Archived Medical Articles

Round-up of published medical topics
Several past editions of The Callout, in its prior incarnation as a newsletter, feature great articles and guides for the medical skills required for Emergency Medical Responders, a certification required of all CoCoSAR Type II and Type I team members.

Compiled below is a list of topics and articles with links to the newsletter. The original author, if available, is also noted. (Please note: requires login to the team members' website to view these articles.)

Step-by-step illustrated guides

Head-to-Toe Assessment, April 2011, Page 8

Bleeding Control and Bandaging, May 2011, Page 8

Splinting and the Sling, May 2011, Page 9

CPR

New CPR Procedures, June 2011, Page 10 

CPR and AED FAQS, by Carol and Mike McMillian, February 2012, Page 11 

Vital Signs

Blood Pressure Basics, by Laura Carmody, RN, October 2011, Page 7 

Blood Pressure: A Closer Look, November 2011, Page 12 

Oxygen

SAR Oxygen Pack, by Mike McMillan, August 2010, Page 11

The Little Green Bottle, by Ian Snelson, August 2010, Page 12 

February Full Team Training

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CoCoSAR’s Mountain Rescue Group organized the February full-team training, a mock search in Mount Diablo State Park. “If it ain't raining; it ain't training,” said Chris Coelho, MRG sergeant, as dark gray storm clouds massed overhead and searchers gathered, bright orange and hooded, at the staging area.

Staging did not stay full for long because the search ramped up very quickly. Teams deployed to scour Mitchell Canyon for two missing subjects. “We put 52 searchers in the field within the first 30 minutes,” said Caroline Thomas-Jacobs, demonstrating an adjustment made by Command Post staff, following the mock night search training, in November 2013.

The first subject to be located, played by team member Natalie Zensius, required extraction by a technical rope rescue team. “I had a unique opportunity to experience what it feels like on the ‘other side’ and be rescued,” she said. “In less-than-stellar conditions, I was quickly warmed and stabilized so that I could be packaged and transported down the mountain.”

Shawn Inks, handling communications for Team 4, located the second subject. “I turned around and saw him,” he said, “but it was kind of lucky. The trail was muddy and treacherous, so we were mostly looking ahead and down.”

Weather was a major factor, hampering radio communications, as well as visibility and trail conditions. “If we had to search Mount Diablo in the rain, this is exactly what it would be like,” said Reza Farasati. “The problems we have today are the problems we’d have to overcome in a real search.”

EMR In Action, ctd.

Team member Will McCammon had a recent medical experience:

I was on my way to a Sunday afternoon shift at the County Fair when I came upon a single-car accident on Highway 4. The car had flipped over and the lone occupant was lying on the side of the road surrounded by a small group of people.  As I didn’t see any first responders on scene, I pulled over to see if I could help. 

A big thank you goes to the EMR training staff for constantly stressing the basics because as I got to the subject, I had my gloves on, was asking if 9-1-1 had been called (it had) and was looking for mechanisms of injury (MOI). While the car was an obvious MOI, I wasn’t sure if the subject had been thrown from the car, had gotten out on his own, or was helped out by bystanders.  

The subject was groaning (ABCs – check) but wasn’t responsive to verbal commands (A&O = 0) and only responded to painful stimuli. Bystanders indicated that he only spoke Spanish and they had pulled him from the car. My first thought was C-spine issues and that he should have been left where he was.

As I was thinking this, an off-duty EMT arrived and asked if he could hold C-spine, which I had him do. A second off-duty EMT (who spoke Spanish) was right behind him and attempted to communicate with the subject (get him to stay conscious and stop moving).  During the few moments before the ambulance and fire personnel arrived on scene, we took vitals (high pulse and rapid respirations) and ascertained that he was injured both on his right side and pelvic area.  

As soon as fire and ambulance responders arrived, everything kicked into high gear. They grabbed C-spine and quickly moved into assessing the patient. Within one or two minutes, they were setting up the patient packaging gear and I found myself applying the skills we train on so often. The only variation with our training was the use of Velcro with the cheese blocks and not tape (I am a convert!) and the need to maintain one leg at a 90-degree angle on the board due to injuries.

