Vehicles
2003 Ford Expedition
In 1997, a year after its creation, Rice EMS received funding from the University to purchase a new Ford Explorer SUV for use by EMS supervisors. In 2003, the Explorer was replaced with a Ford Expedition XLT.
While the vehicle is not used for patient transport its primary purpose is to provide the on-duty In-Charge with fast access to the scene of an emergency. To aid in this, the vehicle is equipped with a Whelen lightbar, interior LEDs, exterior halogen lighting, Traffic Advisor, and siren system. Additionally, the vehicle's lighting equipment is critical in maintianing the scene safety in hazardous road conditions, such as at the scene of a motor vehicle collision.
The truck also carries specialty and reserve medical equipment. This includes two fully-stocked "jump" bags, a pediatric bag, Advanced Life Support packs (IV kits, medications, and advanced airway equipment), backboards and other spinal-related equipment, a Lifepak 12 heart monitor (ECG and defibrillator), KTD, splinting equipment, powered suction, a Stryker stair-chair (used for bringing people down stairwells and out of tight spaces), personal protective equipment rated to shield medics against chemical weapons, and extra oxgen tanks and airway supplies.
Golf Cart
Rice EMS owns one electric golf cart which has been modified specifically for EMS purposes. Though its day-to-day use is primarily for allowing EMTs without cars to travel around campus, it can also be used to move injured patients from areas inaccessible by car to a convenient roadway or sidewalk. Patients can be securedto a backboard, and then placed onto the patient transport section of the cart. In this manner, patients in areas not easily accessible by RUPD cars or HFD ambulances can be taken to the vehicle that will transport them to the hospital.
In addition to a driver's seat and a long section designed to fit a patient strapped to a backboard, a rear-facing seat is used for a second medic who can provide constant airway assessment. The cart also has storage for two oxygen tanks and cabinets for equipment.
During special events, Rice EMTs will also use golf carts from RUPD and Facilties, Engineering, and Planning.
Privately Owned Vehicles
Typically, EMTs will respond to calls in their own vehicles (Privately Owned Vehicles, or POVs, in EMS-speak). These cars typically do not feature lights or siren (unless granted permission from the EMS command staff or if needed for work with outside emergency service agencies). Because on-duty EMTs must respond rapidly to all calls, they need constant access to their vehicles; therefore, special parking permits are issued allowing them to park in reasonable spaces on campus (within specified guidlines). However, these permits are issued only to on-duty EMTs and REMS office staff who are expected to respond when not on-duty in the event additional medics are needed.
Medical Equpment Bags
Duty Bags
Duty bags are the every-day bags used to carry equipment needed in EMS work. These bags are similar to a duffel bag in style, featuring a large center compartment, as well as several smaller compartments on the sides. Typically, they will be red, orange, or blue, and will feature white reflective striping.
Rice EMS' duty bags contain all of the medical equipment and supplies needed for managing everyday emergencies. This includes bandages, small splints, gauze, ice packs, an oxygen cylinder and related equipment, and any tools (like trauma shears, a clipboard, and building keys) that an EMT would need.
College Bags
A college bag contains similar equipment to a duty bag, but is generally smaller. They are used by an EMT living in one of the Residential Colleges whose job it is to respond only to calls at that college.
Special Events Bag
The special events bag is actually a backpack designed for EMTs providing medical coverage for sporting events, fundraisers, conventions, and other special events. The main difference between the special events bag and a standard duty bag is its design and portability.
Other Equipment
Oxygen
Any EMS service will always carry oxygen. Stored in green or silver and green cylinders, oxygen is given under almost any circumstances. Typically, it is administered via a device known as a non-rebreather mask, a clear mask with a small bag and tubing attached. The mask's design allows the patient to breathe in pure oxygen, while the carbon-dioxide the patient exhales is released back into the air. Alternative methods of administering oxygen are through a nasal canula (the small tubes that feed into a patients nose) or through a CPAP, a specially designed piece of equipment for use with certain respiratory conditions.
Oxygen cylinders come in various sizes, but Rice EMS uses the D-cylinder almost exclusively. This size of cylinder is known for its portability, and will supply about 24 minutes worth of oxygen at a high flow rate. Rice EMTs carry these cylinders in their bags. The In-Charge's truck, the EMS golf cart, and some EMTs' private vehicles may also be stocked with oxygen.
