Extract from the BTEC L4 First Person on Scene pre-course study manual
What will you learn if you train with us?

INTRODUCTION TO PRE-HOSPITAL CARE and the First Person on Scene

The importance of high standards in training for the provision of emergency pre-hospital care cannot be overemphasised and without it, many patients would have poorer outcomes. For this reason, it is important to document a standard of what is expected of those providing this activity.

The Generic Core Material manual for Prehospital Emergency Care, is used as a benchmark for training and education for the BTEC Level 4 First Person on Scene qualification. The Faculty of Pre-Hospital Care is justifiably proud of its reputation for seeking to promote high quality care of patients from the minute their illness starts [or they become injured] until clinical responsibility for the patient is transferred to our hospital-based colleagues

This ethos is fully supported by the Professional Bodyguard Association primarily because the provision of prehospital care is a matter of teamwork, co-operation and appropriate deployment of resources. Matching the appropriate response to the situation requires the dispatcher to not only correctly assess the problem, but to know the capabilities and level of expertise of the responders as well. 


Providing the best possible outcomes for patients requires the use of differing systems of response involving input from a variety of individuals with highly differing levels of training. It involves working collaboratively with the other emergency services such as the police, fire service, ambulance service, mountain rescue and being an island, we must not forget the important role of the coast guard. 


There is an increasingly wider range of voluntary aid societies playing a more central role in the statutory emergency service provision, this is exciting and opens up opportunities. To achieve good outcomes for patients we must all deliver care based on best practice, have excellent integration as emergency responders and all this must be done in a swift and co-ordinated manner. 


Training for this level of emergency care can be provided by a wide range of organisations, ensuring that this care standard is available at events such as sports and mass gathering events and to those first responders who by the nature of their role, may well arrive at incidents before the ambulance service. In this case it will be the First Person on Scene and we hope that this training acts as core or additional reference material during your studies.

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SAFETY FIRST


Depending on their role and training all responders in addition to being responsible for managing their own health and safety may have specific involvement in the management of an emergency incident, for example with: 

  • The Dispatch Controller who is responsible for mobilising the appropriate emergency service, the call taker will confirm the location, nature of the emergency and personal details and, using an algorithm-based enquiry system, prioritise and determine the level of response.

  • The Police who are responsible for traffic management, evidence preservation, criminal investigation, aiding with potentially volatile casualties.

  • Fire Departments who manage firefighting, extrication and rescue.

  • The Ambulance Service who manages casualty assessment, treatment, transportation, hazardous area response team.

  • Coastguard agencies who manage coastal access, extrication, search and rescue, sea rescue.

  • Mountain rescue agencies who manage mountain extrication, access, search and rescue, inland water rescue.

  •  Lowland rescue agencies who manage search and rescue, inland water rescue, lowland extrication.

For the First Person on Scene, assessment of safety begins immediately upon approach to the incident. The dispatch controller, police, bystander or other units in attendance may provide information about the incident and the casualty’s condition when the FPOS responder arrives.


This important information must not deflect the responder from a structured approach and no matter how serious the situation is, the priority in emergency care is scene safety, where the emphasis is placed upon the responder not becoming another casualty.


The rule is to never put own life, or the life of other responders in danger and to work within the scope of own training and abilities. 


Always consider the principles of a SAFE approach:

 Shout for help
 Assess the scene
 Free from danger
 Evaluate the patient

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SAFETY 1 2 3 – yourself, the scene and the environment, patient.

  1.  YOU – PPE i.e. Gloves, Eye Protection etc.

  2.  THE ENVIROMENT – Vehicles, Crowds, Weather etc.

  3.  THE PATIENT – Aggression, Infection etc.

A major concern would be the risk of infection, so it is vitally important to be aware of the potential risk where the FPOS responder may not be aware of whether a patient is carrying an infection, and therefore all body fluids and tissue should be considered as potentially infective.


Simple precautions need to be followed to minimise the risk of infection. These are known as "UNIVERSAL PRECAUTIONS" and include:

  • Ensuring you have had Tetanus and Hepatitis B immunisation at the very least.

