Basic & Advanced Disaster Life Support
REMSA is proud to be affiliated with International Center for Prehospital & Disaster Medicine.
Basic Disaster Life Support (BDLS)
BDLS is targeted to multiple disciplines including: emergency medical service (EMS) personnel, hazardous materials personnel, public health personnel, and health care providers. By teaching multiple disciplines simultaneously, a commonality of approach and language will develop, improving the care and coordination of response in WMD disaster and public health emergencies.
Advanced Disaster Life Support (ADLS)
ADLS is an advanced practicum of the principles introduced in Basic Disaster Life Support (BDLS). ADLS includes lectures on the following: MASS Triage in detail; community and hospital disaster planning; media and communications during disasters; mass fatality management. In additonal small group interactive sessions allow students to work through a series of difficult questions of disaster management in a table top format.
Core Disaster Life Support (CDLS)
CDLS is a 4 hour awareness level course that is focused at the medical first responder, but is also useful for non-medical providers.
The program is constructed around the DISASTER Paradigm and is designed to teach core concepts of disaster management. In addition, students are taught concepts that will allow them to be more effective in the recognition and response to medical disasters. MASS Triage is taught to allow these providers to more effectively assist in the mitigation of the disaster and to assist in the process of triage.
Decon Disaster Life Support (NDLS-D)
The ability to decontaminate a large number of victims from a chemical or radiological event will require large numbers of personnel trained and equipped to provide decontamination. Although healthcare providers in PPE will be needed to render immediate care and to triage victims, the majority of the workforce to provide decontamination in a disaster of this nature should be non-medical provider, hospital based personnel. This program is designed to meet this need. After completing CDLS as the awareness level program, students complete an additional 8 hours of instruction over 2 days. Students also serve as victims for other students to practice decontamination so 2 full days is required to complete CDLS and NDLS-D.
BDLS Course Objectives
At the conclusion of the course, participants will be able to:
1. Identify the critical need to establish healthcare preparedness for disasters
2. Define “All Hazards” and list the possibilities
3. Define “Disaster” and “Mass Casualty Incident (MCI)”
4. Identify the components of DISASTER Paradigm
5. Identify & apply the BDLS triage model using “MASS” & “ID me”
6. Describe the differences between BDLS and ADLS
7. Recognize the different levels of personal protective equipment and select the appropriate PPE for a given threat
Program Faculty
Bradford Lee, M.D., JD, Colonel, USAF (Ret), Associate Dean, Center for Prehospital & Disaster Medicine
Alan L. Moloff, D.O., Colonel, USA (Ret), Associate Dean, Center for Prehospital & Disaster Medicine
Gary Klein, M.D., MPH, MBA, CHS-V, FAADM, Center for Prehospital & Disaster Medicine
Continuing Education Credit
BDLS is approved for 7 Continuing Education Hours
ADLS is approved for 15 Continuing Education Hours
Category 1 CME Credits – American Medical Association
State of Nevada EMS CEU / CA EMS 94-0404
BRN CE – Provider NV030198-1
Target Audience
Physicians, Nurses, EMS Providers, and all other Allied Health Professionals
Prerequisites
Basic Disaster Life Support None
Advanced Disaster Life Support Current BDLS provider
Registration & Fees
Call 775-353-0781 to register BDLS (1 Day): $250 ADLS (2 Days): $400 BDLS/ADLS (3Days): $600
Course Location
REMSA Training Center, 240 S Rock Blvd, Reno, NV
PASTHAM – Assessing Dyspnea Complaints
Paramedics have long utilized mnemonics to aid in the assessment of common medical complaints. Mnemonics are useful in jogging memories of essential elements of an assessment when dealing with the critically ill patient. Memory aides become very important in the prehospital environment due to the severity of the patient, and the unstable and chaotic atmosphere surrounding an EMS call. However, mnemonics do have major drawbacks and limitations.
A paramedic who chooses to assess only through the use of these memory aides will fail to be skilled in drawing the appropriate information from complicated patients. Experience teaches us patients do not follow protocol. Patients will easily deviate from a structured mnemonic. Few patients will offer information in a regimented SAMPLE format, or sequentially fill in the blanks of OPQRST. Paramedics who rely solely on these assessment tools produce broken and disjointed assessments when confronted with “poly-protocol” or “poly-mnemonic” patients. Therefore, it is important to realize these tools should be used as a backstop to catch important information that could be lost in the frenzied prehospital environment.
One of the more difficult assessments is the patient complaining of dyspnea. The severity of these patients is usually high which adds to the anxiety of the call. It is important to discern important information quickly. Omission of certain observations can hinder appropriate patient treatment. A mnemonic is a valuable tool when evaluating the detail of a dyspnea assessment. Few mnemonics achieve the details required to assess a patient complaining of shortness of breath. The OPQRST mnemonic is commonly used but is inadequate. The PASTMED mnemonic is designed specifically for the dyspnea complaints.
