You are working as a Paramedic and Technician crew on an EA. You are called to a report of a 40 year old farmer who has collapsed near a slurry pit. You are 5 minutes away from the location.
On arrival at scene, the farmers wife meets you and explains that the patient was looking for a stray sheep this morning. He noticed the sheep was dead on its side on the edge of the slurry pit. He went over to drag the sheep away from the edge but he became dizzy and has collapsed. His sheep dog has even collapsed next to him. The wife saw it all happen and called for an ambulance, she hasn’t gone over to check him yet.
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What are your first actions
Fire Service is on route and will be a few minutes, HART have also been deployed but are 20 minutes away. Control have also sent an RRV Paramedic to back you up in case you need more assistance. What process can help you when looking at possible CBRN/HAZMAT jobs
The Fire Service arrives and quickly dons their BA’s. They drag the casualty away from the slurry pit and bring them over to you. As you have set up the stretcher and kit, they are able to lift the patient onto the stretcher. They advise that their gas monitoring equipment alarmed that there were high levels of Hydrogen Sulfide and Carbon Monoxide in the vicinity of the patient.
Initial assessment of the patient is that they are GCS 3, obviously cyanosed, they have a very slow respiratory rate of around 4, and they have a very rapid and weak radial pulse. There is no catastrophic haemorrhage. What is your first system management on the primary survey
You quickly examine the airway and can see there is significant vomit and secretions collected. You suction the airway and clear it. The wife states he didn’t collapse with significant force, and the Firefighters say the ground was very soft by the patient, so you rule out any C-spine. The patient is still cyanosed and respirations of 4. Given the scenario and the gases involved, what do you do next
Your colleague passes you the BVM and you begin ventilating the patient. You use a head tilt chin lift to assist you, but ventilations are difficult and you are unable to make a good seal with the BVM mask. Your colleague is conducting a breathing assessment using FLAPS TWELVE and advises you that the ventilations are having little effect. What management can you do to better your ventilation’s
You quickly move through the stepwise airway approach and find that an SGA device gives much better ventilations. Your colleague confirms this with their FLAPS TWELVE assessment, and now there is good bilateral and equal air entry. Initial O2 readings were in the low 70% but following a number of successful ventilations with the SGA and BVM, they have now climbed to 95% and the cyanosis has gone. What is your next system assessment
You assess circulation and apart from tachycardia on the ECG at 120 HR and BP of around 95/57, there are no other deficits. Your colleague has gained IV access and you ask a Firefighter to raise the patients’ legs for the BP.
What is your next system assessment
In regards to exposure of CBRN/HAZMAT patients posing further risk to others, you can utilise the Fire Service, HART, and a whole range of other agencies or platforms for more information. But can persons exposed to hydrogen sulfide pose serious risks of secondary contamination to personnel outside the Hot Zone
You are loading the patient into the ambulance while getting a blood sugar reading, temperature, pupil response. Sugars and temp are within normal parameters, pupils were a bit sluggish in reaction. You instruct a Firefighter to get all relevant details from the wife, and they return with a bit of paper with all the details on. The patient is normally fit and well, no medications or PMH, no allergies.
You assess environment/exposure of the patient and don’t find any further injuries or damage. A Firefighter is in the EA and able to assist you while you continue managing airway and ventilations due to the patient still not breathing properly for themselves. Control inform you that back up has been delayed and they will be a considerable time before arrival. The nearest suitable A & E is only 5 minutes away. Do you wait for back up or transfer