REFRESHER WORKBOOK · Instructions for completing your Outdoor Emergency Care Refresher Workbook...

Outdoor Emergency Care

2015OEC Cycle B

REFRESHER WORKBOOK

2 OEC Refresher Workbook

2015 Outdoor Emergency Care (OEC) Cycle B Refresher ProgramINTRODUCTIONWelcome to the 2015 Outdoor Emergency Care (OEC) Cycle B Refresher Program. The purpose of this Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle B is to provide OEC technicians with a “snapshot” view of this year’s material so that they can be well-prepared for their refresher experience. To get the most out of this review, it is important to spend time reviewing the Outdoor Emergency Care Fifth Edition, focusing especially on the topics listed in this year’s Cycle B refresher.

The instructor of record (IOR) for your refresher is the point of contact for any questions that may arise regarding attending an OEC refresher. Annual OEC refreshers are conducted at the patrol, section, region, or division levels. Contact your OEC administrator for refresher details.

What to do to prepare for and complete this year’s refresher1) Review/complete the material.

a. Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle B – must be completed;b. Outdoor Emergency Care Fifth Edition;c. www.mynspkit.com.

2) Update your NSP record.a. Check your personal profile in the “Member Resources” section of www.nsp.org to ensure

that your information is correct, or call the national office at 303-988-1111. 3) Complete the online refresher course (if using the hybrid format).

a. Access the online course by checking with the patrol where you are attending the refresher.b. Follow the directions carefully and completely, and have your Outdoor Emergency Care Fifth

Edition ready.c. Print your certificate and take it with you to the refresher event. If you do not have a

certificate, you may not be allowed into the refresher.4) Gather materials for the refresher event.

a. This Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle B, completed, AND the printed certificate from the online portion (hybrid only).

b. Bring your current OEC, CPR, and NSP member cards. Your OEC card should have a blank space in the Cycle B section.

c. A fully stocked aid belt, vest, or pack, and any additional items required at the refresher you will attend.

d. Weather-appropriate clothing for both indoor and outdoor refresher activities.5) Practice the skills that are identified in the Outdoor Emergency Care Refresher Workbook 2015 OEC

Cycle B. a. This refresher workbook provides objective lists of skills, and skill objectives to practice.b. By being proficient at Outdoor Emergency Care Fifth Edition skills, you will feel more

comfortable during the skill and scenario stations.c. At a traditional refresher, you will be able to be more interactive during the training sessions.

6) Attend the skills refresher.a. Check with your local patrol to ensure that you are both attending and completing the

appropriate refresher format.b. If you complete a refresher with another patrol, be sure to have the host IOR sign the

Refresher Completion Acknowledgement Form on page 30 of this workbook.

What to know in order to complete this year’s refresherProgram content: objectives overview (major topic groupings) Cycle B

• Rescue Basics/Patient Assessment• Airway/Oxygen/Shock• Organ System Disease and Trauma

o Neurological, including spinal assessment and immobilizationo Musculoskeletalo Gastrointestinal/Genitourinary

• Environmental Emergencies• Lifts/Loads/Carries• Adaptive Athletes• Case Presentation

3Cycle B 2015

Program Process OEC technicians must complete an OEC refresher each year. This program offers OEC technicians an opportunity to update, renew, and demonstrate their competency in specific OEC skills and knowledge. The OEC Refresher Program is a standardized program. During each refresher cycle, every OEC technician reviews required material and demonstrates proficiency in specified skills.

Every required skill must be demonstrated during the annual refresher as outlined in this workbook. With every refresher, OEC technicians have the opportunity to hone and improve their clinical skills.

Verification of OEC technician competency in fundamental knowledge, skills, and scenario management is the basis of the OEC Refresher Program.

OEC technician certification is maintained by completing three consecutive annual refreshers. All NSP members must complete each of the refreshers (Cycles A, B, and C) to maintain their OEC certification. The only NSP members exempt from this requirement are mountain hosts, registered candidate patrollers enrolled in an OEC course, members who complete a full OEC course after May 31 of the current year, and members registered as medical associates (M.D. or D.O.).

The OEC Refresher Program does not provide a means for a person with previous emergency care or medical training to challenge the OEC course. Additionally, the annual refresher covers a third of the OEC Program curriculum requirements and does not meet the requirements for certification under the full OEC Program.

An inactive NSP member returning to active status must hold a current OEC technician card, complete any missed cycle(s) that occurred during the inactive period, and pay dues for any missed seasons(s). If the OEC technician card expired during the inactive registration period, the member may need to retake an OEC course. Please refer to the National Ski Patrol Policies and Procedures for guidelines on registering as an NSP member and other OEC technician refresher requirements.

The refresher Each refresher consists of three components:

• Didactic portion (either online or in person); • Completion of the Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle B; and • Completion of the skills component.

In order to receive credit for this refresher cycle, OEC technicians must successfully complete one of the following refresher types:

• The “standard” refresher format consists of two steps. First, the OEC technician reviews and completes the assignments and cases in this Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle B. They then complete a knowledge and skill-based refresher event. They also must demonstrate their OEC skills and discuss the cases they have reviewed. The Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle B must be collected and reviewed for completeness by the IOR prior to completion of the refresher.

• The “hybrid” refresher format consists of three steps. First, the OEC technician reviews and completes the assignments and cases in this Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle B. In conjunction, the technician must complete the online portion that reviews the knowledge-based portion of the refresher and prepares the OEC technician for the skills and scenario-based refresher event that they attend in person. The Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle B must be collected and reviewed by the IOR for completeness prior to completion of the refresher.


OTHER PROGRAM REQUIREMENTSCPR for active NSP members: Active NSP members must ensure that they maintain a current professional-rescuer-level CPR certification and demonstrate their CPR skills annually to an agency-approved certified CPR instructor, regardless of the requirements of the certifying agency or the expiration date on their card. This requirement is not meant to be part of the annual OEC refresher. For a complete list of NSP-approved CPR certifying agencies, please see the National Ski Patrol Policies and Procedures.

Local patrol training, such as local patrol requirements, area needs, lift evacuation, CPR, AED, and other on-hill/on-trail training, is arranged through your home patrol and is NOT officially part of the OEC refresher process. The NSP is not responsible for the content, instruction, or scheduling of this training, so it is important to communicate with your local patrol regarding these requirements.

CYCLE B SKILLS OBJECTIVESDuring the refresher hands-on portion, you will complete the following objectives. For more specific information, please refer to your Outdoor Emergency Care Fifth Edition and the “Refresher Objectives and Skills Checklist” found in this workbook on pages 26-29.

5-7. Describe and demonstrate the following drags, lifts, and carries (choose at least three, plus power grip and power lift):• Shoulder drag;• Extremity lift;• Bridge/BEAN lift;• Human crutch;• Fore and aft carry;• Chair carry;• BEAM lift;• Draw sheet carry;• Power grip, and• Power lift.

3-10. Describe and demonstrate how to ensure scene safety (at all stations).7-4. Describe and demonstrate how to perform a primary assessment.7-5. Describe and demonstrate how to perform a secondary assessment.7-9. Describe and demonstrate how to obtain a SAMPLE history.7-13. Describe and demonstrate the procedure for obtaining respiratory rate, pulse rate, and blood

pressure.9-2. Describe and demonstrate how to manually open the airway or mouth using the following

techniques:• Head-tilt, chin-lift; • Jaw thrust; and• Crossed finger.

9-4. Describe and demonstrate how to place a patient into the recovery position.9-6. Demonstrate the proper methods for choosing the correct size and inserting them:

• Oropharyngeal airway; and • Nasopharyngeal airway.

9-8. Describe and demonstrate how to properly set up an oxygen tank for use.10-9. Describe and demonstrate the management of shock, with a neurological focus (treatment of

shock should be included in all stations).14-5. Describe and demonstrate the steps for properly using portable epinephrine auto-injectors.16-4. Describe and demonstrate how to assess the abdomen.16-5. Describe and demonstrate the management of a patient with a severe gastrointestinal or genitourinary emergency.20-2.4. Describe and demonstrate how to assess a hip/proximal femur injury.20-3.3. Demonstrate how to care for a specific injury to the hip/proximal femur (teams of three–five).21-8. Describe and demonstrate how to assess and treat a patient with head, neck, and spine injuries.21-9. Demonstrate how to maintain proper spinal alignment while placing a patient onto a spine board

from the following positions (group skill): • Lying; and • Sitting.