P – Provoke, Progression
A – Associated Chest Pain
S – Sputum, color & amount
T – Time, Trauma
M – Medications
E- Exertion, Exercise
D – Diagnosis by physician
The PASTMED memory aid is an improvement on OPQRST but still omits important queues. With some additions this mnemonic can be adapted to include the most important pieces of a good assessment. The PASTHAM builds upon and improves the PASTMED memory aid.
P – Progression, Palliation, Position, and Provocation
A – Associated signs and symptoms, and Accessory muscle use
S – Severity, Speech, and Sputum
T – Time, Treatments
H – History
A- Allergies
M – Medications
“P” – Stands for Progression, Palliation, Position, and Provocation. It is important to establish the progression of shortness of breath. Sometimes this information can narrow your differential diagnosis between an exacerbation of chronic bronchitis or pneumonia, or acute onset due to myocardial infarction, pulmonary embolism, or asthma. Palliation is an observation of what makes the dyspnea better. Conversely, and sometimes more importantly, what makes the dyspnea worse. This is a memory aide to prompt the paramedic to ask questions like “Does it get worse when you walk around?” Or “Have you tried anything to make it better?” The later is a reminder to the medic to ask about temporizing measures attempted prior to the activation of 911 such as inhalers. Noting the patient’s position is important in your assessment, documentation, and pass down to the emergency department either via radio or in person. Relaying the position can paint a picture of intensity more accurately than using mild, moderate and severe descriptors. Then impression of a patient that is sitting bolt upright in tripod position, is very different from one lying prone on the couch with legs crossed. The final “P” stands for provokes. What caused or provoked the shortness of breath? Determining what provoked the dyspnea whether smoke, trauma, allergies, exertion, or other innumerable intrinsic and extrinsic factors is important information to gather.
“A” – Stands for Associated signs and symptoms, and Accessory muscle use. Associated symptoms refer to the subjective findings the paramedic must include or exclude. The subjective findings include, but are not limited to nausea, dizziness, carpal pedal spasms, perioral numbness, and chest pain. If the presence of chest pain is established it is important to differentiate whether chest pain preceded the dyspnea or vice versa. Associated signs are those objective findings you will discover during you physical exam. These findings include adventitious lungs sounds, peripheral edema, diaphoresis, and includes the next “A”, accessory muscle use. Accessory muscle use observations should include costal and sternal retractions, belly breathing, and pursed lip breathing. These observations communicate the severity of the dyspnea when documenting or transfer of care.
“S” – Stands for Severity, Speech, and Sputum. When assessing severity the paramedic can use the 1-10 scale to achieve a quantitative measure of the intensity of dyspnea. Rather than using the 1-10 scale it may be more valuable to establish whether this episode of dyspnea is the worst the patient has ever had. Speech is a prompt to note the ability of the patient to speak. This is usually noted as full sentences, partial sentences, 3-5 word sentences, 1-2 words, or nonverbal. Since there is a direct correlation between the ability to speak and the severity of dyspnea this is a valuable objective finding. It is important to the presence, or absence of a productive cough. If the patient does have a productive cough the color and consistency should be determined. The possibilities could be green, yellow, brown, white and creamy, clear, blood-tinged, dark red blood, or bright red blood.
“T” – Stands for Time, and Treatments. The PASTHAM memory aid already addresses the progression of onset. Time is the duration of the current episode. This measure is vital in determining how long the patient has suffered the current signs and symptoms. Treatments have also been addressed using Palliation. This is an additional reminder to ask the patient what treatments they have attempted prior to EMS arrival.
“H” – Stands for History. This is where the PASTHAM mnemonic deviates from the standard PASTMED to the greatest extent. History is the single most important aspect for assessing shortness of breath. It seems almost comical that it should need to be included in an assessment memory aid. There is no way to obtain a thorough history using a mnemonic. Thorough history for a patient with dyspnea can narrow your differential diagnosis between airway obstruction, chronic lung disease, cancer, asthma, viral illness, infections, bronchospasm, pulmonary embolism, trauma, anemia, and cardiac origins of dyspnea. When evaluating a patient’s history it is important to ask “When was the last time you were in the hospital for this?” Or, “Have you been intubated before?”
“A” – Stands for Allergies.
