refresher workbook

REFRESHERWORKBOOK

2 OEC Refresher Workbook

OBJECTIVESTo successfully complete the Outdoor Emergency Care (OEC) annual refresher, each OEC technician will need to complete the OEC Refresher Workbook, or, if eligible, participate in an online OEC refresher course. In addition, OEC technicians will need to attend a registered refresher where they will:

• Review materials that will renew or enhance the fundamental knowledge base of the OEC technician;

• Discuss topics that require a more in-depth comprehension of OEC skills or knowledge;• Demonstrate competency in OEC skills outlined in this refresher; and• Meet local patrol and area training needs in emergency care.

This Refresher Workbook is designed to help the OEC technician complete the annual refresher requirement. It provides direction in what each technician will be expected to know, discuss, and demonstrate at their annual refresher. Taking the time to work through the guide will enhance the OEC technician’s demonstration of competency in OEC knowledge and skills.

The OEC Refresher ProgramOEC technicians must complete an OEC refresher program 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 covers required material and demonstrates proficiency in specified skills. Every required skill must be demonstrated during the annual refresher as outlined in this Refresher Workbook. With every refresher, technicians have the opportunity to hone and improve their clinical skills. Verification of OEC technician competency in fundamental knowledge, skill, and scenario management is the basis of the OEC refresher program.

OEC certification is maintained by completing three consecutive annual refreshers. All NSP members, except medical associates and mountain hosts, must complete each of the refreshers (Cycles A, B, and C) to maintain their OEC credential. The only NSP members exempt from this requirement are 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 annual refresher program does not provide a means for a person with previous emergency care or medical training to challenge the OEC course. The annual refresher only covers a portion 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 refresher cycle(s) that occurred during the inactive period, and pay dues for any missed season(s). If the OEC technician card expired during the inactive registration period, the member may need to complete an OEC course. Please refer to the NSP Policies and Procedures for guidelines on re-registering as an NSP member and other OEC technician refresher requirements.

Additional training, such as local patrol requirements or area needs, lift evacuation, CPR, AED, and other on-hill/on-the-trail training is usually provided through your local patrol or area representative. This training is not specifically part of the OEC refresher curriculum. NSP is not responsible for the content, instruction, or scheduling of local patrol training. Each patroller should consult with his or her patrol representative, area, or resort for schedules, topics to be covered, and other local or area training requirements.

3Cycle C 2013

ATTENDING AN OEC REFRESHERWhen and WhereEvery OEC technician must attend an annual refresher. Checking with your local patrol, region, or affiliate group is the easiest method to determine when and where your refresher will be held. If you have a conflict, you should contact the local patrol representative for other options; you can also check with the OEC region administrator or the NSP course calendar on the NSP website (www.nsp.org) under “NSP Education Programs.”

OEC instructors, OEC instructor trainers, regional administrators, division supervisors, and the OEC Program director must attend an OEC refresher or OEC instructor refresher to meet OEC technician requirements. Refer to local, region, or division requirements on which to attend.

Scheduling Conflict If a scheduling conflict exists with your local or area patrol, please notify your patrol representative or affiliate group leader in advance and prearrange attendance at another refresher course with the instructor of record or patrol representative for the host area. Other patrols may not have the logistics support to allow other NSP members to attend their refresher, so contact and acceptance must be made in advance. If you do attend a refresher with another patrol, be sure the Refresher Completion Acknowledgement Form (located on page 30 of this Refresher Workbook) is completed and returned to your patrol representative. Please ensure that you have signed a Supplemental Roster Information Form (located on page 30 of this Refresher Workbook).

Take Time to Prepare Allow yourself plenty of time to review the refresher course topics and study the Outdoor Emergency Care Fifth Edition references listed in this workbook for Cycle C. To help enhance the learning experience, it is important to read all materials, complete all assignments, and practice identified skills prior to attending the refresher.

Reading and Participation Material The “Case Presentations” section has become a resource for transitioning ideas, knowledge, and experiences into problem solving and skill development. The cases discussed are experiences that have either actually occurred or are very similar to experiences of real patrollers. When reviewing the “Case Presentations,” write down your answers to the questions that follow the scenarios. In addition, make any notes for discussion points called out in the questions. The intention is to challenge the OEC technician to think about scenarios that might present as difficult or complicated and how best to handle those situations in the field. It is helpful if challenging accidents at your local area are reviewed in addition to those in the “Case Presentations.” Please bring the completed “Case Presentations” answers and notes to the refresher with you so that you can participate in the discussion. The 2013 Cycle C Refresher Workbook and the “Case Presentations” are also available as PDF documents in the “Education/OEC” section of the NSP website.

Review and PracticeAn important part of the annual OEC refresher is verifying OEC technician competency in specific OEC skills and knowledge. Use the “Skill Guides” in the Outdoor Emergency Care Fifth Edition to review and practice the skills you will be asked to demonstrate at the refresher. The OEC Cycle C 2013 Complete Sample Refresher Skills Checklist (see pages 28-29) will be verified in its entirety during the OEC refresher. Review and practice each skill listed on the checklist prior to the refresher, as it will help you more fully participate in the refresher and aid in the learning and evaluation experience.

Go OnlineThere are several valuable resources available to help refresher participants review material prior to completing the workbook or accessing the online refresher program. Go to www.MyNSPkit.com to access the many online resources (tools, videos, and activities) available. Use the access code found on the front inside cover of your Outdoor Emergency Care Fifth Edition. Scratch off the silver coating to uncover the code needed to access the website. Once you have registered, you can log in by using the username and password that was created during the registration process. MyNSPkit.com provides additional information that will be helpful during an online refresher (if available through your patrol).


Things to Bring• The 2013 Cycle C Refresher Workbook with your “Case Presentations” answers and

discussion notes.• If you are eligible to participate in the online refresher program, bring a copy of your

completion certificate, or check with your IOR prior to attending.• Your current OEC, CPR, and NSP member cards. You can obtain a duplicate OEC

or NSP member card by ordering it online through the Ski Patrol Catalog. Allow 3-4 weeks for delivery. Be sure that the NSP has your current and correct contact information. Your current OEC card should have a blank line for the Cycle C refresher line.

• A fully-stocked aid belt, vest, or pack, as well as any additional items required at the refresher you will be attending.

• Dress appropriately to participate in both indoor and outdoor refresher activities.

Important OEC recordkeepingBe sure your address and contact information with the NSP is current and on file! If you did not receive your 2013 Cycle C Refresher Workbook or Ski Patrol Magazine, the NSP does not have a correct, current address for you on file. If you move, or your address changes, be sure you notify the NSP as soon as possible! Visit www.nsp.org to verify and update your profile.