5Cycle B 2015

21-10. Describe and demonstrate how to remove a helmet on a supine patient.24-6. Describe and demonstrate how to assess and manage an evisceration.24-7. Describe and demonstrate how to assess and manage an impaled object in the abdomen or pelvis.24-8. Describe and demonstrate how to manage a pelvic fracture. (Skill only: apply pelvic sling as a

team of three–five, and describe a transportation device.)26-3. Describe and demonstrate the assessment and emergency care of a patient suffering from each of

the four types of heat-related illness.26-5. Describe and demonstrate the assessment and care for a patient who has been struck by lightning.27-5. Describe and demonstrate how to assess a patient that has been injured following an encounter

with a toxic plant, an animal, or marine life.27-6. Describe and demonstrate how to manage an exposure to topical toxins.27-7. Describe and demonstrate the proper management of wounds caused by animals, including

reptiles, insects, and spiders.32-7. Describe and demonstrate how to assess an adaptive athlete.32-8. Describe and demonstrate how to care for an adaptive athlete who is injured or ill.

HOW TO FIND THE ANSWERSInstructions for completing your Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle BWelcome to the Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle B. The Refresher Committee’s task was to create a workbook that would enhance your overall refresher experience. There are eight modules, each one directed at different subject matter. You will find it helpful and necessary to use your Outdoor Emergency Care Fifth Edition when completing the workbook. Another excellent resource is the OEC online website “MyNSPkit.” For more information on “MyNSPkit,” check the inside cover of your Outdoor Emergency Care Fifth Edition. Use your Outdoor Emergency Care Fifth Edition and Outdoor Emergency Care Refresher Workbook 2015 OEC Cycle B together to review the topics and chapters as indicated by the title of each workbook module, and answer the questions and complete each exercise.

The title of each module refers to a portion of the chapter(s) you will be reviewing in a particular module. The title is shown in red, and the objective numbers are shown in bold print. Consider this example: Lifts, Loads, and Carries (workbook module title); and 5-1. Define body mechanics. The first number refers to the chapter the answer can be found in, Chapter 5 in this instance. The second number (1 in this example) tells you that this is the first topic to be discussed in the chapter. From there, find the objective in the book, review it, and hopefully the answer will present itself.

For those OEC technicians that use an electronic version of the Outdoor Emergency Care Fifth Edition textbook, we have included keyword searches in bold and italics.

Remember, completing the workbook is an important part of your refresher, and a requirement. The workbook must be brought to the OEC refresher and reviewed by the IOR for completeness.


ANATOMY AND PHYSIOLOGYIn this unit, you will review the following objectives:

6-2. Identify various anatomical terms commonly used to refer to the body.6-4. List the five body cavities. 6-5. Identify and describe the fundamental anatomy and physiology of the gastrointestinal, nervous,

muscular, skeletal, and urinary body systems.6-7. Identify and properly use various anatomical terms to describe body direction, location, and

movement.

Label the various anatomical terms commonly used to refer to the body, and know how to properly use various anatomical terms to describe body direction, location, and movement.

There are five body cavities; using your Outdoor Emergency Care Fifth Edition, please list and review each body cavity.

1).

2).

3).

4).

5).

7Cycle B 2015

ACROSS6) This system is involved in the elimination of waste.8) The is made up of three sets of paired bones: the ilium, pubis, and ischium.10) Coordinates body functions.12) One of the two main anatomical parts of the nervous system.13) The adult has 206 bones.14) The body has over 600 of these, most of which are attached to the bones by strong tissues called tendons.17) The number of lumbar vertebrae.

DOWN1) Involuntary muscles found in the walls of tubelike organs, ducts, and blood vessels. They also form the

intestinal wall.2) Contractions of the system allow the body to move.3) Connects muscle to bone.4) Part of the urinary system, these are located in the lower back outside the abdominal cavity at the lower rib

cage, one on each side.5) This body part secretes digestive enzymes and buffers.7) The are a large storage site for important minerals, especially calcium, needed for many

body functions. 9) The gastrointestinal system is also known as the system.10) This is the most primitive part of the brain, and is the brain’s connection to the spinal cord.11) A clear, colorless fluid that is produced inside the brain and circulates throughout the central nervous

system.15) The is the largest organ in the abdomen, and aids in the digestion of fats by

producing bile. 16) This body part secretes acid and mixes food to start digestion.

GUTS, NERVES, MUSCLES, BONES, AND URINARY


Match the following directional terms with the best description at the right.

__ 1) anterior a. closer to the trunk__ 2) deep b. in the back of the body__ 3) distal c. near the patient’s head__ 4) external d. close to the midline__ 5) inferior e. near the surface of the body__ 6) internal f. refers to the inside__ 7) lateral g. refers to the outside__ 8) medial h. far from the surface__ 9) posterior i. near the patient’s feet__ 10) proximal j. in the front of the body__ 11) superficial k. away from the trunk and nearer to the extremities__ 12) superior l. away from the midline

For more information on “Anatomy and Physiology,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 6, pages 167-212. Keyword search: use bold italic printed words.

NOTES

The CPR mask tha t can w i t hs tand ha rsh env i ronmen ts , co ld , ex t reme a l t i t ude ,and c r u s h i n g f o r c e s . N u M a s k ’ s I n t r a o r a l C P R mask was designed to overcome the inherent l i m i t a t i o n s o f t r a d i t i o n a l f a c e m a s k s . T h e NuMask works intraoral ly; behind the l ips andin front in f ront o f the teeth, l ike a snorkel for a leak- f ree f i t every t ime.

“This is a product all patrollers should have in their packs.”- Dav id H. Johe, MD, Cha i rman NSP Med ica l Commi t tee

• 1 /10 th t he s i ze o f you r cu r ren t mask • T r im- to -s i ze OPA • Eas ie r t o l ea rn , use , and remember • Op t i ona l hands - f ree ven t i l a t i on • Rad i ca l l y imp roves ven t i l a t i on

* *Endo rsed by t he NSP Med ica l Commi t t ee * *

9Cycle B 2015

LIFTS, LOADS, CARRIESIn this unit, you will review the following objectives:

5-1. Define body mechanics.5-5. Explain the difference between an urgent and nonurgent move.

Body mechanics is the proper use of body movement in daily activities to prevent problems associated with posture.

List an example of an urgent move and a nonurgent move.

For more information on “Lifts, Loads, and Carries,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 5, pages 126-166. Keyword search: use bold italic printed words.


RESCUE BASICS AND ASSESSMENTIn this unit, you will review the following objectives:

3-8. List common personal protective equipment used by OEC technicians.3-9. Describe the four components of the scene size-up. 7-6. Define the following terms:

• Assessment; • Chief complaint; • DCAP-BTLS; and • Sign and symptom.

Circle the preferred personal protective equipment (PPE).

Disposable medical gloves Goggles

Eyeglasses Cotton gloves

Latex gloves Neck gaiter

Surgical masks Safety glasses

Stocking cap Hand-washing before patient contact

Sunglasses Medical gowns

Hand-washing after patient contact Ski gloves

The scene size-up usually takes only a few minutes, but may take longer, depending on the situation. A scene size-up has four components: scene safety, the mechanism of injury (MOI) involved or nature of illness (NOI), the total number of patients involved, and the need for additional resources.

Define the following terms.

Assessment:

Chief complaint:

DCAP-BTLS:

Sign:

Symptom:

For more information on “Rescue Basics and Assessment,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 3, pages 56-97, and Chapter 7, pages 213-263. Keyword search: use bold italic printed words.

Common MOIs• Blunt force (fall from a bike, car crash, punch in the

face by a fist);• Penetrating force (gunshot wound, knife wound,

puncture from a broken tree branch or ski pole);• Twisting or rotational force (knee injury from catching

an edge while skiing, hurt back from bending at an awkward angle to pick up something); and

• Explosive force (injury sustained from the shock waves of an explosion).

Common NOIs• Altered mental status;• Respiratory problems;• Cardiac problems;• Gastrointestinal problems;• Substance-related problems; and• Environment-related problems.

