View source for Chapter 04: First Aid and Medical Protocols

== Patrol Specific Outdoor Emergency Care (OEC) Protocols ==
Upon successful completion of the Outdoor Emergency Care (OEC) Course, patrol members are certified as OEC
Technicians by the National Ski Patrol. The following information serves as a supplement to the training and instruction
received by the OEC Technician during the OEC Course. It includes patrol-specific protocol regarding the treatment of
patients, which may differ from the protocol as taught in OEC. It also serves to clarify other items not fully covered in
the Course. For further information, please contact the TBSP OEC Advisor.
===  Infection Control Procedures & Body Substance Isolation (BSI). ===
# Patrollers, as OEC Technicians providing emergency care for patients, are at risk of exposure to blood and other bodily fluids. Such fluids, in particular blood, may potentially contain pathogens and viruses such as Human Immunodeficiency Virus (HIV, the virus that causes AIDS), or Hepatitis B (HBV or HEP-B). Therefore patrollers must always be diligent in protecting themselves from potential exposure.
# To protect against exposure to a patient's body fluids or substances that may contain viruses, patrollers must follow BSI precautions at all times when assessing and treating patients. At a minimum these precautions shall include the wearing of latex or nitrile gloves; it may also require for the wearing of safety glasses, and protective mask or face shield. When safety glasses are not available, the patroller's sunglasses or goggles may have to suffice as a substitute.
# Used, disposable protective materials such as gloves, dressings, and bandages shall be placed and sealed in a plastic bag. The materials shall be passed on to a member of the advanced life support (ALS) crew upon pickup of the injured or ill patient, for subsequent proper disposal at the hospital or other advanced care facility.
# At a minimum, non-disposable and potentially contaminated equipment not delivered with the patient to the ALS team shall be decontaminated in the backcountry with dressings treated with alcohol or other antiseptic, then covered with plastic for transportation back to the TBSP Operations Center or Equipment Shed. Upon arrival at the TBSP Operations Center, affected areas of the equipment shall be sprayed with a dilute solution of chlorine bleach and left to stand in the open air for at least one hour. As needed, it may be given a final cleaning with soap and water. Allow to air dry. Leave a conspicuous tag attached to the equipment for the TBSP Equipment Manager or Operations Officer, noting how and where it was contaminated, and how it had been decontaminated.
# Potentially contaminated blankets, or patroller uniforms or clothing may be machine-washed at the Chalet. Patroller sunglasses or goggles may be decontaminated with antiseptic wipes or with bleach solution.
# Patrollers shall carry an ample supply of antiseptic hand wipes or hand sanitizer, and shall use these materials before and after treating a patient in the field.
# Snow or soil contaminated by a patient's blood or other body fluids or substances shall be buried in soil or in the snow and not left at the snow or ground surface.
# If a patroller may have been exposed to a patient's body substances, the patroller shall thoroughly clean the affected area, and if possible accompany the patient to the emergency room and let the hospital staff know you are an emergency responder exposed to the patients' bodily fluids. They can recommend post-exposure prophylaxis, especially after the patient's blood is tested. Also contact the Patrol Leader and Mountain Manager, and contact the patroller's doctor or caregiver as soon as possible for further direction. Treatment for such exposure may also be covered by the US Forest Service under the volunteer agreement that TBSP operates with them. Contact the TBSP OEC Administration Officer for more information.
===   Vaccinations (HBV). ===
# Though at present no vaccines exist for some viruses such as HIV, there is a vaccine available for Hepatitis B (HBV).
# As first responders that may come into close contact with bloodborne pathogens, all patrollers are strongly encouraged to consult their own doctor for more information about HBV vaccination.  Patrollers should understand the contraindications for this vaccination.
# For more information on HBV and the vaccination, see the attached Hepatitis B Fact Sheet from the Center for Disease Control (CDC):
#  For further information on this and other bloodborne pathogens, contact your doctor. Also visit the Center for Disease Control (CDC) online, at: http://www.cdc.gov/ncidod/dhqp/bp.html
===  Spine Immobilization (Backboarding). ===
# Injuries or conditions requiring patient stabilization and immobilization to a long spine board (backboard) include:
## Head, neck or back injuries
## Unresponsiveness (unless it was caused solely by a witnessed medical condition/emergency)
## Mid-shaft femur fracture
## Proximal femur fracture ("hip fracture")
## Pelvic fracture
## Hip dislocation
# Backboarding is contraindicated if maintaining the patient's airway or the patient's ability to breathe is compromised by strapping to the backboard and/or across the patient's severely injured chest.  Maintaining breathing and the ABC's takes priority over treatment of spinal injuries.
