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Show Working in crews of six trainees, future EMT personnel gain first hand experience in this simulated auto accident rescue. EMTs conduct "primary patient exam," to pinpoint all injuries. EMT instructors Albert Orton and Bob Tuckett, began day's training with instruction on extrication pro cedures. This specialized rescue equipment and EMTs are working to upgrade training and equipment. Volunteer Medics Prove Invaluable in Modern Life-Saving Programs By Nancy Hales Spotlight Slafr Writer The unconscious accident victim was strung by his heels Irom the nearest tree to try to restore breathing. In another case the unconscious accident victim was buried upright with his head and chest exposed and cold water was dashed into his face to attempt to restore breathing. Sound cruel and impossible to believe? These were two of the best recognized methods used several hundred years ago to try to revive an unconscious victim with emergency treatment. Modern day techniques in treating all types of medical emergencies, lor-tunately. are not only more humane but infinitely more successful. Applying these modern day techniques are today's Emergency Medical Technicians (EMT's I. the life-saving crew that responds to your neighbor's middle-of-the-night call when the baby suddenly stops breathing or the grinding auto crash with its mangled vie-trims and tangled wreckage. The EMT's are neighbors helping neighbors, particularly in the rural areas of the state like Garlield County. where the local EMT is likely to be well acquainted with his victim. The EMT is the housewife down the street, a farmer or forester, a secretary or sheriff. In Garfield County it may well be a National Park Service, Bureau of Land Management or Forest Service employee, a county commissioner, or hospital administrator; a woman or man who has seen the "need" and wants to help in some small way. When EMTs or when any individual would give up so much free time to continuously study, drill and sacrilice for the sake of others the answers are pretty much the same. "It's gratifying to know you've been able to help" "It's relieving to anxious family and friends when someone is on the scene immediatley and knows what to do." The rewards are "built into the system," says one EMT. "we see them everyday as we mingle with former accident victims, making bonds of friendship that will last all our lives." Yet another expresses "even in cases where a victim lost, there is satisfaction in knowing that you did everything you could to try to prevent it." During eight w eek for some 30 area-w ide EMT tra inees, repellers George Buckingham and Christine Minefield The idea of well-trained technicians providing emergency medical treatment began about 1970 when the Emergency Medical Technician concept was born. The problem of olten poorly trained ambulance operators had been a longstanding one and accident victims often arrived at the hospital having received well-intentioned, but totally inadequate emergency treatment. The American College of Surgeons, together with the Department of Transportation, recognized the need for well-trained emergency medical experts and started the ball rolling. In Utah, EMT's have been in service for several years with their ranks growing steadily each month. The Utah EMT program is regulated by the division of Emergency Medical Services (EMS) under the State Department of Health. The program is administered on a local level through county governments and hospitals. Bural EMT Delivery With the newest class of 30 trainees soon to graduate. Garfield County will have close to 50 certified technicians. (Continued On Page Eight) received practical training which could proe invaluable In future rescues by the pair. r Medics Prove Invaluable in Life-Saving Programs (Continued From Page One) As a rural area it is always necessary to have more EMT's certified because of the vast area to be covered and serviced. EMT's in each community work about two days per week on an "on call" basis although in areas where there are fewer technicians they are sometimes needed for three days per week coverage. Technicians appear to have a "teamwork" attitude about them when called to serve and generally cover for one another readily if one EMT is unavailable to work a scheduled shift. Earned income Is scant for EMT's sho count actual income more in the "satisfaction" they receive in doing the job well. EMT's are not reimbursed for their "on call" service or for training expense incurred (travel, books, lost wages, etc.) in their continual educational process. They do receive $6.25 for a local run in the Panguitch area or $15 for a run from Escalante, a trip approximately 4-5 hours in length, and $50 per trip for transferring a patient to a Salt Lake City hospital facility, a trip averaging around 12 hours. Travel time by ambulance from Boulder to Garfield Memorial Hospital in Panguitch takes about 4" 2 hours. Ambulances normally travel at regular speeds since emphasis is placed upon the quality of medical care given the patient enroute. In an urban area EMT service is planned so that victims are no more than 10-20 minutes from the nearest hospital. For rural EMT's, most criteria have to be modified to suit the special conditions. In an urban area EMT service is