If you attend another patrol or group refresher, remember to provide your patrol representative with the OEC Refresher Completion Acknowledgement Form on page 30 of this workbook. You should also make sure you contact the instructor of record (IOR) prior to attending a refresher to ensure that you will have completed all pre-refresher work. With some patrols or groups using the online refresher format, it is important that you have the correct materials prior to attending the refresher. To ensure accurate recordkeeping, the OEC technician should ensure that the IOR has all the information necessary to verify your completion of the refresher on a supplemental roster for the national office (see page 30). Necessary information includes your NSP member or OEC technician ID number, your name as it appears in national registration records, current address, and patrol/group affiliation. The IOR of the refresher that you attend must sign and date your OEC card, then return it to you. Be sure to complete the 2013 Cycle C Refresher Evaluation Form on page 31 of this workbook.

Not receiving OEC materials from the NSP? Contact Darcy Hanley at [email protected], or (303) 988-1111.

CPR POLICY (for active NSP members only)Active NSP members must demonstrate their CPR skills to an agency-approved and certified CPR instructor annually, regardless of the requirements of the certifying agency or the expiration date of the card. This requirement is not meant to be a part of the annual OEC refresher, and demonstration should meet the requirements of the standards established by the certifying agency.

You must hold a current, professional-rescuer-level CPR certification from the American Heart Association, American Red Cross, National Safety Council, American Safety and Health Institute, Medic First Aid, or Emergency Care and Safety Institute. During the annual review, the certifying body need not issue a new card unless the current card expires before the start of the upcoming ski season. The unit representative (patrol director) verifies that a patroller has a valid card annually. It is the responsibility of the active NSP member to ensure that they always maintain a current CPR certification.

Do you have enough AEDs?Have you checked your pads?

NSP special: 25% OFF! Safe to use on wet and metal surfaces!

8-year warranty!4-year long life battery!

Rugged and reliable!Easy to use!

Check out Philips on the NSP Pro Page, or Check out Philips on the NSP Pro Page, or call 800-246-3208. Ask for Chris or Julie.

5Cycle C 2013

Making the Refresher Workbook Work for YouThe organization of the Refresher Workbook starts with the topic area. The objectives for each topic are provided to help the OEC technician better understand exactly what he or she needs to do to complete the refresher.

Take the following topic objective:

1) Identify and describe different oxygen delivery devices and when to use each; and2) Demonstrate the proper assembly of an oxygen tank and delivery system.

The OEC technician should study the different delivery devices so that he or she can identify the differences between a mask, nasal cannula, bag valve mask, etc., and understand in what conditions and when you would use each. To meet the second objective, the technician should demonstrate the proper and safe assembly of the oxygen tank, regulator, and delivery device.

The content of this Refresher Workbook provides an outline of the material and will help familiarize and prepare you for what will be covered during the refresher. After you have reviewed the workbook topics and objectives, you will better understand what you need to do to complete the refresher. In some cases, you may feel extremely comfortable with the topics and the expected skills demonstration. In other cases, you will want to spend more time reviewing the material and practicing your skills prior to completing the refresher. This is a refresher, and not all technicians perform OEC skills throughout the year. This is an opportunity for OEC technicians to prepare for the upcoming season and review some of the skills needed.

The workbook also makes reference to specific sections of the Outdoor Emergency Care Fifth Edition; please remember that the OEC book has only recently been published, and that much of the material and information is new. It is important that technicians reference this material. Each OEC technician should have access to the most recent version of the OEC book.

Throughout the workbook, you may see the words, “try this.” This phrase identifies optional activities that will aid your review process. Everyone will use this workbook differently, based upon the personal experience of the technician as an emergency care provider.

Take advantage of the myNSPkit website. By doing activities there, you will be further ahead in preparation for your refresher. Exercises are provided to assist your review. The more you use them, the more prepared you will be.

With optional online refresher materials, you will find that by reviewing the material in the Refresher Workbook first, you will be better prepared for the refresher.

For those that have been through refreshers in the past, the workbook has become a standard part of the refresher and a strong base to work from to be successful in completing the annual refresher requirements. If you have never been through a refresher before, take time to review all the material in the workbook, spend time breaking down the “Case Presentations,” and practice the skills before going to the refresher.

Practice during the off-season, practice before the refresher, and updating skills and knowledge are the mission and goals of the annual OEC refresher. Your participation and use of the Refresher Workbook will enhance your experience at the 2013 Cycle C refresher.

NATIONAL SKI PATROLMedical Supply Purchasing Program

Why Medline?

Our brands have earned recognition and respect throughout the healthcare community and among patients, too.

For more information www.medline.com • Elaine Wanat-Powers • 800-323-1368 ext. 1726 • [email protected] • Fax: 866-605-5777

3 Manufacturer direct pricing

3 Next day delivery

3 Over 100,000 different products

3 Guaranteed savings, easy online ordering

3 Free supply list cost analysis


RESCUE BASICS (INTEGRATED STATION TOPICS)MOI, Scene Safety, BSIYour objectives:

1) Identify the MOI or NOI for a scenario.2) Demonstrate how to ensure scene safety.3) Demonstrate the use of personal protective equipment.

At every incident, as with your refresher practical stations/scenarios, you need to apply some basic principles that will help you achieve the best possible outcome for both you and your patient.

Mechanism of Injury and Nature of Illness• How did the patient come to be in this place and position?

○ If a fall, what type of fall?○ If a collision, what was collided with: the ground, another person, a tree, or a rock?○ If not a fall, is there an illness or medical emergency involved?

• Could there be multiple injuries?

INDIRECTPelvisHip FemurKneeTibia/fbulaShoulderHumerusElbow Ulna/radius

MECHANISM OF INJURY—

The force that produced the injury, itsintensity and direction.

TYPES OF FORCE

• Direct• Twisting• Forced Flexion or

Hyperextension• Indirect

TWISTINGHipFemurKneeTibia/fbulaAnkleShoulder girdleElbow Ulna/radiusWrist DIRECT

LATERAL BLOWKnee Hip Femur

(Very forceful)

FORCED BENDINGOR EXTENSION

ElbowWristFingersFemurKneeFootCervical spine

DIRECT LATERAL BLOW

ClavicleScapula Shoulder girdleHumerus

DIRECT DOWNWARD BLOW

ClavicleScapula

7Cycle C 2013

A significant MOI for a patient who has no signs of physical injury should raise your suspicions. What is a significant MOI that you have encountered or could occur at your area:

A minor MOI does not mean that the patient has no serious injury; don’t be fooled by a simple fall.

Refer to Chapter 3 to review any of these topics or skills.

Scene Safety• Ensure that the environment is free of hazards.• Do not approach a patient if doing so places your own safety at risk.• Move the patient away from danger whenever possible.• Make the scene more visible.• Constantly survey the scene for hazards and control them.

Standard precautions and BSI• Every patient is potentially infectious.• Avoid contact with bodily fluids.• Use personal protective equipment, and safely remove it when done.• Wash hands.• Look for dangers at a rescue scene, and be aware of changing scene dynamics.• Request assistance in hazmat and crime-scene situations.• Do not be afraid to ask for help if you are having difficulty coping with stress.

Review OEC Skill 3-1: “Removing Contaminated Gloves.”