11Cycle B 2015

CRITICAL INTERVENTIONSAirway Management In this unit, you will review the following objectives:

9-6. List the indications of, and uses for, the following airway adjuncts: • Oropharyngeal airway; and • Nasopharyngeal airway.

The indications for using a nasopharyngeal airway (NPA) include patients who are unresponsive or semi-responsive, have altered mental status and an intact gag reflex, have oral injuries and airway compromise, or have had or are having a seizure and whose teeth are tightly clenched. NOTE: The adjunct is relatively contraindicated in patients with massive head injuries due to possible aggravation of the injury and/or damage to the nose. Indications for using an oropharyngeal airway (OPA) are an unresponsive patient with an absent gag reflex.

ShockIn this unit, you will review the following objectives:

10-1. Define shock (neurological focus).10-7. Describe how the body compensates for shock (compensated shock).10-8. List the classic signs and symptoms of shock.

Shock, or hypoperfusion, is defined as failure of the circulatory system to maintain adequate blood flow to tissues, resulting in a state of inadequate tissue perfusion in which cells do not receive sufficient amounts of oxygen and nutrients to meet their immediate metabolic needs. Neurogenic shock is a type of distributive shock caused by disruptions of the central nervous system, most often resulting from a spinal cord injury. Distributive shock occurs when the blood vessels lose their ability to constrict appropriately.

Referring to your Outdoor Emergency Care Fifth Edition, describe how the body compensates for shock, and list the signs and symptoms of shock.

For more information on “Airway Management” and “Shock,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 9, pages 291-328, and Chapter 10, pages 329-354. Keyword search: use bold italic printed words.

336 SECTION 3 CRIT ICAL INTERVENT IONS

organs die, resulting in organ system failure and eventually death. Despite even ag-gressive treatment, this form of shock is neither reversible nor survivable.

Types of ShockAs previously noted, shock occurs when one or more of the components of the car-diovascular system are adversely affected by disease or injury. These problems can beeither volume related (e.g., involve the blood), container related (e.g., involve bloodvessels), or pump related (e.g., involve the heart). With this firmly in mind, OECTechnicians must be familiar with four types of shock: hypovolemic shock, cardio-genic shock, distributive shock, and obstructive shock (Figure 10-6�).

Hypovolemic ShockHypovolemic shock results from a critical decrease in circulating blood volume. It isa blood volume-related problem that is caused by either a loss of circulating bloodor a loss of internal body water. Of the two, blood loss is more common and hasmore far-reaching effects (Figure 10-7�). Blood loss that results in shock, betterknown as hemorrhagic shock, can be caused by a variety of problems, includingtrauma, gastrointestinal bleeding, vascular disruption, vaginal bleeding, and whenbleeding is a complication of pregnancy. Bleeding disorders and certain medications

CONTINUOUS CYCLE OF SHOCK

External blood loss and pooling of blood in largeinternal vessels depresscirculation.

Tissues and organsreceive inadequatesupply of blood.

Blood loss causesrapid heart rate andweak pulse.

Blood vessels constrict inextremities to conserveblood causing cold, clammyskin.

Low levels of oxygen tobreathing control centers ofbrain make respirationsrapid and shallow.

Nervous systemreaction resultsin profuse sweating.

Vasoconstriction failsand blood pressuredrops.

Leaking capillaries leadto loss of vital bloodplasma causingcirculatory depressionand thirst.

Unresponsiveness anddeath may result.

TRAUMA OF ANY KIND

Figure 10-5 The cycle of shock.

10-7 Describe how the bodycompensates for shock.

10-6 List the four types of shock.

M10_NATI4800_01_SE_CH10.QXD 4/8/11 3:53 PM Page 336


MEDICAL EMERGENCIES Allergies and Anaphylaxis In this unit, you will review the following objectives:

14-1. Define the following terms: • Allergy; • Allergic reaction; • Anaphylaxis; • Antigen; and• Hypersensitivity.

14-2. List the four routes by which an antigen enters the body.14-3. List four potential allergy sources.14-4. List the signs and symptoms of an anaphylactic reaction.

Match the following terms with their definitions.

__ 1) Allergy a. a foreign substance that when introduced into the body stimulates the production of an antibody.

__ 2) Allergic Reaction b. a severe allergic reaction that can result in serious cardiac or respiratory compromise.__ 3) Anaphylaxis c. an exaggerated immune response to an allergen, drug, or other

foreign substance.__ 4) Antigen d. an exaggerated immune response to a substance that does not

normally cause a problem.__ 5) Hypersensitivity e. a series of signs and symptoms that occur in response to exposure

to an antigen.

Allergens can enter the body via several routes. They can be inhaled, ingested, injected, or come in contact with the skin (topical).

List four potential allergy sources.

1)

2)

3)

4)

Signs and symptoms of severe allergic reaction and anaphylactic shock

1. Severe anxiety, feeling of impending doom. 2. Decreased level of responsiveness (including coma). 3. Severe respiratory distress (e.g., tripod position, use of accessory muscles).

4. Abnormal lung sounds (can vary from audible wheezing to “silent chest” in which no lung sounds are heard).

5. Severe angioedema of the tongue, face, and hands (eyes can swell shut; may be unable to remove rings).

6. Hives (may be located over face, neck, chest, abdomen, and arms). 7. Inability to swallow. 8. Tachycardia (significantly increased heart rate). 9. Weak or absent peripheral pulses. 10. Hypotension (low blood pressure). 11. Pallor. 12. Cyanosis around lips and face.

Insect stings Plants

FoodMedications

13Cycle B 2015

Anaphylactic shock is identified by simultaneous signs of severe allergic reaction and shock (hypovolemic shock): 1. Systolic blood pressure: less than 90 mmHg. 2. Respirations: greater than 20 respirations per minute. 3. Heart rate: greater than 110 beats per minute; in some cases, patient may have a pulse rate less than

60 beats per minute. 4. Level of responsiveness (LOR): decreased, Glasgow Coma Scale (GCS) less than 14. 5. Oxygen saturation levels: frequently less than 90 percent, and may be less than 80 percent.

6. True emergency: must be treated quickly to prevent death.

Chemicals such as natural rubber and latex are also known to induce allergic reactions in people not previously diagnosed with any other allergic disorder. This explains why medical personnel, including OEC technicians, are strongly encouraged to use latex-free medical supplies and equipment.

For more information on “Allergies and Anaphylaxis,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 14, pages 434-456. Keyword search: use bold italic printed words.

Gastrointestinal/Genitourinary EmergenciesIn this unit, you will review the following objectives:

16-1. List at least six possible causes of emergencies involving the gastrointestinal and genitourinary systems.

16-2. List the signs and symptoms of emergencies involving the gastrointestinal and genitourinary systems.

16-3. Compare and contrast visceral pain and parietal pain.

Circle the words that have to do with the gastrointestinal and genitourinary systems, OR are the signs and symptoms of a gastrointestinal or genitourinary emergency.

Khumbu cough Vomiting Nephrolithiasis Blistering

Dislocated hip Hematuria Colic Dizziness

Hot/dry skin Epinephrine Appendicitis Indigestion

Hematemesis Cool/moist skin Hepatitis Altered mental status

Paralysis Pyelonephritis Nausea Febrile seizures

Chilblains Pain and tenderness Anaphylactic shock Abdominal aortic aneurysm

With parietal pain, the pain can be easily and precisely pinpointed to a specific location. Visceral pain is diffuse, spread over a large area, and the patient cannot pinpoint the exact location.

For more information on “Gastrointestinal/Genitourinary Emergencies,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 16, pages 494-515. Keyword search: use bold italic printed words.


WHO SHOULD BE PUT ON A SPINE BOARD WITH A CERVICAL COLLAR?“My back hurts.” Do you place this patient on a spine board?By David H. Johe, M.D., NSP National Medical Adviser

Since the Outdoor Emergency Care Fifth Edition was published in 2012, many EMS systems have adopted protocols that are based on scientific medical literature that allow EMTs and paramedics in some states to “clear spines” in patients who have experienced significant trauma. OEC technicians are emergency medical first responders, and it is not in their realm of training or expertise to “clear the spine.” Taking a careful history, considering the mechanism of injury, and doing a thorough physical assessment of a trauma patient are OEC skills which, when done well, can help the OEC technician determine who should be placed on a spine board. Once a patroller applies a cervical collar and straps a patient to a spine board for spinal immobilization, only a qualified advanced medical provider can remove the patient from the spine board.

