Respond Appropriately in the Emergency Situations - Case Study Example

Case Study Part 1: Timeline This section highlights the timeline of the “Paramedic-Cradle Mountain Wilderness” incident. It also provides brief information of the events that took place in the course of this incident and how they helped in the decision making process. Time Event 8:00AM – 4.00PM Paramedic on “on-road” work shift 4:00 PM A call comes in informing the paramedics that a bushwalker in the Cradle Mountain National Park got injured in the wilderness area. From the information received; the victim probably has a fractured leg and the area where he is located is inaccessible through road therefore there is need for a helicopter to be used in order to get there. For this operation, only one medical personnel is required and basic medical equipments normally found in a road ambulance. 4:01-4:05 PM The paramedic packs and take ambulance equipment such as; a drug box, some IV and fluid in it, a trauma kit with dressings, a spine board, a cardiac monitor, a neck collar and traction splint. 4:05-4:12 PM The paramedic is driven to the helipad outside Hobart .While on the way, he brain -storms on the possible injuries that the patient may have suffered and also tries to decide on the appropriate materials and equipments that can be used to address the patient’s condition since he could not fit everything in the limited space in the helicopter. 4: 12-4:17 PM Paramedic and police man arrive at the helipad. The pilot warms up and reconfigures the helicopter. Helicopter seats are removed and replaced with a stretcher. Subsequently, the medical equipments and materials are loaded in the helicopter. 4:17-5:01 PM The flight time takes approximately 45minutes and the helicopter arrives at the scene at around 5pm. 5:01-5:30 PM The Rescue team in the helicopter went around the grid reference that was provided to them. The helicopter was about 100 meters above the ground however they were not able to locate the injured patient and the other bushwalkers. At this point, it was getting a bit dark, therefore the rescue team had to use a torch light so that they can be able to illuminate the area in which the injured patient and the two bush walkers were located. Eventually the team was able to locate them a couple of metres away from a place called the Weidorfers Towers. They were down a cliff face on a ledge. 5:30-6:00 PM After locating the patients and the other bushwalkers, the team tried to find a possible landing area for the helicopter but to no avail. Therefore, they were forced to land the paramedic so that he can meet with the rescue police who were on the ground and try to walk up to where the patient was. The paramedic packed the equipment out of the helicopter and was landed safely on the ground where he and two police officers tried to head towards where the patient was located. The two police officers decided to cut through a straight line in the bush so as to get to the patient quickly. Given the fact that these policeman knew the area very the paramedic agree to their plan. He brought along the traction splint in a bag into which he could put equipments such as the survival collar, some IV equipment, two bags for fluid replacement, penthrox inhaler (analgesia) and some dressings. 6:00-9:00 PM onwards The rescue team on the ground penetrated through the thick bushes in darkness in search for where the patient was located. After hours of walking, the team decided to rest for awhile. The paramedic left some of the equipments on the footpath. They later met another rescue team along the footpath, who were able to bring the paramedic equipments that were left by the paramedic along the footpath. The team decided to divide themselves into two groups so that they can be able to locate the patient as soon as possible. The paramedic decided to remain in this area and asked the team to get him as soon as they locate the patient. 9:30 PM onwards After locating the patient, the team came back to get the paramedic. The ground rescue team leave flares on the footpath so as to illuminate the dark way as they go back to where the patient is located. One of the rescue personnel helps the paramedic by carrying his bag. He also tries to help the paramedic to rock climb however, in the process the rescue personnel falls about 10 meters down on the bushy side. Nevertheless, he manages to climb back uninjured. 10:00 PM onwards The paramedic reaches to the location where the patient was located and found the patient cold, damp and writhing in pain. He assesses the patient’s condition and established that the patient has spinal injuries and had fractured his lower leg. He first begins to treat the patient’s injuries. He then places a cervical collar on his neck so as to relieve the pain on his neck. He also administers to the patient a penthrox inhaler so as to relieve his pain. In addition to this, he applies a traction splint on the patient’s leg. 10:45 PM onwards The team erected a tent fly over the patient so as to protect him from the wind and rain. The patient was then placed inside a sleeping bag. Some of the rescue team personnel spent the night under the tent whereas as the rest sat up the entire night until the next day. 6:00 AM onwards Another rescue team arrived the following day with a stretcher and carried the patient to the helicopter. The helicopter was not able to find adequate space for land so it hovered around until the patient and the paramedic were hoisted inside. 