ANATOMY AND PHYSIOLOGYFor this refresher, you will be reviewing three body systems:

• Endocrine system;• Reproductive system; and• Lymphatic system.

Briefly review Chapter 6 of the Outdoor Emergency Care Fifth Edition. It provides an overview of anatomy and physiology. Familiarize yourself with these three systems. Further information is provided in later chapters in the book so that you can go into more detail if you wish.

Endocrine SystemYour objective:1) Review the fundamental anatomy and physiology of the endocrine system.

The endocrine system extends from the brain down to the pelvic area. It is comprised of ductless glands that secrete hormones. The pituitary gland is known as the “master gland;” it secretes chemicals into the bloodstream that regulate growth and the activities of many other glands. One of the critical functions of the endocrine system is to control blood glucose levels.

Exercise: Review Figure 6-25 on page 193. There are eight call-outs featuring various parts of the endocrine system. Cover the bottom line of each illustration and see if you can describe the function.

How could the endocrine system tie into a patient having altered mental status? Clue: review Chapter 11.


Reproductive SystemYour objectives:

1) Review the fundamental anatomy and physiology of the reproductive system, identifying the:

a. Major anatomical structures within the pelvic cavity;b. Functions of the female genitourinary and reproductive systems; andc. Functions of the major gynecologic structures.

Exercise: Review Figures 6-36 and 6-37. Review the call-outs on each page. Each organ described is accompanied by its description.

Anatomy: The reproductive system is a group of organs and other structures responsible for human reproduction. Many of the male structures are located outside the pelvic cavity and are more vulnerable to injury than are those of the female. The female reproductive system consists of the ovaries, fallopian tubes, uterus, and vagina, and it is protected by the pelvic bones.

Physiology: In the male, the testes produce sperm and testosterone, the primary sex hormone. The

sperm contributes half the genetic material to offspring. In the female, the endocrine glands interact with the reproductive system by releasing hormones that control and coordinate the development and functioning of the female reproductive system. The female’s ovum contributes half of the genetic material to the offspring.

To review further details on this system, refer to Chapters 6 and 34.

Lymphatic SystemYour objective:

1) Review the fundamental anatomy and physiology of the lymphatic system.

The lymphatic system is a group of organs and other structures that remove extra fluid from tissues, absorb and transport fat from the circulatory system, and transport immune cells to and from the lymph nodes.

Food for thought: What type of blood cells are produced by this system? Are the tonsils part of this system? If yes, what is their role?

If a patient suffers an injury to the spleen, would that be considered an injury to the lymphatic system? If so, why?

Exercise: Refer to Figure 6-38 on page 207. Review the call-outs on each page; each organ is accompanied by its description. Review these systems in anticipation of dealing with injuries to these areas.

Ovary

Body Fundus of uterus of uterus

Cervix

Vagina

Egg cell

Fallopian tube

SOLIDORGANS

HOLLOWORGANS

9Cycle C 2013

MASS CASUALTY INCIDENTSIncident Command and TriageYour objectives:1) Demonstrate how to use the ID-ME triage system.2) Demonstrate how to use the START triage system.

NIMS and ICS are powerful tools that can be used to provide a formal, standardized, organizational structure, common terminology, and standardized procedures that enable rescue personnel from different organizations to work together at major incident scenes.

START stands for which of the following: ________1) Selective Triage and Recovery Transport.2) Safe Triage and Responsive Transport.3) Simple Triage and Rapid Treatment.4) Sophisticated Triage and Responsive Transport.

Imagine yourself at the following scene; how would you triage these patients?A bullwheel on a chairlift collapses, causing numerous people to be thrown off the lift. The chair has stopped moving, and there is no danger of another collapse or any other dangers. For each of the following patients (a-j), write the number of the correct START system color code in the blank.

1) red2) yellow3) green4) black

_____ a. A 48-year-old male is lying in the snow. Respirations are 31/minute, and he is unable to follow simple commands.

_____ b. A 12-year-old female states that her ankle hurts a little, and she wants to go find her parents.

_____ c. A 36-year-old female complains of neck pain. She is ambulatory and able to follow instructions.

_____ d. A 16-year-old female snowboarder is unresponsive and has no pulse or respirations.

_____ e. A 55-year-old male is sitting on the side of the run, his respirations are 27/minute, and his skin is pale and cool. Capillary refill takes four seconds.

_____ f. A 61-year-old male complains of right shoulder pain. He is oriented and ambulatory.

_____ g. A 34-year-old OEC technician, a good friend of yours, has a massive head injury and no respirations.

_____ h. A 24-year-old male has a ski pole impaled in his left forearm. There is a small amount of bleeding from the wound.

_____ i. A 29-year-old female has severe abdominal pain; vital signs are stable._____ j. A 31-year-old conscious male has uncontrollable bleeding from an open head wound.

Discuss: Have you ever been at an MCI? If so, what was the most difficult part of it?

Refer to Chapter 4, especially if you need to review the Incident Command System and the various titles and organization of ICS personnel.


CRITICAL INTERVENTIONSAirway ManagementYour objective:1) Demonstrate how to properly set up an oxygen tank for use with an appropriate

airway adjunct.

A careful, thorough assessment will help determine the need for providing oxygen therapy to a patient. Once you have determined the need for oxygen, it is your responsibility to provide it safely and correctly. Prepare the delivery system, tank, and mask or cannula and apply it to the patient. OEC Skill 9-4: “Oxygen Tank Setup and Breakdown,” will guide you through this process.

Review the Skill Guide on page 325. How do you fair with this skill? Have you worked with oxygen often, or not? What would you do differently when using it on a child versus an adult patient?

Take a few minutes to work through this Stop, Think, Understand question; the answers are in the textbook.Write either “NPA” or “OPA” in the blanks to correctly categorize the following descriptions._____ a. Indicated for use only in patients without a gag reflex._____ b. For use in unresponsive patients only._____ c. Can be used on a seizing patient with clenched teeth._____ d. A soft, flexible device._____ e. Contraindicated in patients with massive head trauma._____ f. A rigid, hard, plastic device._____ g. Works by displacing the tongue._____ h. Is tolerated by responsive patients._____ i. Can be used on a patient with signs/symptoms of partial

airway obstruction, such as snoring._____ j. Also known as a “nasal trumpet.”_____ k. Provides an unobstructed path from the external nares

to the posterior pharynx.

Oxygen Delivery• A nasal cannula can deliver 24-44 percent oxygen at 1-6 liters per minute (LPM).• A nonrebreather mask can deliver 80-100 percent oxygen at 10-15 LPM.• A BVM can deliver 80-100 percent oxygen at 12-15 LPM.

Continue monitoring a patient who is receiving oxygen and ensure that the airway remains open.

Thoracic Trauma Your objectives:

1) Identify the signs and symptoms and pathology of the following thoracic injuries:a. Flail chest;b. Pneumothorax;c. Hemothorax;d. Tension pneumothorax;e. Sucking chest wound; andf. Pericardial tamponade.