The patroller’s decision on whether to use a spine board on a patient with back pain is made after a comprehensive evaluation that includes evaluating the patient’s mental status, performing a full manual midline spinal exam, and doing a neurologic assessment of the extremities. Other factors in a patroller’s decision-making process regarding the need for spinal immobilization include alcohol or drug intoxication, spinal axial loading injuries, and “distracting” injuries, such as a broken femur.

For reference, you should review the article “Clearing the Spine” (Ski Patrol Magazine, vol. 31, issue 2, pages 72-74), and also pages 714-718 in the Outdoor Emergency Care Fifth Edition. The guidelines for the National Emergency X-Radiography Utilization Study (NEXUS) discussed in the recent SPM article are important to remember.

In the trauma patient with back pain, whenever mental status is altered or diminished (including from intox-ication), or there is impaired neurologic function such as sensory or motor impairment, or there is a distract-ing injury causing significant pain or anxiety, or there are positive findings when you examine the spinous processes of the spine, you should immobilize the patient with a cervical collar and spine board.

If the patient says “my back hurts,” an evaluation is needed before placing him or her on a spine board. Palpate the entire midline spine (top of neck to buttocks), assessing for tenderness or deformity. Pay particular attention to tenderness upon palpation over the spinous processes of the vertebra. Pain over the midline spine, not beside the midline or over the flank, needs immobilization.

During your neurologic evaluation, establish the person’s mental status using the mini-neurologic exam as discussed in the Outdoor Emergency Care Fifth Edition, and use AVPU or the Glasgow Coma Scale. Diminished mental status in a trauma patient with back pain requires immobilization. Patients who are unresponsive, without a witness present or for whatever reason, should be considered to have head and neck injuries until proven otherwise and require full spinal immobilization. In this case, you do not know whether the patient has had a medical or traumatic event causing him/her to be unresponsive.

NEXUS Low-Risk Criteria

1. Absence of posterior midline cervical spine tenderness.

2. No evidence of intoxication.

3. A normal level of alertness and consciousness (baseline mental status).

4. Absence of focal neurological deficit.

5. Absence of any distracting injuries.

(Eyre A., “Overview and Comparison of NEXUS and Canadian C- Spine Rules,” American Journal of Clinical Medicine, 2006, vol. 3, no. 4, pages 12-15.)

15Cycle B 2015

Assess the patient for substance intoxication (drug or alcohol). If a patient is under the influence of an intoxicating substance, an accurate history and neurologic exam cannot be performed, so by default the patient should have spinal immobilization. A neurologic exam includes assessment of sensation and motor strength of all the extremities. If a deficit is found, and it is not caused from an injury to a limb, the patient should receive spinal immobilization.

Direct axial loading to the spine requires spinal protection. This means any force directed to the top or the bottom of the spine. This would occur in a diving accident, or when a person falls on the top of their head or their buttocks, or lands hard on their feet.

Assess for a distracting injury, such as a broken leg, abdominal injury, or excessive bleeding. A distracting injury is anything that could cause the patient more concern, pain, or anxiety than a spinal injury. This does not mean you put all patients with a broken leg on a spine board; use common sense, and if you suspect a spine injury and/or the patient has a significant distracting injury, apply spinal immobilization.

Sometimes patrollers use a spine board as a litter, allowing them to extricate a patient without a spinal problem from a difficult location and use the board to lift or carry them to the toboggan. When a board is used for this purpose, it is different than when using the board for spinal immobilization.

So, not all “my back hurts” patients require spinal immobilization. Assess and examine the patient and determine if putting them on a spine board with a cervical collar is necessary. Putting someone on a spine board with a cervical collar if not indicated should be avoided. If a trauma patient says “my back hurts” and he/she has a normal mental status, is not on drugs or alcohol, has a normal top to bottom midline spinal exam, has normal distal neurologic findings, has no distracting injury, and there is no axial loading on the spine, then there is no need to immobilize the patient with a cervical collar on a spine board.

Completing a thorough patient assessment and evaluation on the hill is the foundation for determining if a cervical collar and spine board is needed. Spend a few minutes and do a good evaluation on the hill. As always, you should confer with your patrol’s medical adviser, in conjunction with area management, and follow your area protocols for spinal immobilization, making sure this is documented. Also make sure you follow any local or state guidelines for first responders when caring for patients.


TRAUMA Neurological Trauma In this unit, you will review the following objectives:

21-2. Define traumatic brain injury.21-4. Describe the signs and symptoms of potential head injuries involving the brain.21-5. Describe the signs and symptoms of potential spinal injuries.21-7. List the signs and symptoms of increased intracranial pressure.

Traumatic brain injury (TBI) describes physical trauma to the brain; it can be localized or diffuse.

Increased intracranial pressure: maintaining the very narrow range of pressure that the circulating cerebrospinal fluid (CFS) exerts on the inside of the skull and on the structures of the brain is essential for preserving homeostasis, because the volume within the skull, whether due to bleeding or edema (swelling), increases the intracranial pressure. The result is compression of the brain tissue, reduction in brain function, and, ultimately, death.

Signs and symptoms of spinal injuries include pain, deformity, tenderness to palpation, swelling, loss of sensation and/or motor function in one or more extremity, breathing difficulty, and absence of respirations if fracture/spinal injury is high enough on the spinal column.

For more information on “Head and Spine Injuries,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 21, pages 697-741. Keyword search: use bold italic printed words.

706 SECTION 5 TRAUMA

TRAUMA RESULTING IN INJURY TO BRAIN

Trauma – blunt force trauma

Primary injuries

Brain damage

Secondary factors

Structural damage

Loss of responsivenessRespiratory and circulatory

changes may result from primary brain injury and increased

pressure on the brain.

• Decreasing mental status from confusion to coma.

• Deformity of skull.

• Drainage of spinal fl uid or blood from nose and ears.

• Discoloration around the eyes (late).

• Unequal pupils or pupils that do not respond to light.

• Respiratory changes.

• Systolic blood pressure may increase.

• Heart rate may decrease.

• Abnormal posturing.

• Sensory or motor defi cits.

Hematomas and brain swelling lead to increased pressure inside the skull and compression of brain tissue.

Laceration or shearing injury

Contusion

Swelling

Hemorrhage

Lacerations occur with or without skull injury.

Bleeding and swelling occur around areas of contusion.

Skull injury

Hematoma pressing on the brain tissue

Signs and Symptoms

Figure 21-14 Trauma to the head and the brain injuries that result.

21-1 The Demographics of TBI

• Males are about twice as likely as females to sustain a TBI.• The two age groups at highest risk for TBI are children under 4 and teens ages 15–19.• Adults 75 years of age or older have the highest rates of TBI-related hospitalization and

death.• African Americans have the highest death rate from TBI.• TBI hospitalization rates are highest among African Americans and American

Indians/Alaska Natives (AI/AN).

M21_NATI4800_01_SE_CH21.QXD 4/11/11 10:18 AM Page 706

CHAPTER 21 HEAD AND SP INE INJURIES 707

can be classified as either retrograde or antegrade amnesia. Patientswith retrograde amnesia have no recollection of events before the in-jury, including the injury itself. Antegrade amnesia is characterized byno recollection of events occurring after the injury. Patients with am-nesia often present with a distinctive speech pattern in which they re-peatedly ask questions such as, “What happened?” or “Where am I?” or “Who areyou?” sometimes for hours following the injury. This condition, known as persevera-tion, is indicative of both the confusion experienced by these patients and of antegradeamnesia.