Automated External Defibrillators
These devices, commonly known as AEDs, are designed to treat a certain type of cardiac emergency. Cardiac arrest (when someone's heart stops beating properly) is a broad category, covering several medical conditions. One possible condition is known as ventricular fibrillation, or V-Fib. In V-Fib, the body stops sending the proper electrical signals to the heart, instead firing off randomly. This influx of uncoordinated nerve signals causes the heart to contract randomly and uselessly, similar to a quivering mass. The medical term for this quivering of the heart muscle is called fibrillation. A defibrillator is designed to give an electric shock that runs through the heart, overriding the improper signals, and hopefully forcing the heart to return to a normal rhythm. An External Defibrillator is one that is applied from outside the body (as opposed to a Pacemaker, which is implanted inside a patient's chest), and an Automated External Defibrillator is one that requires no medical knowledge on the part of its operator.
An AED typically features only two or three buttons, a screen that gives information to the operator, a speaker to give commands and warnings, and the two pads used to deliver a shock. When the machine is turned on, it automatically analyzes the rhythm of the patient's heart, determining whether or not the patient is in V-Fib. If it detects a rhythm consistant with fibrillation, it will give instructions on how to administer electrical shocks. Otherwise, it will inform the operator that a shock is not necessary, and that CPR should be continued until paramedics arrive.
AEDs are carried by the In-Charge on a particular shift, any EMTs working special events, and members of the Rice University Police Department. There are also AEDs mounted in Autry Court near the swimming pool, in Lovett Hall at the Welcome Center, and other locations around campus. An AED that is mounted in a public place, for use by anyone (not just EMTs) is called a Public Access Defibrillator (PAD). As additional funding becomes available, more PADs are being installed at Rice. And though the instructions given by an AED are simple enough that even a child could follow them, it is recommended that you receive training before operating one. Currently, Rice offers a CPR, First Aid, and AED course for credit. Organizations like the American Heart Association and the American Red Cross also offer these courses (usually over a two- or three-week period).
Bandages, Gauze, Splints, and Tape
Rice EMS gets most of its calls for injuries to bones, muscles, and joints (musculoskeletal injuries), typically under the guise of sports-related injuries. To treat these problems, EMTs use bandages, gauze, splints, and tape. For the most part, EMTs do not carry the store-bought self-adhesive bandages both for cost reasons and because their predetermined size limits the situations under which a specific bandage can be used. Instead, EMTs carry medical gauze (both sterile and non-sterile) in a variety of sizes. These pads (typically 2"x2" or 4"x4") can be used to help stop bleeding, provide padding to an injured area, or simply clean up messes. Because they do not come with their own adhesive backings, these gauze pads are applied using the aid of gauze rolls, are affixed with tape, or are held on by hand.
Typically in a sports-related or other musculoskeletal injuries, an injured limb will need to be immobilized in order to prevent further injury or to reduce pain. This is where splints and roller gauze come into play. A splint is any object used to immobilize a part of someone's body. Splints carried by Rice EMS include cardboard splints (which can be folded to hold a limb in place, but do not offer much in the way of a "custom fit"), board splints (long thin pieces of plywood, plasic, or metal, covered in foam for comfort and plastic for easy cleaning), and Sam splints (a specially made material that can be molded to fit the particulars of a given injury). These splints will typically be held in place using roller gauze (gauze in a roll form), other roll-style bandages, or medical duct tape. In certain situations (especially with injuries to upper extremities, shoulders, and collarbones), the patient's own body will be used as a splint. In situations like these, the patient often feels most comfortable holding the injured limb close to his or her body. EMTs can use triangular bandages (large triangular-shaped pieces of cloth) to make a sling for the injured arm, and then use roller bandages to bind the arm to the patient's chest. Once this process has been completed, the patient should no longer be able to easily move the arm, which should prevent additional injury and lessen pain.
IVs
IV stands for Intravenous (within the veins), and can be used both to refer to medications that are injected directly into the veins and the process of giving a patient fluids through a tube inserted into a vein. Most Rice EMTs are not certified to administer intravenous medications, but all EMS In-Charges and Officer Staff are. Typically, an IV will be started when a patient is dehydrated or when there severe bleeding is occuring. In the first situation, the purpose of the IV is to rehydrate the patient, while in the second an IV is used to keep the blood pressure from dropping to a dangerous level.