11 AM The helicopter carrying the patient and paramedic arrive at Hobart. Part 2: Discussion In most cases, emergency situations tend to be stressful and as a result there is pressure to respond appropriately in the shortest time possible. During emergency situations, it is essential to make appropriate decisions regarding the suitable course of action. The decision made should be based on the situation at hand and one’s experience and judgement. According to Klein (2003), intuition and experience are important factors in decision-making particularly during situations characterised by stress and time-pressure. Such situations can bring about severe consequences even when slight mistakes are made (Hammond, 2000). In the Oxford English Dictionary, “intuition” is defined as the “ability to get knowledge without the use of reason or inference”. Intuition provides people with beliefs that they are not able to justify (Flora, 2007). On the other hand, “experience” can be defined as a practical skill or knowledge that is gained as a result of direct participation or observation in a certain event or activity. Therefore, according to Klein intuition and experience when are important when it comes to making decisions in an emergency situation (Klein, 2003). Evidently, the case of the injured bushwalker is an emergency situation that requires appropriate decisions making so as to facilitate suitable course of action. In this case, there were various factors that had to be put into account and various choices that had to be made prior to the rescue mission of the injured bushwalker. Foremost, it was essential for the paramedic to know about the condition of the injured bushwalker and the possible cause of injury. Furthermore, it was necessary for the paramedic to know when the injury occurred and where the injured bushwalker in this case the patient was located. This information aided the paramedic to make appropriate decisions that could contribute to efficient and timely delivery of suitable medical attention to the patient. Some studies have established that failure to obtain relevant and accurate information before making a decision during an emergency situation can bring about negative effects that may even lead to the loss of life (Johnstone, 2002). In emergency incidents, situational awareness has been identified as one of the factors that contribute to positive outcomes. During emergency situations, situational awareness is one of the key indicators of an effective reflective commander (Brunacini et al, 2004). Besides situational awareness and having the ability to avert untoward situations during an emergency, the time element is also essential. Therefore, it is important for incident commanders and paramedics to be trained on how they can work effectively under time pressure (Mitroff &Anagnos, 2001). After a careful and quick assessment of the situation at hand and the information provided, it is important for an incident commander or a paramedic to decide on the best course of action. For instance, after the paramedic received the call informing him about the injured bush walker, he carefully assess the situation and quickly responds by deciding which medical gears, equipments and medications that he will carry along to the rescue mission. He decides that he will carry along with him, a drug box, some IV and fluid in it, a trauma kit with dressings, a spine board, a cardiac monitor, a neck collar and traction splint. The decisions made by the paramedic at this point proved to be helpful since the equipments and the materials that he carried helped to salvage the patient’s condition after he was traced. However, the paramedic failed to effectively assess and make an appropriate decision regarding the location of the incident, what to carry and do in the course of the rescue mission. Given the fact that the incident occurred in the wilderness, it would have been better if the paramedic put into account the possible occurrence of a ground search so as to identify the exact place where the patient was located (Cannon-Bowers and Salas, 1998). By overlooking this factor, there were some unexpected turns that took place in the course of the rescue mission. For example, the paramedic did not wear or carry suitable clothing and paraphernalia like mountain boots to help him walk comfortably in the bush and overalls to protect from the cold weather and rain while they search for the patient in the wilderness. Moreover, the paramedic assumed that this rescue mission would be abrupt or more like a “hit and run” operation. However, due to the fact that the patient fell to a ledge the ground surface could not accommodate the helicopter therefore the helicopter could not land and he was forced to land and take part in the wilderness search for the patient for several hours. Furthermore, by overlooking the details of where the patient was located, the paramedic failed to carry essential materials that might have helped during the search. For instance, he did not carry the map of the area, a knife, a portable tent, emergency drink or food and a tracking