Figure 21-15 For this skier, the primary head injury resulted from a collision withthe building; the nature of the secondary injuries remains to be seen.Copyright Edward McNamara

21-2 Signs and Symptoms of Traumatic Brain Injury

• Initial period of unresponsiveness• Altered mental status• Headache• Nausea, vomiting• Slurred speech• Pupillary dilation or unresponsiveness• Rise in systolic blood pressure and pulse pressure• Slow pulse• Lucid period• Leakage of CSF from ears, nose, open wounds• Slow or irregular respirations• Amnesia• Dizziness• Seizures• Incontinence• Numbness, tingling, or paralysis in one or more extremities• Posturing• Paralysis• Raccoon eyes (a late sign, if seen at all)• Battle’s sign (a late sign, if seen at all)

BLUNTFORCE

CONTUSION• Unresponsiveness or decreased level of responsiveness• Bruising of brain tissue

CONCUSSION• May have brief loss of consciousness or unresponsiveness• Headache, grogginess, and short-term memory loss common

Figure 21-16 Concussion, a type of closed head injury.

retrograde amnesia loss ofmemory of events that occurred before atraumatic event to the brain; an inabilityto recall old information.

antegrade amnesia loss ofmemory of events that occurred after atraumatic event to the brain; an inabilityto recall new information.


17Cycle B 2015

Abdominal and Pelvic TraumaIn this unit, you will review the following objectives:

24-1. Identify and locate the major anatomical structures within the abdominopelvic cavity.24-2. List the five functions of the major anatomical structures within the abdominopelvic cavity. 24-3. List and describe at least six abdominopelvic injuries.

Label the components of the abdominal and pelvic cavities.

Liver Spleen Pancreas

Gallbladder Large intestine Small intestine

Stomach Diaphragm Duodenum

Iliac crests Symphysis pubis Umbilicus

Left upper quadrant Right upper quadrant Left lower quadrant

Right lower quadrant Urinary bladder Kidneys

Posterior to abdominal cavity

Bonus: Can you locate the iliac crests and the symphysis pubis in the center (solid organs) diagram?

The functions of the major anatomical structures within the abdominopelvic cavity include:

• Grinds and digests food; • Fights infection and removes old red blood cells; • Processes chemicals in the blood; • Removes waste;• Stores urine until it can be excreted from the body; and• Houses the largest blood vessel in the body.

List and describe at least six abdominopelvic injuries.

1)

2)

3)

4)

5)

6)

For more information on “Abdominal and Pelvic Injuries,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 24, pages 793-812. Keyword search: use bold italic printed words.

HOLLOWORGANS

SOLIDORGANS


ENVIRONMENTAL EMERGENCIESAltitude Illnesses In this unit, you will review the following objectives:

28-4. Describe strategies to prevent altitude illness. 28-5. List the signs and symptoms of the following altitude illnesses:

• Acute mountain sickness; • High-altitude pulmonary edema;• High-altitude cerebral edema.

28-7. Describe the assessment and treatment of a patient with altitude illnesses.

Strategies to prevent altitude illnesses

• Gradual ascent; • Avoiding rapid ascent; • Incorporating a layover at an intermediate altitude; • Once above 10,000 feet, limit increases in altitude to 1,000 feet per day; • At higher altitudes, get more rest; smaller altitude gain may be necessary; • Avoid heavy physical exertion for the first 24-48 hours; • Stay hydrated; • Avoid alcohol and other depressant drugs and tobacco; • While at altitude, eat a high-carbohydrate diet; • If you begin to show signs of altitude illness, do not go higher until symptoms resolve; • People acclimatize at different rates; make sure everyone in your group is properly acclimatized

before going higher; and• Climb high and sleep low.

The following exercise is a two-step process. (Please note: letters and numbers may be used more than once.)Step one: Using the given list of signs and symptoms, put the letters in the blank next to the

corresponding altitude illness.Step two: Using the given list of assessment and treatment options, put the numbers in the blank next to

the corresponding altitude illness.

Acute Mountain Sickness (AMS)

Signs and symptoms:

Assessment and treatment:

High-Altitude Cerebral Edema (HACE)

Signs and symptoms:


High-Altitude Pulmonary Edema (HAPE)

Signs and symptoms:


Signs and symptoms

a. headache b. malaisec. anorexia d. dizzinesse. dry cough f. inner chillg. fatigue h. drowsinessi. paralysis j. sleep disturbancesk. difficulty speaking l. comam. nausea and vomiting n. dyspnea on exertiono. low urine output p. persistent dry coughq. severe dyspnea upon exertion r. true medical emergencys. cyanosis may be in lips and nail beds t. onset of marked fatigue during exerciseu. hallucinations and psychotic behavior v. preceded by AMS; HAPE may also be presentw. altered mental status x. headache and nausea, progresses to ataxiay. serious, potentially life-threatening labored breathing at rest; chest congestionz. about half of the patients experience signs and symptoms of AMS first

19Cycle B 2015

Assessment and treatment

1. ABCDs 2. Ask SAMPLE and OPQRST3. Secondary assessment 4. Immediate high-flow oxygen5. Correct any problems with ABCDs 6. Halt ascent7. Rapid descent 8. Keep patient warm9. Minimize exertion 10. Transport immediately to hospital11. High-flow oxygen 12. Initiate life-saving treatment as needed13. If symptoms do not resolve, descend 14. Self-administer conventional analgesics15. Use of Gamow bag 16. Make delivery of oxygen a top priority17. Place in position of comfort (unless spinal injury is suspected).18. Anticipate vomiting, and be ready to clear the airway.19. Rapid descent of at least 1,500-3,000 feet from where symptoms were first noticed.20. At first sign of ataxia or change in responsiveness, transport to lower altitude of at least 1,500-3,000 feet from where the symptoms were first noticed.

For more information on “Altitude Illnesses,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 28, pages 896-918. Keyword search: use bold italic printed words.

Cold and Heat EmergenciesIn this unit, you will review the following objectives:

25-2. List the signs and symptoms of cold exposure.3-2. Describe the four mechanisms of heat loss.26-2. List the signs and symptoms of a patient with each of the four types of heat-related illness.26-6. Explain what one can do to prevent heat-related illness.26-4. List the signs and symptoms of a patient who is a victim of a lightning strike.

Injury to the body from exposure to cold can be localized, or involve the entire body. Directly exposing skin to a cold environment can cause frostnip or the more severe frostbite. As the entire body chills, hypothermia can occur.

Match each heat-related condition to its description; the terms may be used more than once.

__ 1) heat-induced sycope a. a life-threatening condition characterized by a decreased level of responsiveness, a core body temperature of 104 F or higher, and elevated heart and respiratory rates.

__ 2) heat stroke b. a temporary loss of responsiveness caused when blood is temporarily shunted to the peripheral circulation to support heat loss at the body’s surface.

__ 3) heat exhaustion c. a condition characterized by painful thigh or calf muscles caused by electrolyte imbalances and dehydration.

__ 4) heat cramps d. usually occurs when an individual is standing and is preceded by nausea, light-headedness, sighing, and yawning.

e. characterized by decreased sweating or no sweating. f. a common condition among the elderly living in unventilated buildings or among young children left alone in cars. g. characterized by nausea, fatigue, dizziness, headache,

excessive sweating, decreased urinary output, and elevated core body temperature below 104 F.

MECHANISMS OF HEAT LOSS

ConvectionBody heat is lost to surrounding air, which becomes warmer, rises, and is replaced with cooler air next to the body.

RadiationBody heat is lost to the atmosphere or nearby objects without physically touching them.

EvaporationPerspiration or wet skin results in body heat lost when the liquid evaporates.

ConductionBody heat is lost to nearby objects through direct physical touch.

CHAPTER 25 COLD-RELATED EMERGENCIES 825

HypothermiaAs previously noted, hypothermia is divided into three categories that are defined bycore body temperature ranges. In the field, measurement of core temperature can bedifficult or impossible. Table 25-2� presents a system for estimating core body tem-perature and the severity of hypothermia based on the patient’s presentation.

Mild Hypothermia

Generally, mild hypothermia (below 95°F or 35°C) first mani-fests as shivering, which can be vigorous. Shivering is an impor-tant mechanism that significantly increases muscle activity andheat production. It initially starts when the body’s core temper-ature falls below 96.8°F (36°C). Unless other factors are pres-ent, shivering should enable the patient to overcome heat lossand elevate core temperature. In fact, most patients with mildhypothermia are able to warm themselves through shiveringalone, although they still require protection from further heatloss in the form of warm, dry insulation for the body.