2) Demonstrate how to assess and care for a patient with an open chest wound.

3) Demonstrate the proper use of oxygen.

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 * *

11Cycle C 2013

Important to understand: Chest injuries account for approximately 25 percent of all traumatic deaths in the U.S. Patients with chest trauma may appear to be stable at first, but if the injury is not recognized and treated quickly, severe consequences that can rapidly lead to death are possible. If you need to review the anatomy and physiology of the thorax and its internal organs, refer to

Chapter 6.

Match each of the following injuries to its description. (The answers can be found in the Outdoor Emergency Care Fifth Edition answer key.)

____ 1) Pulmonary contusion a. Two or more ribs fractured in two or more places.

____ 2) Myocardial contusion b. A well-protected bony structure that is usually fractured only by severe force trauma.

____ 3) Scapular fracture c. An injury to the thoracic cavity that may result in internal injuries.

____ 4) Flail chest d. A bruised heart muscle that can no longer maintain a regular beat, resulting in cardiogenic shock.

____ 5) Sternal fracture e. A potentially life-threatening fracture which can result in myocardial or pulmonary contusion or a ruptured aorta.

____ 6) Fractured rib f. A bruised lung, which can result in the alveoli filling with fluid and blood, causing hypoxia.

Open Chest WoundReview Skill Guide: “Managing an Open Chest Wound,” at the end of Chapter 23. What are the critical performance indicators for this skill?

Important to understand: Signs and symptoms of thoracic trauma will vary, depending on the MOI. These may include, but are not limited to, pain at the injury site that can be aggravated by breathing, abnormal chest wall findings, dyspnea, tachypnea, cyanosis, hemoptysis, tachycardia, and falling blood pressure.

Managing a Serious Chest Injury• Provide rapid care for ABCDs.• Support ventilation with a BVM, if needed.• Give oxygen at 15 LPM via a nonrebreather mask.• Immobilize spine if spinal injury suspected.• Use occlusive dressing on chest wounds, especially sucking chest wounds.• Rapidly transport to definitive care at medical center.• Provide advanced life support en route, if available.• Consider air medical transport.

CHEST CAVITY

Trachea

Sternum

Ribs

Heart and majorblood vessels

Clavicle

Lungs

Diaphragm

Intercostalmuscles

EsophagusCarina


Proper use of oxygenReview OEC Skill 9-4: “Oxygen Tank Setup and Breakdown.” What are the critical performance indicators for this skill?

Setup• Inspect the cylinder and regulator.• Momentarily “crack” the valve.• Attach the regulator.• Align the two smaller pins.• Finger-tighten the regulator.• Set the flow rate to zero.• Open the oxygen valve.

Safety• Never use near a spark or open flame.• No smoking when oxygen is in use.• Keep petroleum materials away.• Turn off cylinder when not in use.• Protect the valve stem from damage.• Leave protective caps in place.• Clear stem before attaching regulator.• Do not over-tighten the regulator.

Substance Abuse and PoisoningYour objectives:

1) Identify the four ways a drug can enter and move through the body.2) Identify commonly abused substances and poisons.3) Identify the signs and symptoms of commonly abused substances and poisonings.4) Identify emergency sources for poison-related and chemical-related information.5) Demonstrate the proper care of a patient who has abused a substance or been poisoned.

Points for discussion: Substance abuse or toxic exposure are common problems that OEC technicians will likely encounter. Assessment centers on recognizing that a toxicological event has occurred and identifying the signs and symptoms.

Depending on the substance involved, an exposure may be accidental or intentional. The effects of substances on the human body can vary greatly, and can range from being medically therapeutic, to producing minor distortions in perception and coordination, to becoming immediately life-threatening.

Terms• Absorption: the way the substance or poison enters the body.• Ingestion: through the gastrointestinal tract.• Inhalation: through lung tissue.• Injection: through placement of substance in or near bloodstream.• Transdermal absorption: through the skin.

Management of a toxicological event• Summon assistance as needed, i.e. fire department, law

enforcement, hazmat.• Reduce substance exposure. Only dilute ingested poisons if

instructed to do so by your medical director or poison control center AND there is no contraindication to do so, i.e. nausea/vomiting, depressed level of responsiveness.

• NEVER induce vomiting in the field.• Topical poisons: brush off dry particles and rinse away any remaining particles with water. • Liquid poisons: thoroughly rinse with water.• Ocular exposure: immediately irrigate with sterile water or irrigation solutions.• Inhaled poisons: immediately remove patient from source of poisoning.• Maintain airway, give high-flow O2, consider ALS transport.

If this person fell and landed flat, slamming his chest over a rocky area, how would you proceed?

13Cycle C 2013

Points for discussion: Have you ever been involved in a toxicological event? Please share this information at your refresher if the opportunity arises.

To review the assessment and management of other poisoning situations, consult Chapter 12.

TRAUMAPrinciples of TraumaYour objectives:

1) Identify the role of the trauma center in improving the survival rate of a trauma patient. 2) Identify the five mechanisms of injury.3) Compare and contrast high-velocity injuries and low-velocity injuries.

Points for discussion: What medical centers are located near you? What level are they? What are the specialization, complexity, and availability of care that they can accommodate? What is your state or local protocol for transferring patients to advanced care centers? Review Chapter 17 to refresh yourself on this topic.

Mechanisms of Injury• Blunt Injury: “Closed” injury. Kinetic energy is transmitted

through the skin, but does not break the skin. Causes damage to underlying tissues.

• Penetrating Injury: “Open” injury. Breaks the skin and damages underlying structures. This type of injury is divided into two categories, high-velocity wounds and low-velocity wounds. High–velocity wounds occur when an object is moving faster than 2,000 feet per second; low–velocity wounds occur when an object is moving slower than 2,000 feet per second.

• Rotational Injury: Occurs when energy is transmitted to the body in ways that are not compatible with the normal range of motion of affected joints.

• Crush Injury: Occurs when a body part is caught between two or more heavy objects and is subjected to significant compressive force or pressure.

• Blast Injury: Caused by an explosive force. There are four categories: primary, secondary, tertiary, and miscellaneous.

Refer to matching question 1 in Chapter 17 on page 529. Match up the MOIs with the incident descriptions. How did you do?

There are several accident photos in the “Principles of Trauma” chapter. Take a look at them; have you ever treated patients having similar MOIs? If so, what was your greatest concern?

Exercise: Next time you are in your sports area, pick two locations where you might possibly find an accident victim. Have a friend lie on the ground in a slightly angulated position and pretend to be unconscious. Imagine five possible ways in which that person could have ended up there. Too often, rescuers think they know what happened and might overlook injuries if they don’t determine the actual MOI.

Face, Eye, and Neck InjuriesYour objectives:

1) Identify the signs and symptoms of emergent injuries to the face, eye, and neck.2) Demonstrate how to care for an impaled object in the eye.3) Demonstrate how to care for a soft tissue wound to the neck.


