fire and EMS organizations use triage systems that result in patients being numbered in sequential fashion. This box represents the results of that triage process here. The crews triaged 12 patients, categorizing them by compromise of the ABCDE body systems.

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