Although I wasn‘t tracking our time, I believe the total packaging time was around five minutes. This says something about constant training! The subject was loaded into the ambulance and I was able to head off to the County Fair for the rest of my day.

Reflecting on my first medical experience taught me several valuable lessons:

·       Always be as prepared as possible by having BSI and basic equipment such as a CPR mask readily available – I was heading to the County Fair, so I was geared up.  I can’t count on that in a future event unless I plan for it.

·       A big thanks to the EMR training team and their training process – BSI, scene safety, calling for help, ABCs, etc. rapidly came to mind. What wasn’t so easy was when the process didn’t follow our standard scenarios (patient speaks English and is awake, etc.). I need to mentally rehearse and practice thinking outside the easy patient assessment routines and prep for when the process breaks down. This includes ascertaining available help and skills with bystanders. (I was fortunate an EMT was on-hand to hold C-spine.)

·       Practice, practice, practice – My day job does not provide me with any training in the medical arena, so it’s up to me to develop the skills to feel comfortable and prepared if and when the need arises.

AmGen Medical Detail Recap

It's not every day that CoCoSAR gets front-row seats to a major sporting event. The near-final, seventh stage of the Amgen Tour of California afforded our team the ability to see the “Greatest Cycling Race in America” while practicing patching up some road rash.

With 5,000-plus cyclists (including the crowd), thousands more onlookers, and some steep drop-offs that would make your Camelback pucker, team members provided on-scene medical support by staffing three aid stations and several roving patrols. 

The day was beautiful and the teamwork was even better as the team adapted, improvised and overcame a variety of obstacles from last-minute operational changes to difficult communications. Of course, CoCoSAR pulled it off without a hitch with both style and flare (note the pictures).

Thanks to all those that participated, especially Robert Harrison, our new medical sergeant, for whom the SAR-gods chose this as his first event.
 

Summer Is Here

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By Nancy Hart

Our summer Search and Rescue missions can bring us into some long hot days. It's important to know the signs and symptoms of heat illnesses for ourselves, for our subjects, and for our teammates. I know this well now after my experience at this year's County Fair. It was in the upper 90s on Friday and a whopping 105 degrees on Saturday. Even with sunscreen, I was sunburned on Friday. My body's cooling system just couldn't keep up on Saturday with the burn and the even higher temperatures. Although I drank plenty of water and wore sunscreen, I still succumbed to heat exhaustion by late Saturday. And like the subject in Diane Blue's scenario at last month's full team training, I tried to keep going!  Thanks to a teammate who kept insisting I had too much sun, I finally signed out and spent the next two days nursing a headache and staying indoors. Be safe out there!

Heat Illnesses To Be On The Watch For

Heat edema (and it starts)
Heat causes blood vessels to dilate (open up) and as the body is starting to have trouble with using salt to sweat out, fluid will pool in the hands and legs. Ever get those puffy fingers when running or hiking?

Heat exhaustion (milder initial stage)
Move into an air-conditioned environment and don’t go back out into the sun for at least a day or two or the condition will return and possibly be worse!
• profusely sweating
• rapid weak pulse
• rapid breathing (just can’t “catch your breath”)
• blood pressure drops when standing up (you feel dizzy)
• fatigue (you might feel a little “out of it” and “tired”)
• reddened face changes to -> pale, cool, and moist
• headache
• muscle cramping
• nausea (sometimes vomiting)

Heat stroke (next stage, can be deadly!!)
Immediately get out of the sun, in an air-conditioned room preferably, and sponge cool water on the skin. Call for an ambulance to the emergency room.
• sweating has stopped!! – skin is dry, red and hot (body’s sweating mechanism has failed)
• body temperature is up over 101 degrees F
• confusion (Can your teammate or subject remember where they are? What the plans were for the day? What day of the week it is? Their name or your name?)
• throbbing headache and nausea
• severe cramps (as if muscles are encased in cement and you can’t move)
• pulse is fast, breathing rapid, blood pressure low

CDC Facts on Heat Illness, Heat Exhaustion, Heat Stroke
 

In the wee hours of Monday morning in Antioch…

Over half of the CoCoSAR team participated at the Contra Costa County Fair in Antioch as set-up volunteers, medical support and Reserve duty deputies for four days of fair activity. However, an unseen few worked the closing operations. 
 