If core temperature continues to fall, uncontrollable shiver-ing is observed until the core temperature reaches approxi-mately 90°F (32°C). The exceptions to this are exhaustedpatients who are unable to shiver, and some cases of chronic ex-posure (greater than 6–8 hours) in which exhaustion occurs andshivering stops. Such patients generally remain responsive, al-though they may be confused and exhibit both a loss of judg-ment and decreased fine motor coordination (Figure 25-14�).

Moderate Hypothermia

The transition to moderate hypothermia (86°–93.2°F or30°–34°C) is characterized by cessation of shivering (usually ata core temperature of about 90°F or –32°C). A progressiveslowing of metabolism also occurs, as evidenced by a slow pulse

25-1 Signs and Symptoms of Frostnip and Frostbite

Superficial (frostnip) Skin appears cool and pale and may be painful; tissues remainintact

Partial thickness(frostbite)

Skin has white or gray colored patches that are not painful; tissuemay indent if pressed; tissue loss, if present, is minimal

Full thickness(frostbite)

Skin is cold and feels hard or woody; tissue is white or gray and willnot rebound when pressed; the area is numb (no pain); no pulsecan be detected

25-2 Severity of Hypothermia

Severity ofHypothermia Patient Presentation

Core Body Temperature

Mild Alert but may be confused, shivering below 95°F (35°C)Moderate Drowsy, decreased level of responsiveness,

not shivering86°–93.2°F (30°–34°C)

Severe Unresponsive, may not be breathing � 86°F (� 30°C)

Figure 25-14 Confusion is one of thefirst stages of hypothermia.



Place the following signs and symptoms of hyperthermia in order from least severe (1) to life-threatening (5).

__ a. sweating__ b. heat exhaustion__ c. heat stroke__ d. syncope__ e. heat cramps

To maximize tolerance to hot environments, a program for heat acclimatization is important. Ensuring adequate hydration by consuming water or electrolyte drinks to maintain adequate fluid volume is also important before and during a trip into a hot environment. During periods of exercise lasting several hours or more, salty snacks and adequate water intake are necessary to maintain adequate salt balance and prevent hyponatremia from salt and water losses in sweat. Wearing loose-fitting, lightweight, light-colored clothing and a wide-brimmed hat, avoiding exercise during the hottest part of the day, and resting frequently in the shade are all important measures for preventing heat illnesses.

List six signs and symptoms of a lightning strike.

1)

2)

3)

4)

5)

6)

For more information on “Cold and Heat Emergencies,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 25, pages 813-837, Chapter 26, pages 838-860, and Chapter 3, pages 56-97. Keyword search: use bold italic printed words.

Plant and Animal EmergenciesIn this unit, you will review the following objectives:

27-1. Compare and contrast poison, toxin, and venom.

It is important to understand the difference between a toxin, a poison, and venom. A toxin is a poison made by a living creature, whether plant or animal. A poison can come from a living creature or from chemicals or substances that do not come from living creatures. Venom is a specific toxin or poisonous secretion of an animal, most commonly from a snake, spider, or scorpion, usually transmitted by a bite or sting.

For more information on “Plant and Animals Emergencies,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 27, pages 861-895. Keyword search: use bold italic printed words.

Water EmergenciesIn this unit, you will review the following objectives:

29-1. Compare and contrast dry drowning and wet drowning.29-3. Define the following terms:

• Submersion injury; • Drowning; • Near-drowning; • Arterial gas embolism; and • Decompression sickness.

29-6. List nine ways in which a water-based emergency may be prevented.29-8. Describe how to manage a patient who has suffered a water-related emergency.

21Cycle B 2015

Dry drowning is more common than wet drowning, and involves aspiration of a small amount of fluid and violent laryngospasm, which tightly seals the airway. In this form of drowning, very little fluid actually enters the lungs. By contrast, in wet drowning, either the laryngospasm is minor or the airway muscles quickly relax, allowing liquid and any material it contains to flood into the lungs. Dry drowning usually precedes wet drowning, although wet drowning may occur alone.

Match the following terms with the correct definition.

__ 1) Submersion injury a. suffocation by submersion in water.__ 2) Drowning b. a condition following a rapid ascent in which air bubbles

from a ruptured alveolus get lodged in the bloodstream.__ 3) Near-drowning c. the formation of nitrogen bubbles in tissues from too rapid

an ascent; usually occurs hours after ascent.__ 4) Arterial gas embolism d. survival for at least 24 hours after being suffocated by

submersion in water.__ 5) Decompression sickness e. any injury that occurs while a person is under water.

List nine ways in which a water emergency may be prevented.

1)

2)

3)

4)

5)

6)

7)

8)

9)

Describe how to manage a patient who suffers a water-related emergency; the answer can be found in Chapter 29 of your Outdoor Emergency Care Fifth Edition.

For more information on “Water Emergencies,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 29, pages 919-941. Keyword search: use bold italic printed words.


SPECIAL POPULATIONS AND OUTDOOR ADAPTIVE ATHLETESIn this unit, you will review the following objectives:

32-1. Define and contrast the following terms:• Disability;• Handicap; and• Impairment.

32-4. Describe four elements of effective communication with a person who has an intellectual disability.

32-6. List the signs and symptoms of autonomic dysreflexia.

Match the following words with their correct definitions; a definition may be used more than once.

Handicap: _____ a. any loss or limitation of physical or intellectual function.Disability: _____ b. any condition that impairs normal function or daily activity.Impairment: _____

List four elements of effective communication with a person who has an intellectual disability.

1)

2)

3)

4)

Review the signs and symptoms of autonomic dysreflexia (found in Chapter 32 of your Outdoor Emergency Care Fifth Edition).

For more information on “Adaptive Athletes,” please refer to Outdoor Emergency Care Fifth Edition, Chapter 32, pages 1009-1038. Keyword search: use bold italic printed words.

23Cycle B 2015

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CASE PRESENTATIONIt is a cool fall day at the Apple Festival at a Northeastern ski resort. Part of the entertainment is a team of five skydivers landing near the base lodge. The designated landing area is in close proximity to the festival’s bandstand. A crowd of partygoers starts to gather around the landing site, several layers deep. As the skydivers start to land, the crowd cheers them on and moves in closer to see the action.

As the last parachutist attempts to land, the landing zone has become drastically smaller as a result of the encroaching crowd, and he has to quickly abort his intended landing area. With quick thinking and maneuvering, the skydiver diverts his flight path to the next most acceptable landing area, which takes him close to the stage.

Knowing that he is headed for the 20-foot tower of stacked speakers, the skydiver hikes up his legs to avoid them, but he ends up skimming the top of them with his buttocks. With horror in their eyes, the bystanders scramble to get out of the way as the speakers come down.

A woman who is struck by one of the unseated speakers lands hard on the ground on her right side, and the speaker comes to rest on top of her. The force of the falling speaker strikes the woman’s left shoulder, hip, and leg. The woman has suffered double-impact trauma by being hit by the speaker on her left side and then hitting the ground with her right side. Fellow bystanders come to her aid to remove the speaker and secure a safe scene.

The landing skydiver has managed to make a safe landing, despite the speaker impact, and is found lying some distance from the original crowded landing zone. OEC technicians, on duty for the event, rush to evaluate the fallen skydiver and the female bystander, who is screaming in pain.

The 49-year-old woman, presently lying on her right side, complains primarily of right hip pain. She is fully conscious, and explains that she did not hit her head upon impact with the ground, just her right hip area. Hip compression between the fallen speaker on the left hip and impacting the ground on the right side suggests a crushing injury to the pelvis.

The woman insists on staying in a position with her legs drawn up, as in the fetal position. She has intact sensation in her lower extremities, and is hesitant to move her legs or have them repositioned due to severe pain. There are no obvious signs of any external bleeding. The patient is very anxious, with a pulse rate of 110 and a respiratory rate of 24. Her skin is pale and cool. The patient reports no chronic medical problems, with the exception of being a heavy smoker. She ate a hamburger for lunch today, and drank a couple of beers in the last hour. OEC technicians would like to put the patient on a spine board for spinal precautions; however, the patient is refusing to straighten out her legs or lay flat.

The skydiver is a 29-year-old male, a former paratrooper who has made over 500 aerial jumps in his career and has never encountered a problematic landing like today. Although he hit the speaker tower, the parachutist made a soft landing. He is alert and lying on the ground while still attached to his chute as an OEC technician approaches.