planned so that victims are no more than 10-20 minutes from the nearest hospital. For rural EMT's, most criteria have to be modified to suit the special conditions. Two trained technicians respond to an emergency call at all times with backup assistance always available from fellow EMT's if needed. Helicopter or air rescue would be used in more remote points of the county but at this time such aircraft cannot be accommodated in many areas of the county. At airports adequate lighting, refueling and communications are essential and often helicopters are much too far away to make rescue attempt feasible. However, once an ambulance reaches Panguitch, a determination by doctors can be made if the patient may need specialized treatment at another facility. Doctors may then communicate with Life Flight services out of Salt Lake City and have the patient evacuated by fixed wing aircraft. Pickup can generally be made in Panguitch at the Panguitch airport but only during day light hours as the airport is not equipped with landing lights. Often an alternate pickup point is made at the Bryce Canyon airport which is equipped with runway lighting. One of the future goals of the county is eventual upgrading of facilities at both locations. Radio communications in the county (150 miles east-to-west) can also present a problem. Depending on weather conditions, the hospital radio in Panguitch can reach Wide Hollow Reservoir area near Escalante for ambulances traveling to Panguitch from the Boulder-Escalante vicinity. The ambulance may be fortunate to pick up radio communication once again in the Henrieville area, but only rarely, since usually it will be nearing Red Canyon before once again establishing contact. A new repeater may be installed at Barney Top mountain to alleviate some of the problem if hoped for grant funds materialize. Presently, EMT's in Panguitch use individual pagers and the use of "beepers" will be possible in other areas of the county also with improved radio conditions. Currently, the emergency number for reaching EMT's in Panguitch is 676-2411. With the improved planned communications throughout the county, that will become the number for the entire county. EMT Acceptance Initially physicians and nurses may have felt somewhat threatened by what they looked upon as "upstarts." Where physicians and nurses had spent man years learning their highly skilled crafts, emergency medical technicians, with slightly over 80 hours training were taking over some of the duties of their professional counterparts. Time has changed all that and physicians, nurses and emergency medical technicians for the most part all share a common respect for one another. EMT coordinator and physician's assistant at Garfield Memorial Hospital, Bob McCullough, says he is "pleased with the progress of the EMT organization in the county." It is a tight, cohesive unit of dedicated workers who have worked hard to see that EMT service in the county meets the standards set up for rural areas." Training Arduous A number of EMT's in Garfield County have been serving for three years or more with one member, Karen Breinholt, Panguitch; having served since the outset of the program in Utah. In addition to serving two days per week "on call," EMT's must spend 48 hours recertifying every two years and must recertify in cardio pulmonary resuscitaiton (CPR) once yearly. Their education continues year round with new information being constantly assimilated. The turnover rate in EMT personnel is relatively high. The job is a demanding one for most people and frew remain beyhond three years. While training, future EMT's are expected to attend all classes. Recently a class was held in Escalante with 30 trainees. The course extended over eight weeks, with participants attending Friday evenings and eight hours on Saturdays. EMT's are evaluated by the instructor on their dependability, attitude, maturity and the ability to relate well to others. They are issued name tags at their first class and these must be worn at all times while in the hospital and while riding in the ambulance. At the conclusion of the series of classes, the potential EMT's must successfully complete a written test. They are allowed only two attempts at the 100 question multiple choice test. A practical examination is also administered consisting of two CPR (cardiopulmonary resusciation) stations, a situational examination and a physician's interview. These are administered on a pass-fail basis. Trainees must also work one eight hour shift in a hospital emergency room. Garfield County trainees travel r to a large Salt Lake City hospital to gain this experience where a varietv of emergencies are handled in any one eight hour period. They must also spend a total of eight hours in an ambulance or medical assist unit. At the outset of training, each potential EMT is issued a yellow completion card to be signed off by instructors and clinical personnel during each aspect of training. Actual certification upon completion of the course requires about six weeks while the results of the tests are being processed. The trainee becomes a full-fledged EMT upon receipt of his state certificate, identification card, patch and decal. The course is a difficult and arduous one. More than one trainee has been heard to say, "This is harder than anything