The stokes type basket is the most mis-understood and mis-used tool on the rescue truck. We will start with a little history of the device and for Veterans Day we will recognize it's militay beginings

This week on The Resultant we are looking at the pre-rigged basket Look at your rescue truck, are you ready to go into service in seconds? We pre-connect rescue tools and such but we seem to keep rope rescue equipment in bags, slowing us down in getting over the hillside to the patient.

Patient packaging in the stokes needs to do a few things for us and the patient. Comfort and controlling heat loss are huge factors we sometimes overlook

This week we on The Resultant we are looking at patient protectionn and medical monitoring. Head and eye protection are forgotten many times: is this from lack of prepardness or a lack of training? I have watched many classes where the maninkin is thrown into the stokes, strapped in somehow and nothing else is done for the patient. So on the real rescue scene this becomes the norm if we dont change our training to incorporate patient protection nto the scenario. Being hit in the eye with a piece of brush or trig from a tree can cause a perminate eye injury. Being able to assess the patient during movement is important for long extrications Pulse, pulse ox, lung sounds, blood pressure, and temperature are all important V/S to be able to monitor. Some newer monitors allow us to do cardiac and all the other V/S in one unit.

Do we need to have a litter attendant on the basket? There are a few issues to look at to make this decision. 1. Are we doing it because the patient needs the rescuer or is it because this is what we have done in a class, and it looks cool? Time in the air, patient needs, system safety, are all things to consider when making your rescue plan. If we ware lowering from the roof of a four-story building the time the patient is over the edge and lowered to the ground might not warrant to additional exposure of attaching a rescue to the basket. If that same basket is going to be lowered to the ground static loaded to an aerial ladder or tower ladder we probably are not going to put the additional weight into the system. 2. The patient needs some intervention or is scared and needs a rescue with them. I find humour in this question because we always get the “What is the patient needs to be bagged?” question. Intubate, secure the airway and use a mechanical ventilator, like an Autovent, with the patient properly packaged in the basket. Or the other question “What if we are doing chest compressions?” That question has a lot of variables to be answered. Some are hard question like “Why are we continuing efforts?” has there been some ROSC etc. Access to a mechanical compression device, like an Autopulse or Lucas devise etc. If it is a child or a scared patient needing someone with them and we can not sedate the patient might be a valid reason 3. There are obstacles the basket needs to move around is a valid reason if we can not find a better way to extricating the patient to avoid the obstacles 4. The patient needs to be packaged from an elevated position. Like a pickoff from a ledge that required the patient to be packaged into a basket for extrication This operation takes practice to do efficiently. 5. I know there are other variables I have not mentioned, what did I miss? Rescue is not a cookie cutter operation. We don’t have bread n butter rescues; each presents its own challenges. Chief officers need to stay current with techniques but also use common sense when we need to move a patient via rope. Safest, Easiest, Quickest isn’t always the most glamorous of operations, but it is probably the best for the patient.

We hope everyone is haveing a safe and happy holiday. This week we are looking at the Pros and Cons of using a live 'patient' in rescue training. Our stance is pro use of the live patient, it forces the crews to work on communication and patient packaging/protection. We have seen to many classes where a manikin is thrown into the basket, not properly assessed and packaged. I have heard some students say that the assessment of the patient is the job of EMS. Remember without a patient there is no rescue. Patient care becomes everyone on the scene bussiness. A quick, efficient and safe extrication is what is best for the patient.

When is the last drill you challenged your team to package a patient on their side or package a 6 year old in to the stokes basket? Work through these operations with them. Thank about the patient packaging adjuncts needed and patient care issues. The goal of training is to put nuggets of information into the hard drive of our rescuers so when faced with a difficult issue they have some ideas to pull from for the best patient outcome.

The stokes type basket is the most mis-understood and mis-used tool on the rescue truck. We will start with a little history of the device and for Veterans Day we will recognize it's militay beginings

The stokes type basket is the most mis-understood and mis-used tool on the rescue truck. We will start with a little history of the device and for Veterans Day we will recognize it's militay beginings

The stokes type basket is the most mis-understood and mis-used tool on the rescue truck. We will start with a little history of the device and for Veterans Day we will recognize it's militay beginings

Patient tie in systems have been one of the great rescue developments in the past 10 years. It has lead to shorter extrications due to a quick, efficient and safe way of attaching a patient into the stokes basket in an austier enviroment

Why do we attach the end of the rope to the patient's harness. Thinking critically does this make sense to anyone else?

This week we start to look at patient care in the stokes basket. The #1 killer of trauma patients is hypothermia. The common misconception is we encounter hypothermia when it is cold outside. It isnt an injury we can see so it gets put on a back burner in patient treatment unless we train ourselves to treat for it on every trauma patient. The trauma triad of death is a medical term describing the combination of hypothermia, acidosis, and coagulopathy. This combination is commonly seen in patients who have sustained severe traumatic injuries and results in a significant rise in the mortality rate. Severe bleeding in trauma, internal or external, diminishes oxygen delivery, and leads to hypothermia. This in turn can halt the coagulation cascade, preventing blood from clotting. In the absence of blood-bound oxygen and nutrients (hypoperfusion), the body's cells burn glucose anaerobically for energy, causing the release of lactic acid, ketone bodies, and other acidic compounds into the blood stream, which lower the blood's pH, leading to metabolic acidosis. Such an increase in acidity damages the tissues and organs of the body and can reduce myocardial performance, further reducing the oxygen delivery and leading to more profound hypothermia. Keep all trauma patients warm!! The thought of "they will only be in the stokes for a short period of time" is not acceptable. Put yourself in the shoes of the patient's spouce, parent, sibling or child. Would you want your loved one treated for the hypothermia issues that could cause further injury or death? This weeks resultant is an easy hypothermia wrap that can stay in the baskt all year long. This one is prerigged for rapid patient care. I have seem some departments keep all these supplies in a bag. This concept means you have to spend time to rig the basket before the patient can be put into the stokes, slowing patient care. Our #1 objective is quick, efficiant and safe patient packaging and extrication. Think of ways that we can do those objectives in all the rescue disciplines