device. There was a possibility that the paramedic might have gotten lost thus by carrying a tracking device and map, it would have been easier for him to search around the area more efficiently. In addition, based on the area where the patient was located, it was also possible that the rescue mission would have taken more time than the paramedic had estimated. By overlooking this fact, the paramedic failed to carry essentials such as food, drinking water and a tent. The drive to the helipad provided the paramedic adequate time to brainstorm what needed to be carried and done in order to address the situation at hand. It is worth noting, that the information provided concerning the condition of the patient and where he was located was not exact. Therefore, the paramedic had to rely on his intuition and experience so as to make decisions on what equipments and materials will be needed during the rescue mission. Moreover, due to the fact that the information provided was not exact, the paramedic also had to make assumptions. For instance, he assumed that the area where the patient was located was spacious enough to accommodate the landing of the helicopter. Soon as the rescue team reached the location they discovered that the helicopter could not land. As a result, the initial plan of the rescue mission was altered and the team had to use other means so as to get access to the area where the patient was located. A lot of time was wasted, as the team tried to use another plan to locate the patient. A lot of time would have been saved if the team had the exact information regarding where the patient was located. This would have enabled them to prepare and quickly execute their plans. Driscoll and Kent (1999) observe that during an emergency situation, time is one of the key considerations that should be put into account. If the paramedic and the other rescue personnel were adequately prepared to embark on a ground search for the patient, much time would have been saved since they would have been easily dropped to the area next to where the patient was located. Another consideration that might have been overlooked was the timing of the operation. When the helicopter left the helipad in Hobart, it was nearing dusk and chances were that any delay that may have taken place particularly with regards to locating the patient could have brought about detrimental effects to the operation. During the recue operation, delays were experienced when locating the patient and finding an area where the helicopter can land. The helicopter did not have a license to fly at night, this implied that it was not equipped to carry out rescue operations during the night. Therefore, the timing of the operation was somewhat limited. In the course of emergency situations delay of any form has been linked to lengthened rescue period and lower chances of survival for the patient (Feero et al, 1995). The experience of the paramedic during ground search operation was somewhat difficult. The paramedic experienced difficulties while traversing through the thick bushes towards where the patient was located. He admitted that at some point he threw his bag in front so as to traverse through the thick bushes. By throwing his bag, he might have compromised the medical equipment and materials that he was carrying. If the paramedic was carrying a flashlight and a Swiss knife it might have been easy for him to navigate through the thick bushes. Although the ground rescue policeman declared that they know the area very well, the paramedic should have still been careful and prepared for any anomalies. A map and a tracking device would have helped them to get to the patient quickly. Given the fact that it was at night, the temperatures were high, it was going to rain and the paramedic had food, water or any form of protection from the rain, it is possible that these conditions could have been risk factors to his health (Hoffman, 2007). In the course of the rescue mission, the well-being of the paramedic and other rescue personnel was crucial to the success of the operation. Wyatt et al (1997) observes that approximately 50-75% of trauma deaths that occur in the United Kingdom take place in the pre-hospital environment. Hence, it is essential for paramedics to ensure that patients get effective and proper medical attention. Whereas the way leading to the patient is not the actual accident scene, scene management often starts when there is need to make sure that the patient, the paramedic, the rescue team and even the bystanders are safe. The presence of other rescue personnel on the ground providing additional help to carry tents, gears drinks and food showed that they were prepared to embark on a rescue mission. If the rescue team on the ground has relied on the rescue team on the helicopter for provision, the rescue operation could not have been as successful as it was. This goes to show that team work is important during emergency situations (Crandall, Klein, & Hoffman, 2006). In this rescue operation, the initial information provided was not conclusive, therefore it was an oversight on the part of the incident commander, the paramedic and the police to rely on the initial information provided. Based on the information provided, the paramedic assumed that the operation was going to be a “walk