Blood is visible from the rip in the back of the patient’s jumpsuit, and he is trying to hold pressure over his buttocks with both hands. In addition to bleeding, the patient complains of pain across his buttocks and some swelling in what he refers to as his “saddle area.” He denies hitting his head or back.

25Cycle B 2015

Upon further questioning, the OEC technician determines that he needs to visualize the anterior and posterior pelvic regions. With discreet shielding, and having undone the chute harness, the skydiver’s buttocks are exposed and a large horizontal laceration, approximately one-inch deep and eight inches across, is revealed. The genital exam reveals diffusely enlarged bilateral scrotal sacs, about three times their usual size. In addition to the OEC technician being shocked at what he sees, the patient starts to panic and hyperventilate.

What happens from here?

Injured Female1. During the secondary assessment, you find pain in the pelvis and the patient refuses to move from

the position she is in. Her arms are falling asleep from holding her head off the ground. She does not complain of pain in her back, and states she was on the ground when the speaker struck her. How are you going to immobilize this patient for her pelvic injury?

2. How do you treat this patient for shock?3. What SAMPLE, DCAP-BTLS, and OPQRST questions are pertinent in treating this patient?4. What level of prehospital care and transport is needed for this patient?5. Can you put on a pelvic binder (sheet or Sam Sling) while the patient is in the lateral position?6. Since she is reluctant to get on a board, is there a better device for getting her off the ground? Hint:

she is in a parking lot and the ambulance can drive right to her.

Injured Male1 How do you stop the bleeding in the buttocks?2 During the secondary assessment, is there any reason to think the patient needs spinal

immobilization?3 How are the genitals treated (splinted/packaged/supported, etc.)?4 How do you ensure the scene is safe with the parachute and others around?5 How do you treat this person for shock?

What really happenedThe woman would not allow the OEC technicians to move her until the ambulance arrived. An EMT covering the event completed a primary and secondary survey and found multiple spots of pain in the pelvic region. There was no fluid loss of any kind. The woman had sensory perception and a pulse in both legs, but was afraid to move her legs. Oxygen was started and the OEC technician convinced her to bend her knees a little more to alleviate some of the pressure. She did not feel the urge or need to void, and she did not void during the incident.

Advanced life support with paramedics was brought to the scene, which was located at the edge of the parking lot. Medication was administered to alleviate the pain, and the patient then allowed the team to use a scoop stretcher to pick her up and move her to the spine board. She eventually allowed the team to roll her onto the spine board and secure the pelvis in the position in which she was most comfortable. Oxygen, blankets, and monitoring were all that was needed before the ambulance arrived on scene.

For the skydiver, after securing the scene, ensuring BSI was in place, and contacting management, a large trauma dressing was applied over the buttocks to cover the laceration. Direct pressure was put in place to control the bleeding. Once the wound was covered, the bleeding stopped. The skydiver had released himself from the apparatus so that no one would become entangled and strangle him. He took his helmet off after the secondary survey showed no signs or symptoms of pain along the back or neck and the bleeding had been stopped.

Trauma from hitting the speaker caused both the laceration and genital injury. Treatment for the genitals was to try and reduce the swelling by applying ice. The skydiver was then taken to a trauma facility via advanced life support.

Management was called, and a thorough accident investigation was conducted using the master of ceremonies and OEC technicians trained in accident investigation.


Refresh

er Objectives an

d S

kills C

heck

list (cont.)

Describe and dem

onstrate how to ensure scene safety (at all stations).

xx

Describe and demonstrate how

to perform a prim

ary assessment.

x


to perform a secondary assessm

ent.

x

Describe and dem

onstrate how to obtain a SAM

PLE history.

x

Describe and dem

onstrate the procedure for obtaining respiratory rate, pulse rate, and blood pressure.

x

Gastrointestinal/G

enitourinary

Identify and locate the major anatom

ical structures within the abdom

inopelvic cavity.x

x

List the functions of the m

ajor anatomical structures w

ithin the abdominopelvic cavity.

xx

List and describe at least six abdominopelvic injuries.

xx

List at least six possible causes of em

ergencies involving the gastrointestinal and genitourinary system

s.x

x

List the signs and sym

ptoms of em

ergencies involving the gastrointestinal and genitourinary system

s. x

x

Com

pare and contrast visceral pain and parietal pain.x

x

Describe and dem

onstrate how to assess the abdom

en.

x

Describe and dem

onstrate the managem

ent of a patient with a severe gastrointestinal and

genitourinary emergency.

x


to assess and manage an evisceration.

x


to assess and manage an im

paled object in the abdomen or pelvis.

x

Lifts, Loads, Carries, M

usculoskeletal Trauma, Adaptive

Define body mechanics.

xx

Explain the difference between an urgent and nonurgent m

ove. x

x

Describe and demonstrate the follow

ing drags, lifts, and carries (choose power grip and pow

er lift, plus at least three others):

•Shoulder drag;

•Extrem

ity lift;•

Bridge/BEAN lift;

•Hum

an crutch; •

Fore and aft carry; •

BEAM lift:

•Chair carry; and

•Draw

sheet carry.

pow

er lift and pow

er gripx

Define and contrast the following term

s: •

Disability; •

Handicap; and •

Impairm

ent.x

x

Describe four elem

ents of effective comm

unication with a person w

ho has an intellectual disability.

xx

List the signs and symptom

s of autonomic dysreflexia.

xx

For th

e describe an

d d

emon

strate objectives, the p

atroller shou

ld verbalize w

hat th

ey are doin

g wh

ile dem

onstratin

g the sk

ill.

27Cycle B 2015

Refresh

er Objectives an

d S

kills C

heck

list

Station

Objective(s)

On

line

Inform

ational

objectives

Each

OE

C

techn

ician m

ust

perform

the

followin

g skills

OE

C

techn

ician

mu

st p

articipate

as a team

mem

berS

kill

comp

leted

Overall

Integrate the appropriate use of scene size-up, BSI, and shock managem

ent at each station.x

x

Anatom

y and Physiology

Identify various anatom

ical terms com

monly used to refer to the body.

xx

List the five body cavities. x

x

Identify and describe the fundam

ental anatomy and physiology of the gastrointestinal, nervous,

muscular, skeletal, and urinary body system

s.x

x

Identify and properly use various anatom

ical terms to describe body direction, location, and

movem

ent.x

x

Airw

ay Managem

ent


to manually open the airw

ay or mouth using the follow

ing techniques:

•Head-tilt, chin-lift;

•Jaw

thrust; •

Crossed finger.

x

Describe and dem

onstrate how to place a patient into the recovery position.

x

List the indications of, and uses for, the following airw

ay adjuncts: •

Oropharyngeal airw

ay; and •

Nasopharyngeal airw

ay.x

x

Demonstrate the proper m

ethods for choosing the correct size and inserting them:

•O

ropharyngeal airway; and

•N

asopharyngeal airway.

x


to properly set up an oxygen tank for use.

x

Shock

Define shock (neurological focus).x

x

Describe how

the body compensates for shock.

xx

List the classic signs and symptom

s of shock.x

x

Describe and dem

onstrate the managem

ent of shock, with a neurological focus (treatm

ent of shock should be included in all stations).

xx

Rescue Basics and Assessment

List comm

on personal protective equipment (PPE) used by O

EC technicians.x

x

Describe the four com

ponents of the scene size-up.x

x

Define the following term

s: •

Assessment;

•Chief com

plaint;•

DCAP-BTLS; •

Sign and symptom

.x

x


Com

plete S

amp

le Refresh

er Sk

ills Ch

ecklist (con

t.)