Orthostatic intolerance: someone in an upright position not moving their legs can experience orthostatic intolerance. A patient in a trench trapped against the wall, an unconscious patient in a stokes basket in a vertical configuration, hanging in a fall protection harness, etc. It is interesting that the Safety Professional world keeps calling it suspension trauma and blaming the harness. There are 18,000 web hits for suspension trauma/harness induced syndrome and only 5 medical studies that show the harness is not the cause, but it is positional. Most of the harness manufacturers supply or have an add on trauma strap system. But what is this system meant to do for the patient? Standing upright your body can only pump blood up your legs about 6-8 inches. The veins have valves in them to keep blood from back flowing. The muscles around the veins constrict the vessel when you use the muscle, this is a muscle pump, pumping blood back to the heart. AN unconscious patient or entrapped patient cannot move their legs pumping blood to the heart, so blood starts to pool in the legs. The patient starts to lose blood volume due to this, thus less oxygenated blood to the body, less heating/cooling system blood through the body, causing hypothermia and hypovolemia, and leads to death. Some of the same issues we see with crush syndrome / rhabdomyolysis start to appear in the patient. Those trauma straps on fall protection harnesses are there for this reason. A conscious person deploys them and puts them around their feet to stand and sit in the harness, thus using muscles in the legs to pump blood. Some try and teach that the harness is acting like a torniquet. This might be true of peripheral vessels but not deep vessels. Anyone who has put on a real tourniquet or tried to stop a junctional bleed can understand the pressures needed to stop this blood flow. The femoral vein runs along side the femoral artery, not very easy to occlude. We need to move patients in the vertical configuration, whether that be a harness, stokes, Spec Pak, Sked etc. Try and keep them horizontal, reverse Trendelenburg as much as possible Limit our time in the vertical position to 7 minutes or under. This is the recommendation of most of the patient packaging adjuncts just for the reason stated above. Now you know the rest of the story.

Everyday we are dealing with larger and larger patients, sometimes referred to as bariatric patients. You have probably been on a call or heard about one where the crews were faced with a patient that there were problems with extrication due to the size and or weight of the patient. When is the last drill you did with two Rescue Randys duct taped together? Are your straps long enough to secure the patient. Is the basket big enough for the patient. How are you moving the patient into the basket? There are many adjuncts on the market for lifting and moving a bariatric patient. Each takes practice to be used appropriately. Rescue Technology and other companies make an extra large stokes basket just for bariatric patients. One big issue is bariatric patient positioning in the basket, a bariatric patient cannot lay flat for an extended period. Lots of padding/pillows behind the head to help keep the airway inline and making sure we keep the basket in reverse Trendelenburg to keep the patients head elevated. This will make it easier for the patient to breath. Prepare for the patient you may see tomorrow. Be preparatory not reactionary. Lots of rescue services have an incident then go out and get the equipment and training. We should be brainstorming and looking at what we might encounter and preparing for it.

Complacency kills. Every rescue is different. We get sucked into the feeling that the rescue is just a low angle hillside evacuation. High angle and low angle are equally dangerous. How can that be? One reason is exposure. In a high angle rescue we have the patient and maybe a rescuer over the edge and a few rescuers helping at the edge. In a low angle we have a patient, probably a police officer, and up to 4-5 rescuers over the edge plus people at the edge. Our exposure to injury is higher. Someone slipping on loose terrain, tripping on a tree root, etc all seem like minor injuries but impact the rescue and slow the extrication of the patient. Command and control are important. At high angle incidents it is usually easier because of the nature of the incident to make a hot, warm, and cold zone areas to work. The low angle rescue can be harder to get control because of the perceived severity of the incident. Civilians ‘trying’ to help, police over the edge thinking they are helping, and it could be our crews, engine, medic etc doing the same, all without accountability and safety equipment. Now make that at dusk and getting darker and or colder. All making the low angle incident an accountability nightmare and a paperwork generator. Just my two cents. Do not let your guard down because it is just a low angle rescue.

This week we are looking at patient positioning again. For years we were taught to elevate the legs (Trendenenburg) in a trauma patient Studies have shown that was detrimental to patient outcome. A paitent in a stokes can easily get into the Trendelenburg position if we dont speand the time to properly adjust the stokes bridle. A trick is to adjust it higher than you think you will need. The patient in Trendelenburg has their abdominal contents pushing on their diaphram and lungs, making it harder to breathe. The increased blood volume due to the position, fools the baroreceptors into thinking there is too much blood volume and starts pushing fluid to the kidneys, decreasing blood volume even more. The blood going to the brain has a harder time leaving the skull increasing the intracranial pressure . All are not good things for the trauma patient Reverse-Trendelenburg, lowers the inracranial pressure, and takes the pressure off the diapham and lungs allowing for better lung expansion and gas exchange. SLow is smooth, smooth is fast. Take the time to package and position your patient correctly it can make a difference in their life.

The stokes type basket is the most mis-understood and mis-used tool on the rescue truck. We will start with a little history of the device and for Veterans Day we will recognize it's militay beginings

The stokes type basket is the most mis-understood and mis-used tool on the rescue truck. We will start with a little history of the device and for Veterans Day we will recognize it's militay beginings

The stokes type basket is the most mis-understood and mis-used tool on the rescue truck. We will start with a little history of the device and for Veterans Day we will recognize it's militay beginings