To start an IV, and EMT trained at the Intermediate or Paramedic level will begin by selecting an entry point. Typically, this is into one of the veins on the arms. The area to be used will be sterilized using iodine or alcohol, and then the catheter (the tube that sits in the vein) will be inserted. Contrary to popular belief, the needle used does not stay in the patients arm during IV fluid administration; only the catheter remains in the vein. The catheter is a thin tube of plastic which is slipped over a needle. Catheters are categorized by their size (in units known as "gauge"), and wider cateters (lower gauge) are used when more fluid (or a faster fluid flow) is needed. When the IV is initially started, both the catheter and the needle will be placed in the patient's vein, but the needle is then immediately removed, leaving only the catheter. The end of the catheter that remains outside the body typcially has a port or lock to which IV tubing, syringes, and blood-draw devices can be attached.
Rice EMTs will usually only use an IV to administer fluids. In this situation, a bag of a sterile 0.9% saline solution (salt water) will be attached to a special set of tubing. At one end of the tube is a large piece of plastic with a beveled edge which is used to "spike" the bag of fluid, piercing a special opening and allowing fluid to flow into the tube. Somewhere along the length of this tubing is a device known as a drip set. It features a clear chamber with a small needle at the top. As fluid flows from the bag through the tube, it drips from the needle into this chamber. EMTs measure the flow rate of an IV using the number of drops per minute, and this special needle and chamber device allows them to easily measure this flow. Fluid exits the drip set through the bottom and flows down through more tubing until it reaches the end which gets attached to the catheter. Some sets of IV tubing will have a second length of tubing also entering the catheter, which allows hospital staff to perform tasks like administering medication through that IV.
Advanced Airway Equipment
In addition to starting and managing IVs, EMT-Intermediates and Paramedics are also trained in the use of advanced airway equipment. In any situation where a person has stopped breathing, one of the EMT's top priorities is to ensure that the patient's airway remains open so that oxygen can be delivered. Any number of things can close an airway, including a patient's tongue (typically seen when a patient is lying on their back), swelling (such as during a severe allergic reaction), or their own bodily fluids like blood or vommit. EMTs have several temporary tools that can be used to open an airway, called OPAs and NPAs, which are inserted into the mouth and nose respectively. However, these will not keep a patient's airway open if it is swelling shut or if there are bodily fluids blocking it. In this situation, intubation is indicated.
Intubation is the process of literally placing a tube in a patient's throat. The tubes used are sterile and specially-designed to achieve maximum usefullness. They feature a special cuff around their outer edge that can be inflated to create a seal (bridging any space between the outside of the tube and the inner edge of a patient's windpipe), and some also have safeguards to prevent accidental insertion into the esophagus. They are inserted with the aid of a special tool called a laryngoscope which not only helps open the mouth and lift the tongue out of the way of the airway, but also provides a light to help the EMT properly insert the tube.
Because of the invasive nature of this procedure, along with the discomfort it can cause a patient, its use is almost always restricted to those already unconcious. Special procedures do exist for intubating concious patients, but these involve the use of parlysis-inducing medications that most Rice EMTs cannot administer.
Spinal Immobilization Equipment
In the event of an injury to the head, neck, or back, or a sever traumatic situation like a fall or motor vehicle accident, spinal immobilization may be required. Down the center of the spine runes a bundle of nerves called the spinal cord. These nerves control everything from essential body functions such as breathing and hearbeat down to the movement of one's toes. Any fracture of the spine could potentially dammage or sever the spinal cord, causing temporary or permanent paralysis. As such, in any situation where an EMT suspects that there may have been an injury that could have resulted in dammage to the spinal cord, the neck and spine will need to be immobilized to prevent the situation from worsening.
Typically when people think of spinal immobilization, they think of spinal collars (or cervical collars) and backboards. The first is a piece of plastic molded to fit around a person's neck and over their sholders. It is not tight enough to restrict a patient's airway, but is stiff enough to prevent the patient from turning or moving their head if properly applied. Spinal collars come in numerous sizes (typically based on the length of a person's neck, in conjunction with their body frame size), and Rice EMS carries at least one of every size in the In-Charge truck. Applying a cervical collar is sufficent to keep a person's head from moving, but is not enough to fully immobilize their spine. To do this requires some form of mechanical immobilization.
The most common and most recognized form of mechanical spinal immobilization is the use of a backboard. A roughly rectangular-shaped piece of wood or plastic, the backboard is designed to run along a patient's back from his or her head down to the feet. An injured patient will be rolled on their side using a special technique called "log-rolling" which keeps their spine in a straight line, the backboard will be slid under them, and then they will be rolled back onto the board. The patient will then need to be secured to the backboard; this is accomplished using nylon webbing, velcro straps, or sometimes medical duct tape. The straps will be tight enough to prevent the patient from moving at all, even if the board is tilted or flipped over. The final step in spinal immobilization is the securing of the patient's head to the board, which is accomplished using padding around the head in addition to a strap, or the use of commercially available tools, like a Head Bed.