The anatomical structures of the face and neck are confined to a relatively small area. Because of their close proximity, trauma to one sensory or vascular structure may be accompanied by injury to other structures. Understanding these anatomical relationships helps you better evaluate the extent of injuries when caring for patients.

Face Injuries: The face is vulnerable to a variety of injuries, most of which affect the lips, mouth, and tongue. Bleeding can be severe due to the vascular nature of the skin. Fractures can occur, and some may result in airway obstruction.

Eye Injuries: Light-related injuries are the most frequent. Exposure to UV rays (from the sun or welding), chemicals, and various gases can cause eye damage. Eyes are very vulnerable to abrasive and penetrating injuries. Blunt trauma can result in vision distortion and sensitivity to light.

Neck Injuries: Injuries involving the structures of the neck can be immediately life-threatening. Blunt trauma is a leading cause of neck and throat injuries that may damage not only the vital structures in the anterior neck, but also the cervical spine.

List some of the signs and symptoms for these injuries:1. Major abrasion from the eyebrow on down across the nose and lips:

2. Blunt trauma to the right eye with orbit fracture; part of the bone is impaled at the edge of the eye:

3. Laceration of the medial side of the neck requiring pressure bandage:

Now, think about how would you treat these injuries; make notes if that would help:

Refer to Chapter 22 if you would like to review more about managing these types of injuries.

Management of Eye InjuriesEye injuries can result in blindness. These patients need to be evaluated by a physician quickly. Some small foreign bodies can be removed with cotton-tipped applicators, if the patient allows. Objects penetrating the surface of the eyeball, regardless of how deep, require eye stabilization prior to transport and urgent consultation with an ophthalmologist. Have you encountered any of these types of injuries in the field? If so, how did you handle the situation? Note your recollections and mention this at your refresher, if possible.

Review Figure 22-20 a-d for minor foreign body removal, and OEC Skill 22-1: “Stabilizing an Impaled Object in the Eye.”

15Cycle C 2013

Injuries to the Knee, Tib/Fib, Ankle, Foot, and ToeYour objectives:1) Compare and contrast the signs and symptoms of dislocations, sprains, strains, and fractures of the lower extremities.2) Review the use and application of different splints.3) Demonstrate how to remove a ski or sport boot from an injured lower extremity.4) Demonstrate the care of the following specific leg injuries. (If available, a variety of

splints should be used.)a. Knee (dislocation);b. Tib/fib (open fracture); andc. Foot or ankle.

The information that will help you meet these objectives is in Chapter 20.

Dislocations, sprains, strains, and fractures of the lower extremitiesDislocation

• Separation or displacement of bones at a joint.• Usually the result of forceful trauma.

Sprain• Stretching or tearing of a ligament.• Tears may need surgery.• Joint is displaced beyond its normal alignment.

Strain• Stretched or torn muscle.• Overexertion or poor body mechanics.• May range from minor to severe.

Fracture• Break in a bone.• May be open or closed.• May be displaced or nondisplaced.• May be associated with internal or external bleeding.

Types of Fractures• Butterfly• Comminuted• Compression• Epiphyseal• Greenstick• Impacted• Oblique• Pathologic• Spiral• Transverse

Points for discussion: How would the signs and symptoms vary with each type of fracture? Multiple structures and surrounding tissues may be injured in a single event. Soft tissues, nerves, and blood vessels may be involved.

Use and application of different splints for lower extremity injuriesWhat specific splints does your rescue group have available for splinting lower extremities? Have you ever had experience with others shown in the text? What splints does your local EMS provider carry? Can you splint a fractured tibia using a long spine board?

TECHNOLOGY FOR ACTION Opedix patented technology reduces stress on the knee. Utilizing a scientifically designed tensioning system integrated with a comfortable, form-fitting base layer, the KNEE-Tec™ Tights align your joints to improve performance.

To order or to learn more about other great Opedix products, please visit www.opedix.com. Enter code nspdiscount at checkout for pro pricing.

Reduces destructive forces on the knee

Reduces quadriceps fatigueand knee pain

Improves dynamic balance for athletic performance

©2013 Opedix, LLC. OPEDIX and the Opedix mark are registered trademarks of Opedix, LLC, Scottsdale, AZ USA. US Patent 8,296,864


Removing a ski or sport boot from an injured lower extremityRead OEC Skill 20-14: “Removing a Boot,” to review this procedure. What types of boots or footwear do you deal with in your outdoor sports environment? What difficulties might you encounter when trying to treat a lower extremity injury in a patient wearing a boot?

Caring for the following specific leg injuries What types of splints can you use for each of these?

Knee (dislocation): _______________________________Tib/fib (open fracture): ____________________________Foot or ankle: ___________________________________

Which ones will you be able to practice applying before your refresher?

Leg falls forward over top of boot and breaks

Tibia

Fibula

Boot-toptransverse fracture

Knee cap

Femur

Ski and boot stay in place

Spring-loaded binding clamp

Pain due to nerve damage

Internal bleeding

Soft-tissue damage

Restrictedblood flow

Closed injurybecomes open injury

Discoloration initially red due to internal bleeding pale or blue and cool due to lack of blood and oxygen

Exposed bone orpunctured skin

Deformity swollen injury site bent where there is no joint

Swelling due to bleeding in the tissues

17Cycle C 2013

SPECIAL POPULATIONS AND SITUATIONSPediatric EmergenciesYour objectives:1) Identify the anatomical and physiological differences between children and adults.2) Describe communication tips and techniques for assessing and interacting with pediatric patients.

3) Identify the signs and symptoms of respiratory distress and failure in a child.

4) Identify the use of the pediatric assessment triangle.5) Review the use of specialized equipment involving pediatric patients.6) Discuss and/or demonstrate the care of an asthmatic pediatric patient

with signs and symptoms of abuse and/or neglect using the pediatric assessment triangle (PAT).

7) Demonstrate the assessment and emergency care of a pediatric orthopedic trauma patient.

Children can present with very different illnesses, problems, and patterns of trauma than adults. A child’s unique physiology changes continually from birth to adulthood, which can make assessment and care difficult for the OEC technician.

Points for discussion: When caring for a child, always be honest. If something you will do will cause the child pain, say so in a kind way. Trust is essential when interacting with a pediatric patient. Explain to children that are old enough to understand what you are doing, step-by-step.

Child’s Appearance• Is the child injured or ill? Sick or not sick? What is the likely cause?• Is the child active and moving, or still and quiet?• Is the child having difficulty breathing?• Does the child make eye contact?• Does the child appear irritable or agitated?• Does the child respond to his or her caretaker’s voice?• Are urgent inventions needed?

If you need to review the signs and symptoms of respiratory distress and failure in a child, see Chapter 30.

A child who is unresponsive, has labored breathing, is pale, and/or has major bleeding should alert you to a possible life-threatening problem. Assess the child’s skin color for clues regarding the perfusion of the patient’s tissues. If low-light levels, cold environments, or dark skin make assessment more difficult, assess the sclera of the eyes, the lips, or the palms of the hands.