“M” – Stands for Medications. Aside from general impression of a patient there is not greater assessment tool to evaluate a patient with dyspnea than an evaluation of current medications. Is the patient a fragile asthma patient who requires high dose inhaled glucocorticoid (GC), or continuous oral GC to control their asthma? Or, is the patient taking cardiac glycosides, ACE inhibitors and diuretics for treatment of congestive heart failure? Does the patient take quinolones, or macrolides for chronic bronchitis? Having an in depth understanding of home medications can greatly assist the paramedic when assessing a poor historian or a patient that in unable to communicate secondary to dyspnea.
It is important to hold true to the paradigm that mnemonics should be used only to check the completeness of an assessment and not used as a script. The best choice for a memory aid is the PASTHAM mnemonic. It can serve as an effective tool to aid the paramedic in assessing a patient with dyspnea.
Russell Barnum, CCEMTP
Water Skiing Safety
Water-skiing is an exciting and challenging sport. However, it can also be a dangerous sport if all safety precautions are not obeyed and followed. REMSA would like to remind water skiers of some safety tips to follow while enjoying the summer months while water skiing:
The Ski Area
The size of the water area in which you intend to ski determines the number of boats and skiers that can operate within it at the same time. Each boat should be able to maintain a 200-foot wide “ski corridor” (100 feet on either side of the boat). The entire “skiing course” should be at least 2,000 – 3,000 feet long to avoid constant turning and risky maneuvering.
A minimum depth of five to six feet of obstacle-free water is suggested for safe skiing to:
* Keep the skis from dragging bottom during starts.
* Allow for a margin of safety against hitting bottom or submerged obstacles during a fall.
Serious injuries can result from hitting fixed objects such as docks, pilings or stumps. While many areas with obstacles are marked by warning buoys or signs, it is up to the boat operator, observer and skier to be alert to any potential hazards in the skiing area.
Avoid solid objects when landing. Many serious injuries occur when skiers attempt to stop near docks or pilings. Ski only in areas you are familiar with. Consult charts of the area, ask other skiers who possess “local knowledge,” and personally drive through the course before you actually ski it.
Weather
As a rule, avoid skiing when the water is rough due to high winds. Choppy water demands a greater skill level and causes the skier to fatigue more quickly, often because the tow boat cannot maintain a constant sped. Skiing in the rain is not recommended because of the loss of visibility experienced by the boat operator.
When skiing in cooler weather, be aware of the effects of hypothermia. Loss of body heat leads to a reduction in coordination and judgment. The use of wet suits is an effective way to ward off the chilling effects of wind and cold water.
Safety Tips For Water-Skiers
Don’t take unnecessary risks while water-skiing. The following tips will help you safely enjoy this thrilling sport:
* ALWAYS have an observer in the boat. This is a legal requirement in many states. The boat driver cannot watch the skier and operate the boat safely at the same time.
* ALWAYS wear a Coast Guard approved Personal Flotation Device (PFD) designed for water skiing. Ski belts are NOT recommended. Your approved PFD will help keep you afloat.
* NEVER ski in rough water. High waves or a choppy sea will prevent the tow boat from maintaining a steady course and speed.
* Stay well clear of congested areas and obstructions. Water-skiing requires a lot of open area.
* Don’t spray or “buzz” swimmers, boats, or other skiers. Such stunts are dangerous, discourteous, and could cause an unintentional collision.
* NEVER ski after dark. It is hazardous AND illegal. Any boat traveling fast enough to tow a skier is traveling too fast to navigate safely at night.
* NEVER water-ski while under the influence of alcohol or drugs. Such activity is extremely dangerous because of the impairment to your judgment and ability to respond. A recent study conducted with expert skiers who were deliberately intoxicated indicated that even their ability to ski was dramatically reduced.
* Use hand signals between the skier and observer. Agree before you start what each signal means so there is no confusion at a critical moment.
Retrieving a Skier
Falling down in the water while water-skiing is a common occurrence, especially for beginners. If a skier has fallen or made a water landing, pick them up as soon as possible, since floating skiers are difficult for other boats to see. While waiting to be picked up, the skier should hold up a ski to increase their chances of being recognized in the water.
The boat operator reduces speed immediately while the observer maintains visual contact with the skier and directs the operator. Return to pick up the fallen skier with the boat at reduced speed and headed into the wind or current, whichever is stronger. Always turn off engine when approaching the skier.
The observer is to watch for the skier’s signal to indicate the skier is alright. If the signal is not seen, the operator must assume the skier is injured and needs immediate assistance. If the skier is injured but is able to grasp and hold a line, maneuver the boat upwind and close to the injured person. Turn off the engine, throw the injured skier a line and gently haul them in.
If they cannot grasp and hold a line, follow the same procedure, but let the boat drift towards them without power. Always keep the operator’s side toward the victim and NEVER retrieve anyone from the water with the engine running. Put a swimmer in the water to retrieve a skier only as a last resort.