Describe and dem

onstrate the assessment and care for a patient w

ho has been struck by lightning.

xx

x

Compare and contrast dry drow

ning and wet drow

ning.x

x


s: •

Submersion injury;

•Drow

ning; •

Near-drow

ning; •

Arterial gas embolism

; and•

Decompression sickness.

xx

List nine ways in w

hich a water-related em

ergency may be prevented.

xx

Describe how to m

anage a patient who has suffered a w

ater-related emergency.

xx

Describe strategies to prevent altitude illnesses.x

x


s of the following altitude illnesses:

•Acute m

ountain sickness (AMS);

•High-altitude pulm

onary edema (HAPE);

•High-altitude cerebral edem

a (HACE).x

x

Describe the assessm

ent and treatment of a patient w

ith an altitude illness.x

x

Allergies, Anaphylaxis, Plants and Anim

als


s: •

Allergy; •

Allergic reaction; •

Anaphylaxis; •

Antigen; and•

Hypersensitivity.x

x

List the four routes by w

hich an antigen enters the body.x

x

List four potential allergy sources.

xx


s of an anaphylactic reaction.x

x

Describe and dem

onstrate the steps for properly using portable epinephrine auto-injectors.

x

Com

pare and contrast poison, toxin, and venom.

xx

Describe and dem

onstrate how to assess a patient that has been injured follow

ing an encounter w

ith a toxic plant, animal, or m

arine life (choose one).

x

Describe and dem

onstrate how to m

anage an exposure to topical toxins.

x

Describe and dem

onstrate the proper managem

ent of wounds caused by anim

als, including reptiles, insects, and spiders.

x

For th

e describe an

d d

emon

strate objectives, the p

atroller shou

ld verbalize w

hat th

ey are doin

g wh

ile dem

onstratin

g the sk

ill.

29Cycle B 2015

Refresh

er Objectives an

d S

kills C

heck

list (cont.)

Station

Objective(s)

On

line

Inform

ational

objectives

Each

OE

C

techn

ician m

ust

perform

the

followin

g skills

OE

C

techn

ician

mu

st p

articipate

as a team

mem

berS

kill

comp

leted

Describe and dem

onstrate how to assess an adaptive athlete.

x


to care for an adaptive athlete who is injured or ill.

x


to assess a hip/proximal fem

ur injury.

x

Dem

onstrate how to care for a specific injury to the hip/proxim

al femur (team

of three- five).

x

Describe and dem

onstrate how to m

anage a pelvic fracture. (Skill only: apply a pelvic sling as a team

of three-five, and describe a transportation device.)

x

N

eurological Trauma

Define traumatic brain injury.

xx

Describe the signs and symptom

s of potential head injuries involving the brain.x

x

Describe the signs and sym

ptoms of potential spinal injuries.

xx


s of increased intracranial pressure.x

x

Describe and dem

onstrate how to rem

ove a helmet on a supine patient.

x


to maintain proper spinal alignm

ent while placing a patient onto a

spine board from either of the follow

ing positions: •

Lying; or•

Sitting (group skill).

each technician m

ust lead once


to assess and treat a patient with head, neck, and spine injuries.

x

Environmental Em

ergencies


ptoms of cold exposure.

xx

Describe the four mechanism

s of heat exchange.x

x


ptoms of a patient w

ith each of the four types of heat-related illness.x

x

Explain w

hat one can do to prevent heat-related illness.x

x


ptoms of a patient w

ho is a victim of a lightning strike.

xx

Describe and dem

onstrate the assessment and em

ergency care of a patient suffering from each of

the four types of heat-related illness.

each technician m

ust lead tw

o


2015 Cycle B OEC Refresher Completion Acknowledgement

(VISITING OEC technician uses and returns this form to their patrol representative after IOR signs. DO NOT SEND TO NSP; return it to your patrol representative!)

Have this form signed by the instructor of record at the refresher, then return it to your NSP patrol representative. This verifies that you have attended and successfully completed all requirements for the 2015 refresher. Please print.

OEC Technician Name:

NSP ID #:

Ski Patrol/Affiliate Group Registered With:

Refresher Location/Date:

OEC Instructor of Record:

IOR Signature:

2015 Cycle B OEC Refresher Supplemental Roster Information

(VISITING OEC technician fills out this form and gives it to the IOR of the refresher they attend when they arrive. DO NOT SEND TO NSP; in order to receive credit for the refresher, leave the completed form with the IOR!)

This will help the instructor document your completion of this year’s OEC refresher requirements to the national office. Please print.

OEC Technician Name:

NSP ID #:

Address:

City: State: Zip:

Email:

Ski Patrol/Affiliate Group Registered With:

Refresher Location/Date:

OEC Instructor of Record:

31Cycle B 2015

REFRESHER EVALUATION FORMName (optional): Date: Home Patrol: Refresher Location:

1. The refresher was well-organized. Strongly agree Agree Neutral Disagree Strongly disagree

2. The presentations were clear and well-prepared. Strongly agree Agree Neutral Disagree Strongly disagree

3. At the skills stations, I understood what I needed to do at each one. Strongly agree Agree Neutral Disagree Strongly disagree

4. The equipment we used was in good condition, and there was enough to go around. Strongly agree Agree Neutral Disagree Strongly disagree

5. The instructor(s) provided fair feedback of my skills. Strongly agree Agree Neutral Disagree Strongly disagree

6. The refresher was run in a relaxed, positive manner. Strongly agree Agree Neutral Disagree Strongly disagree

7. I am confident in applying the skills reviewed and presented in this refresher in a rescue/patrolling environment.

Strongly agree Agree Neutral Disagree Strongly disagree

8. The workbook was very helpful in preparing for this refresher. Strongly agree Agree Neutral Disagree Strongly disagree

9. Did you use your Outdoor Emergency Care Fifth Edition to review the refresher topics and complete your workbook?

Yes No

10.The “Case Presentation” was helpful, and a valuable part of the refresher. Strongly agree Agree Neutral Disagree Strongly disagree

11.Overall, I would rate this refresher: Excellent Very Good Good Needs Improvement

12. What are the strengths of the refresher?

13. What could be improved in the refresher?

14. I’d like my instructors to do a better job of:

15. My instructors did an excellent job of:

16. Have you used your OEC skills in a place other than your normal patrol environment? If so, where? We welcome your comments and suggestions for improving NSP OEC programs. Please be as specific as possible, and use another sheet of paper if needed.

William Devarney (Chair)Eastern Division Admin. [email protected]

Leisa GarrettSummit East/Hyak Ski [email protected]

Kathy GlynnThree Rivers Ski [email protected]

Alida Moonen, Ph.D.Boston Mills/Brandywine Ski [email protected]

William C. SmithWintergreen Ski [email protected]

Tim ThayerAfton Alps Ski [email protected]

2015 Cycle B OEC Refresher Committee StatementThe mission of the OEC Refresher Committee is to provide assistance to all Outdoor Emergency Care technicians so that they may effectively review Outdoor Emergency Care content and skills each year and render competent emergency care to the public they serve. The objectives of the program are to:

• Provide a source of continuing education for all OEC technicians.• Provide a method for verifying OEC technician competency in OEC knowledge and skills.• Review the content of the OEC curriculum over a three-year period.• Meet local patrol and area training needs in emergency care.

Please take a moment and let us know how we can make your refresher better! Email the Refresher Committee at [email protected].

2015 OEC REFRESHER COMMITTEE

PHOTOSMike Halloran, David Johe, M.D., Jason Lombard, Ed McNamara, Scott Smith, Tom Stillo, Mary Thayer.Front cover photos (clockwise from top left): Patrick Bauer, Brendan McClue, Candace Horgan, Kris Morehead. Middle: Stu-dio 404.Back cover photo: Candace Horgan.Illustrations: Debbie Coleman.

The Outdoor Emergency Care Refresher Workbook is published annually by the National Ski Patrol System, Inc., a nonprofit association of ski patrollers which is located at 133 S. Van Gordon Street, Suite 100, Lakewood, CO 80228. 303.988.1111. © 2015 by National Ski Patrol System, Inc.

MEDICAL REVIEW PANELDavid Johe, M.D., NSP Medical Adviser

INDEPENDENT REVIEW PANELJason Erdmann, Central DivisionBryant Hall, Eastern Division

OEC EDUCATION STAFFDavid Johe, M.D., NSP Medical AdviserDeb Endly, NSP OEC Program DirectorSheila Summers, Ph.D., NSP Education DirectorCandace Horgan, NSP Communications DirectorJill Bjerke, NSP Education Assistant

DESIGNCandace Horgan, NSP Communications Director

REFRESHER WORKBOOK · Instructions for completing your Outdoor Emergency Care Refresher Workbook...

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