Describe any specialized equipment your rescue unit has on hand for pediatric patients. Do you have pediatric oxygen masks, airways, malleable splints, or pediatric spine boards?

Basic principles for treating pediatric patients are the same as those for treating adults: mitigate any hazards and correct any ABCD-related problems. Because children have a smaller blood volume, control external bleeding aggressively. Children can easily go into shock from a minor head laceration that is bleeding profusely.

Appearance Work ofBreathing

Circulation to Skin


Obstetric and Gynecologic EmergenciesYour objectives:

1) Identify causes of abdominal pain of gynecologic or obstetric origin.2) Identify causes of abnormal vaginal bleeding.3) Demonstrate care for a normal childbirth, including the primary assessment and care of

the newborn.4) Demonstrate how to care for a pregnant

patient with abdominal trauma.

The female anatomy is unique in that it enables reproduction and the continuation of the human species. The woman’s genitourinary, gastrointestinal, and reproductive systems are located within the abdominopelvic cavity. Obstetric emergencies pertain to a woman who is pregnant or is delivering an infant, or in the period immediately after delivery, even if the emergency is related to a nonreproductive medical condition such as asthma. Gynecologic emergencies are emergent conditions unique to women, and involve the genital or reproductive tract.

Common OB/GYN Emergencies Review • Abdominal Pain Causes: dysmenorrhea,

cystitis, ovarian cysts, pelvic inflammatory disease, and ectopic pregnancy.

• Vaginal Bleeding Causes: physiologic (normal menstruation), hormonal, or organic problems of the reproductive system.

Chapter 34 provides more in-depth information on these emergencies. Reviewing the multiple choice questions will help you prepare for your refresher.

Review OEC Skill 34-1: “Assisting with Childbirth,” and the accompanying Skill Guide (page 1094).

Transport a woman in labor to a higher level of care under the following circumstances:

• If it takes more than 20 minutes to get there.• If the umbilical cord is visible in the vagina (a prolapsed cord).• If any part of the baby other than the top of the head is visible in the

vagina (breech delivery).• If the woman says her doctor says she will need a C-section.• If this delivery is the woman’s first childbirth, and the amount of the

baby’s head that is visible is smaller than 1 inch across.

After delivery, dry off the infant and cover it with a blanket, except for the face. While drying and stimulating the baby, assess its APGAR score; either 0, 1, or 2 points are assigned at 1, 5, and 10 minutes after birth for these five categories:

• Appearance;• Pulse;• Grimace or irritability;• Activity or muscle tone; and• Respirations.

Placenta

Symphysis pubis

Urinary bladder

Vagina (birth canal)

Fundus of uterus

Umbilical cord

Cervix of uterus

Rectum

Perineum

Uterus

Amniotic fl uid

19Cycle C 2013

Always be prepared for an emergency delivery. Use BSI precautions at all times, including wearing sterile disposable gloves and a face mask with an eye shield or safety glasses.

Care for a pregnant patient with abdominal traumaCare is similar to any other trauma patient. Administer high-flow oxygen. If possible, position the woman on her left side, or if her injuries prevent this, either elevate the right hip or manually displace the uterus until she is immobilized on a spine board to avoid possible supine hypotension from pressure on the vena cava.

Behavioral Emergencies and Crisis Response Your objectives:

1) Identify the four factors that can cause stress and lead a person to behave strangely.

2) Identify the signs and symptoms of common behavioral emergencies.3) Identify techniques to help maintain rescuer safety when responding to a

behavioral emergency.4) Demonstrate how to assess and care for a patient with a behavioral emergency,

and review state and local protocol.

Abnormal or bizarre behavior is not an unusual occurrence in prehospital settings, and is a sign that the central nervous system is in distress. This is due to a variety of causes, not all of which are psychiatric in origin. The goals of treating a patient exhibiting abnormal behavior in a prehospital setting are to ensure the safety of everyone involved, correct potential threats to life, and treat symptoms as they become apparent. Rescuers may be able to de-escalate a potentially violent or hazardous situation.

Common Behavioral EmergenciesProvide an example for each of these factors that can lead a person to be stressed or act strangely:

Medical Disorders:

Chemical Exposures:

Trauma:

Behavioral Conditions:

Chapter 33 contains further information on behavioral emergencies and crisis response. Consult the chapter to assist you in meeting refresher objectives.

Behavioral Emergency: Signs and Symptoms• Agitation;• Paranoia;• Speech that appears stressful;• Bizarre thinking or actions;• Self-destructive behavior or attempted suicide;• Mental confusion;• Hostility/anger/uncontrolled rage; or• Uncontrolled crying.


Important: Calming the patient is one of the most important components of managing a behavioral emergency.

Review OEC Skill 33-1: “Physical/Mechanical Restraint of a Patient.” Remember not to attempt to restrain a person unless you are following local protocol. The best thing you can do is to keep the scene safe and protect yourself and others. If it is necessary to restrain someone, be sure to have enough assistance to do so.

What is your rescue unit’s protocol for intervening in a behavioral emergency? Please note it here:

What are the six critical performance indicators (CPI’s) in the “Patient Restraint Skill Guide?”

21Cycle C 2013

Types of splints.

Treating an eye injury.

Removing a ski boot.

Using an inhaler.


Case Presentation 1

Time Events and Information: Case 1 Decision

Backgroundinfo:

Temperature34 F at 11:00

a.m.

Your patrol has been asked to be on standby for the Fall Festival, which includes several hayrides in a small town near the ski resort. You have been issued a radio and are in contact with the patrol director at the ski patrol base, which is seven miles behind you on the route of the proposed hayride. A call comes in over the radio of an accident near you involving the hayride, and you respond to the scene. A Boy Scout troop and family members were riding on the hayride trailer being pulled by a farm tractor. There are 11 children, ages 7-15, involved in the accident, along with three adults: a Scout leader, a tractor driver, and the driver of a truck.

11:15 a.m. The truck, going too fast, came out of a curve and rear-ended the trailer. The tractor was knocked into the ditch on the right and the trailer jackknifed, throwing most of the people off. You are the first rescuer to arrive after the accident, and begin triage. Police and other first responders have been contacted, but are not yet present.

11:16 a.m. When you yell, “Anyone who is able to walk, please come to me!” six children begin to walk toward you. Describe how you deal with this group, and how to keep them out of the way of arriving emergency vehicles.

Mark each individual patient with a triage color (green, yellow, red, or black) or ID-ME categorization (I – Immediate, D – Delayed, M – Minimal, or E – Expectant). In the START/color column, indicate when you have sufficient information to make your decision by placing an A for ability to walk, R for respiration, P for pulse, or M for mental status next to the color that was selected.

Indicate all six children as a single choice:

START/ID-ME

G ____ I ______R ____ D ______Y ____ M ______B ____ E ______

23Cycle C 2013


11:18 a.m. Patient 1: Scout in red and black jacket, blue boots, with very swollen left ankle. He is crying and breathing. Breaths are 15/minute if counted, pulse is present in right arm if palpated, and he will blink his eyes or state his name and address if asked.