# An adjustable cervical collar is to be sized and installed as soon as possible.
# Backboard straps shall be hook-and-loop (Velcro) "Spider" straps. If Spider straps are not available, 1" minimum width nylon webbing from a patroller's sled hauling kit may be used, criss-crossed across the patient's body starting from the shoulders down.
# Head is to be stabilized using a blanket roll. Blanket may be rolled long and placed in a horseshoe shape from top of shoulder to top of head to top of opposite shoulder, or a dual-rolled blanket slid under the patient's head with each roll against each ear. Blankets may be doubled to provide required volume for proper stabilization.
# Cervical spine is stabilized manually throughout the backboard process until the patient's head is taped to the backboard and all backboard straps are tight. Two to three passes of tape in an "X" over the forehead is required. No tape is to be placed over or under the patient's chin.
# Padding should be placed under the patient's knees before strapping. A long rolled blanket provides modest padding while gently flattening the lumbar spine. Padding under the knees is required for a pelvic fracture.
# Prior to strapping, additional blankets shall be applied to fill "voids" around the legs or hips due to other injuries such as hip dislocations or femur fractures.
# Diaper or foot hitches using cravats shall be used as needed to supplement the backboard straps for patients on steeper inclines or when injuries near the hip prevent the hip straps to be pulled snugly.
# Arrange the suctioning device and oxygen on the patient's left side if possible. Patroller monitoring the airway should be ready to suction from that side. If patient vomits, patient should be rolled to the left.

===  Mid-Shaft Femur Fracture (Kendrick Traction Device) ===
# Patients with a fractured femur mid-shaft shall be splinted with a Kendrick Traction Device (KTD).  Open fractures are to be bandaged prior to splinting.
# Prior to arrival of the splint, manual traction shall be applied distal to the injury. To maintain the rescuer's hands free, a manual traction "hitch" should be fashioned using cord or webbing, attached to the patient's ankle on the injured side, and wrapped around the rescuer's back. Manual traction may be maintained by leaning against the hitch, with the rescuer's foot pressed flat against the patient's foot on the uninjured side. Manual traction shall be maintained constantly until traction is pulled with the KTD.
# The RED Velcro strap shall be placed directly over the midshaft and injury.
# Feet shall be tied with a figure-of-eight to prevent rotation of the injured leg.
===  Boot Removal ===
#   Boots shall generally be left on the patient's injured leg, provided adequate assessment of the distal pulse, sensation, and motion can be made.
# Boot buckles and/or laces shall be loosened on the injured side to allow for swelling and for patient comfort.
===  Splinting of Lower Leg Injuries ===
# In lieu of a quick splint, patroller may fashion a proper splint by using the patient's ski poles, ensolite pad, cravats, and if needed, additional padding.
# As with all splints, the injury site shall not be completely covered by the splint to allow for regular, subsequent injury assessment while waiting for or during transportation.
===  Reductions & Compromised Distal CMS ===
# If the patient's injury (dislocation or fracture) exhibits compromised distal CMS before splinting, and transport to an advanced care facility is greater than one hour, at least one attempt to realign the injury to improve distal CMS is required.
# Shoulder dislocations or AC (acromioclavicular) separations may require careful reduction in the field if transport to an advanced care facility is greater than one hour. Assist patient in reduction of the dislocation.
# Reductions of lower extremity joints shall not be attempted.
===  Airway Administration ===
# Oropharyngeal or oral airways shall be properly sized and installed with all unresponsive patients without a gag reflex.
# Nasopharyngeal or nasal airways should be installed with responsive patients with a compromised airway.
=== Hypothermia ===
Hypothermia in the backcountry is a significant danger. TBSP provides specific guidelines for the gentle handling of hypothermic patients during prehospital care and transport.