Once on a backboard, a patient can be easily lifted and placed on a stretcher. Also, because modern backboards are not made from metal, the patient does not need to be taken off the board in order to have X-Rays taken (which are used to determine the extent of the injuries to the spine).
An alternative to the backboard which is often used with small children or those trapped in tight spaces is called a Kendric Extrication Device, or KED. Made of a large number of parallel vertical pieces of stiff plastic, contained in a vaguely vest-shaped cover, the KED is used to immobilize a patient in a sitting position. The device is slipped behind the patients back and is then brought around over the front of their chest. Special straps are used to make sure the device is tight (keeping the spine from moving) while others are placed to keep the legs in the sitting position. The top portion of a KED wraps around the sides of a patient's head, which in conjunction with a cervical collar immobilizes the neck.
Because a KED is not as secure as a backboard, rescurers will typically apply a KED when the patient is still trapped in a tight space, free up an opening and remove the patient (in a process known as extrication), and then place them on a backboard. They will then be secured to the backboard while the KED is still attached.
Typically, however, KEDs are not used in the field. In most cases, there is sufficent room to safely maneuver a patient onto a backboard without the need to apply a KED. Hoewever, they are used in rescue situations (which on Rice's campus are managed by the Houston Fire Department, not Rice EMS) or for children who are too small to be properly secured to a backboard.
MCI Equipment
An MCI is a Multiple Casualty Incident, or any situation where multiple people are injured. In an MCI, there will typically be a limited number of rescure personnel trying to care for a large number of patients. In order to distribute care efficently, special procedures are used in an MCI.
Initially, a process known as triaging will occur. During this process, a designated indivual or individuals will go around to anyone involved in the incident and classify them based on the severity of their medical condition.
- Priority I (Immediate) patients are coded as Red. These patients have very serious injuries and may be suffering from a condition known as shock. They receive medical care before all others, and are transported to hospitals first.
- Priority II (Delayed) patients are coded as Yellow. These patients have injuries that are serious, but do not represent a threat to their lives. They will receive treatment after all Red patients have been cared for, or will be treated by EMTs with lower levels of training. They will also be transported later than Priority I patients, or will be taken to hospitals that are smaller or farther away.
- Priority III (Walking Wounded) patients are coded as Green. These patients have only minor injuries, are able to walk on their own, and are not suffering any life threats. Typically, these patients will receive little to no on-scene treatement. They will be transported to hospitals by bus or in larger groups, as they do not require constant attention by a medical professional. Oftentimes, uninjured patients will also be grouped into the Walking Wounded category.
- Priority 0 (Deceased) patients are coded as Black. If a patient is found without a pulse and not breathing, and an effort to reopen their airway does not cause respiration to restart, medics will cease further treatment and will not attempt to reucessitate the patient. This is done because having medical personnel performing CPR on the patient would prevent them from treating other injured people, which could be dangerous or deadly.
- More advanced triage techniques add a Blue (Expectant) and White (Dismiss) level. The former is for people whose injuries are so severe that they will die soon. They are typically provided only with painkillers and no advanced care is given. The latter is for those with very minor care (who do not require a doctor for treatment) or for those who are uninjured. In this situation, the Green (Walking Wounded) category is limited to those who though injured and need to see a doctor can wait up to several hours before receiving care.
Rice EMTs are trained to place patients at an MCI into the first four (Red, Yellow, Green, and Black) categories only. Patients are marked using a tag which contains not only their category, but also a tracking number, basic information about their injuries, and any special instructions (such as whether or not the patient has been decontaminated in the event of a chemical spill, for example). These tags stay with the patient through their transport to the hospital, and are the primary method by which patient information is passed from one group of medical personnel to another. All on-duty Rice EMTs carry sets of triage tags in the event an MCI occurs.
During an MCI, someone is needed to supervise the overall operations. This person is usually the highest-ranking person on-scene, and is called the Incident Commander. They are responsible for overseeing rescue operations, medical treatment, communication, and transportation of the injured to hospitals. Typically, they will also be a bridge between different emergency agencies (such as police, firemen, and EMTs) and emergency works from different departments (such as between Rice EMS, the Houston Fire Department, and the West University Place Fire Department).