START/ID-ME

G ____ I ______R ____ D ______Y ____ M ______B ____ E ______

11:19 a.m. Patient 2: Scout in plaid coat with no obvious injury. Not responsive and not breathing. When jaw thrust used to open airway, Scout gasps and begins breathing. Breaths are 15/minute if counted, pulse is present in right arm if palpated, but he will not respond to any requests.

START/ID-ME

G ____ I ______R ____ D ______Y ____ M ______B ____ E ______



11:20 a.m. Patient 3: Scout leader in red shirt. Left leg is severed below knee with moderate bleeding. He is conscious and is able to talk to you. Breaths are less than 22/minute. If you take a radial pulse, it is absent. If you ask him to blink his eyes twice, he complies.

START/ID-ME

G ____ I ______R ____ D ______Y ____ M ______B ____ E ______

11:21 a.m. Patient 4: Scout with brown hair, green jacket. Bruise on forehead over left eye, dazed, not responsive to shouts or pinching of inner arm. Breaths are 18/minute, radial pulse may be detected if palpated. He does not respond to a request to blink his eyes.

START/ID-ME

G ____ I ______R ____ D ______Y ____ M ______B ____ E ______

11:22 a.m. Patient 5: Tractor driver with black coat and blue hat. Has deformed fracture of the right arm and is moaning and holding injured arm with his left arm on ground next to running tractor. Breathing is irregular due to moaning, and breaths are 36/minute. Pulse is present in good arm if palpated, and he will talk to you and answer questions if asked.

START/ID-ME

G ____ I ______R ____ D ______Y ____ M ______B ____ E ______

25Cycle C 2013


11:23 a.m. Patients 6 and 7: Scout 6 in black and grey jacket with no visible injuries is sitting beside Scout 7 in a camouflage jacket, who is holding his right knee.

Scout 6 is screaming for someone to save his big brother, Scout 7. He keeps screaming the same thing over and over. Breaths are 18/minute if counted, pulse is present in right arm if palpated, and he will blink his eyes or state his name and address if you get in his face and demand he answer. He returns to screaming as soon as he answers the question.

Scout 7 in camouflage jacket is holding his right knee and is breathing. He is dazed, and will not answer anything you ask. Breaths are 15/minute if counted, pulse is present in left arm if palpated, and he will not blink his eyes, nor state his name and address.

Patient 6START/ID-ME

G ____ I ______R ____ D ______Y ____ M ______B ____ E ______

Patient 7START/ID-ME

G ____ I ______R ____ D ______Y ____ M ______B ____ E ______

11:25 a.m. Patient 8: Truck driver. No injuries noted, but walks around in a daze, screaming, “This was not my fault, this was not my fault. I never even saw the trailer. I need another beer. What did I do with my beer?”

START/ID-ME

G ____ I ______R ____ D ______Y ____ M ______B ____ E ______


Case Presentation 2

Time Events and Information: Case 2 Vitals

9:12 p.m. John and Mary arrive at your house with their son Mike, age 5. They are new neighbors you met several days earlier. They explain that they asked another neighbor and learned you were trained in first aid. They tell you Mike fell down the basement stairs and hurt his right leg. While Mary holds Mike, who is crying, you begin to talk to Mike at eye level and ask him about a truck he is holding. Your question John and Mary why they did not call an ambulance, and they answer that Mike bounced right up and said he didn’t hurt anything other than his leg.

9:16 p.m. Mike calms down, and you begin to gain his confidence. He lets you take his hand and you begin to take his pulse. When you ask Mike if it is OK to roll up his sleeve to put a balloon on his arm, John says that it is not necessary. Mary looks down and says nothing. You explain that you need a baseline BP and have a pediatric BP cuff that will fit Mike, and it will not hurt Mike at all but will be fun. Mike says he would like to see the balloon. Nothing seems unusual until you roll up his left sleeve to take the BP and notice several round marks the size of a pencil eraser on the inside of his forearm and upper arm. There are eight marks total, one of which has a slight blister that looks several days old.

AVPU: ATemperature: normalPulse: 96, regular and normal for a five year old.

9:20 p.m. You do a primary survey and take SAMPLE and vitals and find nothing remarkable. In doing your secondary survey, you examine the uninjured leg and continue to talk to Mike about his truck. He allows you to examine his injured leg, and you see a bruise on the lateral side of his calf that is slightly yellow and looks old. As you continue to check the leg, you find it is very tender at the midshaft of the fibula on the right leg. Mike also lets you lift his shirt to check his back, and you notice several red lines across his back. John and Mary tell you this is from the stairs, but the marks are sharp and distinct lines, not like normal bruise marks from an impact.

AVPU: APulse: 96, regular and normal.Resp.: 18, regular and normal.B/P: 116/86Temperature: 99 FSkin: warm, dry, and pink.Eyes: PERRL

27Cycle C 2013


STATIO

N

#O

bjectiveInform

ational O

bjectives

Each OEC

technician will

individually perform

the follow

ing skills

OEC

technician will

participate as a team

m

ember

Reqs m

et

4

Perform an assessm

ent as the lead rescuer on a pediatric trauma patient, including the

following:

_____ Scene size-up;_____ Prim

ary assessment;

_____ Secondary assessment; and

_____ Reassessment.

X

4Dem

onstrate how to properly set up an oxygen tank for use w

ith the appropriate airway

adjunct.X

4Dem

onstrate the use of the following airw

ay adjuncts, including sizing and insertion:_____ O

ropharyngeal airway; and

_____ Nasopharyngeal airw

ay.X

4Identify the anatom

ical and physiological differences between children and adults.

X4

Describe comm

unication tips and techniques for assessing and interacting with pediatric

patients.x

4Identify the signs and sym

ptoms of respiratory distress and failure in a child.

X4

Describe the use of the pediatric assessment triangle.

X4

Review the use of specialized equipm

ent involving pediatric patients. X

4Discuss and/or dem

onstrate the care of an asthmatic pediatric patient using the pediatric

assessment triangle (PAT).

X4

Demonstrate the em

ergency care of a pediatric orthopedic trauma patient.

X5

Review the fundam

ental anatomy and physiology of the endocrine system

.X

5Review

the fundamental anatom

y and physiology of the lymphatic system

.X

5Review

the fundamental anatom

y and physiology of the reproductive system, including

identifying the:_____ M

ajor anatomical structures w

ithin the pelvic cavity; and_____ Functions of the fem

ale genitourinary and reproductive system.

X555

Identify causes of abdominal pain of gynecologic or obstetric origin.

X5

Identify causes of abnormal vaginal bleeding.

X5

Demonstrate the care for a norm

al childbirth, including the primary assessm

ent and care of a healthy new

born. (Refer to the Skill Guide: “Assisting with N

ormal Childbirth,” Chapter 34.)