While 90-plus team members helped with SAR operations during the fair, eight individuals helped with the dismantling and transfer of equipment back to the OES, some of whom had already spent many hours on medical and SAR duty. Still, with good spirits and a hope to finish quickly, they focused on the task at hand. 
 
Of course, Murphy’s Law always came into play (“If anything can go wrong, it will”).  So, in the wee dark hours of Monday morning, they had to contend with an uncooperative vehicle and trailer set-up on Hwy 4. But no matter, for the problems were addressed and solutions were found. By 0230 their task was complete, with only the need to get themselves home safely. 

The names of our unsung heroes are Kevin Batewell, Benjamin Fandinola, Erin Field, Robert Harrison, Tim Murphy, Casey Riggs, Micheal Riggs and Paul West. 

Rick Kovar led this merry band of workers. He wished to have these heroic few given a well-earned note of credit for their hard work and willingness to endure. Give them all a thank you for completing the final task and adding to the success of the 2013 County Fair.

Save The Dates!

The SAR medical season is heating up. We need your support during a wide range of coming activities. Each of these events provides a unique opportunity to practice your medical, communication, navigation and search skills while getting to know your SAR teammates. There is also the opportunity to enjoy the festivities while being ready to help; most even include a free meal.

So mark these dates on your calendar now to be ready to sign up when spots open up. Details of each event will be released as the dates approach. Contact Bob Harrison, SAR medical sergeant, if you need more information right now.

SERT competition, Friday, June 28
The SERT competition is a competition between various law-enforcement agencies, primarily those involved with corrections. SAR members will be assigned with teams representing different agencies to lend support. Lunch will be provided along with possible shooting time at the range for all team members who participate. Contact Chris Retta to sign up now for this event.

Danville Fourth of July parade, Thursday, July 4
A hometown parade start 9 a.m. and ends at approximately 11:30 a.m. The parade currently draws 30,000 to 40,000 people, making it the largest single event in the Bay Area. SAR is there to provide medical assistance to the crowds.

Hot Summer Nights 1, Thursday, July 18
This event combines classic cars and camaraderie to create an evening of summer celebration. Downtown streets are lined with muscle cars, hot rods and vintage rides dating back to 1969 while live bands play '50s and '60s music. There are also food, drink and souvenir booths throughout, along with downtown shops and restaurants.

Hot Summer Nights 2, Thursday, August 15
A repeat performance of the event provides another opportunity to view old cars, listen to music and walk the downtown streets as described above.

El Sobrante Stroll, Sunday, September 15
This annual downtown event features a range of ethnic foods, live music from multiple bands of different styles, a variety of booths and shops along San Pablo Dam Road, a Kid Corral and a Grand Parade.

Mount Diablo Challenge, Sunday Oct. 6
This event is a 10.8-mile timed bike ride starting at Athenian School in Danville and climbing up Southgate Road 3,249 feet to the summit of Mount Diablo. One-thousand cycling enthusiasts compete in several categories. A ceremony is held at the summit with food and beverages for all. 

Lafayette Reservoir Run, Sunday Oct. 27
The Lafayette Reservoir Run is the city’s most popular “family affair,” involving kids, parents, grandparents and hundreds of serious runners from throughout the Bay Area. Over 2,000 participants compete in a 10k, 5k, or 2-mile race through the heart of the downtown, around the reservoir and back. Sprinters, walkers, the “stroller brigade” and many of Lafayette’s top four-legged residents share the streets that festive morning. 

Diablo Trail Adventure, Sunday Nov. 3
Save Mount Diablo hosts a fun series of races on the mountain: family hike, 5K, 10K, and half-marathon. The 5K, 10K and half-marathon will all begin and end at Castle Rock Park in Walnut Creek. The 50K is a point-to-point run beginning at Round Valley Regional Preserve and finishing at Castle Rock Park. It is challenging course with steep climbs, descents and creek crossings.

EMR In Action, ctd.

Team member Kristl Bulurun witnessed a cycling accident in Walnut Creek after picking up her son from school:

"A 40-something y.o. female was cycling and went over her handle bars. I and two other witnesses in separate cars pulled over to assist. As soon as I got out of my car, I announced myself as someone with medical training and asked if I could help (got consent!). Also, I had my medical kit in hand as I've always got my gear in my car. 