  • Keeping cuts and grazes covered at all times

  • Maintaining good personal hygiene, in particular, regular hand washing using the Aycliffe hand washing technique

  • Keeping nails short and clean

  • Ensuring that your hands are washed thoroughly before and after contact with a patient

  • Wearing gloves* and other protective equipment such as safety glasses and overalls when in contact with a patient

  • Disposing of any clinical waste (such as used bandages) through the Ambulance service, who will provide clinical waste bags for this purpose

  • Ensuring that any equipment you have used is either disposed of safely (as per clinical waste guidelines), or sent for cleaning and disinfecting

* Gloves issued should be latex free as standard.


NOTE: Clothing that may be contaminated must be treated properly, and if washed at home, separated from the rest of the family and in water of at least 60 degrees centigrade.


Dealing with spillages of blood or body fluids


All equipment considered disposal such as used single-use items and items that are no longer reusable include: general waste, clinical waste, sharps bin must be disposed of appropriately. 


Spillages of body fluids or bloods represent a hazard and need to be dealt with carefully. 

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There are two main considerations when dealing with spillages:

  • to ensure their safe disposal

  • to minimise the risk of infection to the provider and others

Generally, small blood or spills should be wiped up with a paper towel (or similar) and placed in a yellow clinical waste bag ready for disposal. It is advised that small and large spills should be saturated with Chlorhexidine which is an antibacterial concentrated solution used as a disinfectant and for other applications, but it is effective immediately.

Responders should follow their company SOPS when it comes to restocking of disposed items.


NOTE: Gloves must be worn at all times especially when dealing with spillages!
 

Personal Risk
 

There is always concern about the risk from 'mouth to mouth' rescue breathing. Although there have been no reported cases of the transmission of HIV by this route, it is still important to use basic principles to reduce the risk of becoming infected, both for the responder and the patient.


The reality is that the chain of infection does exist and sources of infections that can be encountered are:

 

  • Gastrointestinal, e.g. gastroenteritis, norovirus

  • Blood-borne infections, e.g. HIV, hepatitis

  • Respiratory infections, e.g. influenza

  • Skin infections, e.g. MRSA


Micro-organisms will transfer from the reservoir of infection via a point of exit such as:

  • skin

  • respiratory tract

  • mucus

  • blood

 

The method of spread or mode of transmission could be:

  • direct contact

  • indirect contact

  • airborne

  • vector borne

  • food

  • droplet

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This transference is via a point of entry such as:

  • skin

  • injection

  • open wound

  • respiratory tract

  • mucus

  • eyes


Susceptible hosts could be anyone, so the use of PPE is appropriate to minimising the risk of self and others contracting infections. At the very least, gloves must always be worn before making contact with the patient, and when performing resuscitation, it is recommended that a pocket mask should be used to avoid direct contact with the patient's mouth. It wouldn’t be a bad idea to have protective eyewear as well.


SCENE APPROACH


The generic core understanding for prehospital emergency care as directed by the FPHC is very specific in that individual prehospital providers will encounter emergencies in a number of ways whether through being on duty or whilst off duty (unexpected and non-anticipated emergencies).
This section details the broad principles of:

 

  • Preparation

  • Scene approach and management

  • The handling of an emergency call

  • The use of personal protective clothing and equipment

  • Driving to the scene

  • Scene assessment


These components will have different relevance depending on the type of responder, but the principles should be known by all providers and put into practice where relevant. 


The example chosen here is based on the response to a road traffic collision, although the principles apply equally to any other type of emergency.


In the UK an emergency (999 or 112) call is initially routed to the appropriate emergency service by the telephone company emergency operator. At the ambulance emergency control centre, the call taker will confirm the location, nature of the emergency and personal details and, using an algorithm-based enquiry system, prioritise and determine the level of response.

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Whilst a dispatcher within the control centre is identifying the resources and tasking the ambulance resources and other relevant resource to respond, the call taker will, if necessary, provide emergency telephone pre-arrival advice, again based on algorithms in the software system that they use.


The FPOS Responder should keep the line open as it can be helpful with the dispatcher talking the caller through a sequence of first aid actions which can have a significant impact on outcome. . . . . . . . 

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