X5

Demonstrate how

to care for a pregnant patient with abdom

inal trauma.

X5

Demonstrate proper care of a patient w

ho has abused a substance or been poisoned.X

5Identify the four w

ays a drug enters and moves through the body.

X5

Identify comm

only-abused substances and poisons.X


ptoms of com

monly-abused substances and poisonings.

X5

Identify emergency sources for poison-related and chem

ical-related information.

X

Com

plete S

amp

le Refresh

er Sk

ills Ch

ecklist (con

t.)

29Cycle C 2013

Com

plete S

amp

le Refresh

er Sk

ills Ch

ecklist

STATIO

N #

Objective

Informational

Objectives

Each OEC

technician will

individually perform

the follow

ing skills

OEC

technician w

ill participate as a team

m

ember

Reqs m

et

OV

ER

ALL

Identify the MO

I or NO

I for a scenario.X

X

OV

ER

ALL

Demonstrate how

to ensure scene safety.X

X

OV

ER

ALL

Demonstrate the use of personal protective equipm

ent.X

X

1Identify the five m

echanisms of injury.

X

1Com

pare and contrast high-velocity injuries and low-velocity injuries.

X1

Identify, compare, and contrast the signs and sym

ptoms of dislocations, sprains, strains,

and fractures of lower extrem

ities.X

1Dem

onstrate patient assessment for traum

a, focusing on an adult with a low

er extremity

injury.X

1Dem

onstrate how to rem

ove a ski boot from an injured low

er extremity.

X1

Demonstrate the care of the follow

ing specific leg injuries, using a variety of splints:_____ Knee (dislocation);_____ Tib/fib (open fracture); and_____ Foot or ankle.

will lead one

of the threew

ill participate in all three,

lead one1

Identify the role of the trauma center in im

proving the survival rate of a trauma patient.

(Refer to state/local protocol.)X

2Discuss and/or dem

onstrate how to use the ID-M

E triage system.

XX

2Discuss and/or dem

onstrate how to use the START triage system

.X

X2

Identify the four factors that can cause stress and lead a person to behave strangely.X


ptoms of com

mon behavioral em

ergencies.X

2Identify techniques to help m

aintain rescuer safety when responding to a behavioral

emergency.

X2

Demonstrate care for a patient w

ith a behavioral emergency in accordance w

ith state and local protocol. (Refer to patrol director and area m

anagement.)

X2

Identify several public safety activities that are classified as special operations.x

2Identify basic operational tasks or objectives of several special operational groups.

X2

Identify HAZWO

PER.x

2Identify the purpose of the International Hazard Classification System

diamond placard

system.

X2

Identify the three hazard control zones.X

2Identify the purpose and m

echanism of action for contents of a nerve-agent antidote kit.

X3

Identify the signs and symptom

s of emergent injuries to the face, eye, and neck.

X

3Dem

onstrate how to care for an im

paled object in the eye.X

3Dem

onstrate how to care for a soft tissue w

ound to the neck.X

3

Identify the signs and symptom

s and pathology of the following thoracic injuries:

_____ Flail chest;_____ Pneum

othorax;_____ Hem

othorax,_____ Tension pneum

othorax;_____ Sucking chest w

ound, and _____ Pericardial tam

ponade.X

3Dem

onstrate how to assess and care for a patient w

ith an open chest wound.

X3

Demonstrate the proper use of oxygen for treatm

ent of chest injuries.X


2013 Cycle C 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 2013 refresher. Please print.

OEC Technician Name:

NSP ID #:

Ski Patrol/Affiliate Group Registered With:

Refresher Location/Date:

OEC Instructor of Record:

IOR Signature:

2013 Cycle C OEC Refresher Supplemental Roster Information

(VISITING OEC technician fills out this form and gives 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 C 2013

REFRESHER EVALUATION FORMName: Date: Home Patrol: Patrol Name:

1. The refresher met my expectations. Strongly agree Agree Neutral Disagree Strongly disagree

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

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

4. The skills stations were valuable, and I understood what I needed to do at each one. Strongly agree Agree Neutral Disagree Strongly disagree

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

6. The instructor(s) created a professional atmosphere and provided fair feedback of my skills. Strongly agree Agree Neutral Disagree Strongly disagree

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

8. 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

9. Overall, I would rate this refresher: Excellent Very Good Good Needs Improvement10.The Refresher Workbook was very helpful in preparing for this refresher. Strongly agree Agree Neutral Disagree Strongly disagree

11.The “Case Presentations” were helpful, and a valuable part of the refresher. Strongly agree Agree Neutral Disagree Strongly disagree

We welcome your comments and suggestions for improving NSP OEC programs. It is helpful if you are as specific as possible. Please use another sheet of paper if needed.

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 ever used your OEC skills in a place other than your normal patrol environment? If so, where?

Deb Endly (Chair)NSP OEC Program DirectorThree Rivers Ski Patrol2300 Overlook DriveBloomington, MN 55431-3939(612) [email protected]

Tony AtkinsChina Peak Ski Patrol2763 West Browning AvenueFresno, CA [email protected]

Morgan ArmstrongWintergreen Ski PatrolP.O. Box 699Collinsville, VA [email protected]

Jamie ButlerPajarito Mountain Ski Patrol10101 Maya Court NEAlbuquerque, NM [email protected]

Sheila Daly Mt. Wachusett Ski Patrol7 ED Clark RoadHubbardston, MA [email protected]

William DevarneyEastern Division Admin. Patrol45 North Main StreetWest Boylston, MA [email protected]

Jeannine MoganThree Rivers Ski Patrol5755 West 132 StSavage, MN [email protected]

Jodie JeffersSummit Ski Patrol1375 Prairie Clover AvenueKeizer, [email protected]

Cathy SetzerBoyce Park Ski Patrol36 Northgait DriveSlippery Rock, PA 16057(724) [email protected]

MEDICAL REVIEW PANELDavid Johe, M.D., NSP Medical Adviser Edward McNamara, NSP board of directors member

INDEPENDENT REVIEW PANELJason Erdmann, Central DivisionKathy Lee, Pacific Northwest DivisionBryant Hall, Eastern Division

OEC EDUCATION STAFFEdward McNamara, NSP board of directors memberDavid Johe, M.D., NSP Medical AdviserDeb Endly, NSP OEC Program DirectorDarcy Hanley, NSP Education DirectorCandace Horgan, NSP Communications DirectorJill Bjerke, NSP Education Assistant

DESIGNCandace Horgan, NSP Communications Director

2013 Cycle C 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].

2013 OEC REFRESHER COMMITTEE

PHOTOSCraig Brown, Mike Halloran, Andrew Jeffers, Eddie Lawrence/Darling Kindersley Media Library, Ed McNamara, Scott Smith, E.M. Singletary M.D., Studio 404 Photography.com.Front cover photo by Scott Marland.Back cover photo by Mike Hinckley.

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. © 2013 by National Ski Patrol System, Inc.

refresher workbook

Documents