The subject was initially disoriented and at first said no, but she was pretty banged up and bleeding from her hand and face, so I convinced her that I could help. She said she was a nurse so she kept saying she was fine, but we all know how that goes. Anyway, one witness helped direct traffic and I asked the other witness to assist and hold c-spine while also holding the gauze to her face where she was bleeding (I gave the witness a pair of gloves to put on). The witness' daughter called 911.

I then determined A&O (she was x4) and CMSTP. I also did a modified head to toe, but didn't want to take her helmet off in case she ended up having a neck injury. She only complained of shoulder pain, but I checked for broken bones anyway.

Paramedics & ambulance showed up in about 5 minutes; after giving them an update on the subject, they took over and I stood back.

As the paramedics were working on her, another gentleman who had stopped to help started talking to me and asked what happened. I gave him the rundown and then he asked, "So, are you a nurse?" I replied, "No, I'm with Search and Rescue and trained as a first responder." So then he says, "Oh… search and rescue where?", to which I said, "Contra Costa County", to which he replied, "Oh really? I'm with Contra Costa County, too… I'm the Under Sheriff"

UMMMMMM… WHAT?! 

So yes, I was observed by the Under Sheriff. He asked me how long I'd been on the team and I told him not long, but that we just completed our EMR training, so I was glad that it all kicked in. Funny thing he asked was "so… you carry your medical kit in your car???" I said, "Yeah, all my gear is there… you never know when a we'll get a callout."

And he said, "Yeah, you guys are a great team."

OMG. I am soooo glad I did not know who he was until I was done. OH THE PRESSURE!! He was so super nice though. Chatted for a little bit more until the police officer on scene needed a statement.

Anyway, he left after a little bit (he had lights on, so that's when I really knew it was the Under Sheriff). Once they got her on the stretcher, I gave a statement to the officer, said goodbye to the subject, thanked the EMTs & the witnesses, and then left.

I have been hoping for a situation to use my EMR skills (I know… it's a sickness), so this was quite exciting. Plus having the Under Sheriff there really beats all.

The thing is… it's clear to me that it's all because of the training. The importance of those 4 months of EMR and the medical training last Saturday really became clear today. Everything kicked in like clockwork (although I'm sure I forgot something really important). 

So thank you for all our training. Thank you to the entire team for all our training. This situation was so crazy to have been a part of, but I'm so grateful for the skills and the confidence to have done it. "

 

EMR in Action, ctd.

Team member Mikel Kinser was at home, where his wife was hosting a couple’s baby shower for one of her coworkers:

“I was outside when I heard a loud crash and my wife yelled from inside for help. I ran inside and found one of her guests prone on the floor next to a chair that had fallen over. My wife said she fell over after saying she was dizzy and had asked for a glass of water.

Her head hit the ground hard and she lost consciousness for a moment. I told my wife to call 911. As the guest started to come around, I began speaking to her, asking her questions. She was A&OX3, not knowing what happened to her, but did know her name, where she was, and what day it was. I also took her pulse and respiration. I began feeding this information to my wife, who was on the phone with 911.

She also had a large bump on her head where she hit the ground, but no blood. She had free motion with her head and neck so I did not feel there was any spinal or neck injury. I checked her eyes for PERRL and all was good. I kept her on the ground where I found her, and checked with her for comfort (warm or cold). Paramedics arrived within five minutes of the call and took over. I relayed the info again to them: patient name, what happened and patient vitals. From there I just observed the five emergency workers. They did an EKG on her (normal) but they did find that when she stood up her BP dropped a lot. She refused transport, and I had to sign as a witness.

She remained at our house until a friend of hers could come and pick her up. We told the friend to keep an eye on her as she had hit her head and could have a concussion. She returned the next day for her car and was fine except for the bump.

Looking back on it, I felt calm going through the steps, but could have done better (I had a BP cuff in my office and I did not think about it until later). I also did not do CMSTP, which I should have. I feel worse for the things I did not do than good about what I did do, because I know from my EMR training what is supposed to be done. I can see that continued exposure to this is the only way to stay on top of it and do it correctly.”