I ever took in college!" James L. Hendrickson, Chief of Emergency Medical Services trianing in Salt Lake City says, "Our standards are high and will remain high in order to maintain our place on the medical team and in the community." During the eight weeks training on weekends, potential EMT's read extensively to prepare for each class. They learn mouth-to-mouth resuscitation, mouth-to-nose resuscita tion, and cardio pulmonary resuscitation to revive the non-breathing victim. They also learn to use a bag mask for resusciation, a portable device which may be used inside or out of the ambulance. Physicians generally prefer that EMT's use the bag mask where practicable, but it requires proper training in its use and a highly skilled technician to operate efficiently and safely so that the victim is assured of getting sufficient air. The EMT trainees are instructed in the use of oropharyhngeal airways which they carry with them In their jump kits. They learn to help an unconscious victim with an obstructed airway and a conscious victim with the same problem. As they train they become proficient with oxygen equipment and suction equipment. They learn to take a patient's blood pressure accurately and how to monitor it carefully, as well as take the rate of respiration and pulse. EMT's learn to control all types of bleeding from wounds and the proper and safe use of tourniquets. They study and practice bandaging various types of wounds in class until they become proficient at handling even the most serious types. Flail chest wounds, sucking chest wounds, and wounds to the eyes or abdomen are some of the more serious types they may encounter. They also learn splinting of broken bones. At the Scene Treatment In any emergency EMT's perform a "primary patient exam." In the course of this swift and methodical examination, EMT's determine first the state of consciousness of their victim, evaluate his respirations, check the pulse and check for life threatening bleeding. The pulse is counted, respirations counted, and blood pressure taken to provide the assessment of vital signs. Then, as soon as possible, a secondary survey begins. The patient,. where possible, is asked his name and age and information is sought about his current problem. His chief complaint is ascertained, the onset, location, prior symptoms, drug allergies, any chronic illness, and types of medication being taken. Next, the EMT checks the patient's head for lacerations, contusions, and skin color. He assesses the level of consciousness according to the Glascow Coma Scale. He checks the pupils and feels gently for any depressions in the skull. He checks ears and nose for fluid or blood, and the mouth for foreign objects or bleeding. He observes and feels for areas of tenderness and deformity of the neck. He palpates (or tests by touching) the clavicles and shoulders and checks for wounds, making certain that both sides of the patient's chest expand normally as he breathes in. He checks the ribs for pain and listens with his stethoscope for lung sounds on both sides of the patient's chest. He observes for distention of the abdomen or wounds in the abdominal area, and carefully palpates the four quadrants for tenderness or rigidity. The pelvic area, back, arms and legs are cautiously examined for tenderness, numbness, sensation, wounds or deformity. The attentive EMT always checks to see if the patient is wearing a medical alert tag that would indicate some special health problem. Periodically the EMT checks his own hands for blood that could come from hidden wounds of the patient. Extrication Often when EMT's respond to an automobile accident, they find one or more victims trapped in the tangled wreckage. Extricating a victim takes place in five stages: gaining access to him, giving lifesaving emergency are, disentanglement, preparation for removal, and finally, removal. Their goal is to remove the car from the victim, not the victim from the car. First move is to try to stabilize the condition of the trapped patient by establishing and maintaining an airway, giving artificial ventilation and controlling bleeding. If conditions permit, two fire hoses are loaded and ready, one for inside use and one for outside the vehicle. They cover and protect the victim from glass and sharp objects with blankets, towels or tarps. If the victim's head or body is against the car, they use pads to protect them from the sounds and vibrations of the rescue tools. In stabilizing the vehicle, they use cribbing if they lift the car, so that it does not fall back upon the victim, or, if it is on its side, so that it does not fall over. They never use a dry chemical fire extinguisher Inside the car with the victim. If the door cannot be freely opened, they spread the door at the post to determine the location of the lock posts. Upon gaining access," EMT's must be sure to check that the victim is pinned in. They are advised to use a backboard in removing the patient from the vehicle. Recently, at training sessions held in Escalante, participants had practical experience in extracating a victim from a wrecked vehicle. The victim was EMT instructor Bob McCullough, who simulated an injured person trapped in a vehicle at the bottom of a cliff. In groups of six, trainees had to work their way down to the auto, conduct the |