in the park.” Nonetheless, the operation turned out to be challenging and demanding (Flin, 2002). Generally, when it came to providing medical attention to the patient, the paramedic was efficiently prepared. He carefully assessed the condition of the patient and used the suitable intervention to address his situation. Lessons learnt Subsequent to the rescue operation at the Cradle Mountain Wilderness, the following are some of the vital lessons that can be learnt from this case study. Communication One of the challenges experienced in the course of the rescue operation was poor communication. During the operation, ineffective devices such as two-way radio were use for communication. The development of advanced information and communication technologies has surpassed the use of devices such as the two-way radios that are in most cases obstructed by height and location. Currently, mobile communication devices have tracking systems and GPRS that enable one to know the exact location where someone is as long as they area in which they are in is covered by internet satellites. Preparation of equipments From the on-set of the rescue operation, the success of the rescue mission was largely dependent on the equipments and materials that were going to be used. Before driving to the helipad, it was essential for the paramedic to carry proper gears and equipments such as those often used by mountaineers and campers. These equipments would have facilitated his traverse through the wilderness. Carrying appropriate equipments and materials is key to the success of emergency rescue operations. Knowledge of the local terrain During an emergency situation, it was important to know the nature of the locality where the incident has taken place. It was therefore essential for the rescue-team to double -check the location where the patient was located. Training Training, experience and education are some of the effective ways of developing skills and knowledge. In a case where experience is lacking, training can provide a starting point especially for neophyte rescuers. Training in handling emergency situations and challenging locations should focus on teaching rescuers how they can navigate through challenging locations such as mountain areas, forest, rivers, wilderness and other natural and man-made environment that are difficult to pass. Procedures It is also important for paramedics to employ appropriate procedures when embarking on emergency rescue operations especially in wilderness areas. Bigger helicopters that can fly at night Over time, thrill-seekers, trekkers and other adventurers have embarked on even more bolder and riskier activities. There is therefore need for more effective and versatile rescue equipment and means of transport such as helicopters that fly at night and are equipped to address the situation at hand. The observations above provide profound lessons that could help paramedics and rescue personal to respond to emergency situations more effectively. Conclusion From this case study, it is evident that, emergency situations tend to be stressful and as a result there is pressure to respond appropriately in the shortest time possible. During emergency situations, it is therefore important to make appropriate decisions regarding the suitable course of action. Nevertheless, through effective training and preparedness, it is possible to make the right choices and positive outcomes. Other factors that should be put into account in the course of emergency rescue situations include; the use of effective communication devices, proper preparation of equipments, the use of effective procedures and conclusive knowledge of the situation at hand and the nature of the locality where the incident has taken place. References Brunacini, A. & Brunacini, N. (2004). Command Safety. Preoria: Across the Street Productions. Cannon-Bowers A. & Salas, E. (1998). Making decisions under stress. Washington: American Psychological Association. Crandall, B., Klein, G., & Hoffman, R. (2006). Working minds: A practitioner's guide to Cognitive Task Analysis. Massachusetts, London: MIT Press. Feero, S., Hedges, J., Simmons, E. & Irwin L. (1995). “Does out-of-hospital EMS time effect trauma survival?” American Journal of Emergency Medicine; 13: 133-35. Flora, C. (2007). “Gut Almighty”. Psychology Today 40(3), pp. 68-75. Flin, R., & Arbuthnot, K. (2002). Incident command: Tales from the hot seat (pp. 12-18). Aldershot England: Ashgate. (CSU - Bathurst - 363.34 FLI 1) Hammond, R. (2000). Judgment under stress. New York: Oxford University Press Inc. Hoffman, R. (2007). Expertise out of context: Proceedings of the Sixth International Conference on Naturalistic Decision Making. New York: Lawrence Erlbaum Associates. (CSU - Bathurst - 796.082 FEM 1)   Klein G. (2003). The Power of Intuition. New York: Currency Books. Johnstone, G. (2002). State Coroner’s Office, Victoria Linton Wildfire: Report of the Investigation and Inquests into a Wildfire and the Deaths of Five Firefighters at Linton on 2 December 1998 Melbourne: State Coroner’s Office . Mitroff, I. &Anagnos, G., (2001). Managing Crises Before They Happen. New York: Amacom. Wyatt, J., Beard, D., Gray, A., Busuttil, A., Beattie, T., Robertson, C. (1997). Timing of paediatric deaths after trauma. BMJ; 314: 868. Read More