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Apr 28, 2019

WADEM Congress on Disaster and Emergency Medicine 2019

An Emergency Medical Triage Tool for Swiftwater Rescue

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swift water rescue

triage

EMS

flash flooding

Abstract

Abstract

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Keywords

swift water rescue

triage

EMS

flash flooding

Abstract

Introduction: Climate change and overdevelopment increase intensity and frequency of flash flooding, which may generate more swiftwater rescue (SWR). Rescue personnel may fail to properly risk stratify (triage) these victims due to limited medical and/or variable SWR training. SWR victims may attempt to refuse medical evaluation due to lack of awareness of incident- related morbidity and/or comprehension of risk. Aim: To develop a SWR emergency medical triage tool. Methods: A cross-sectional literature search identified SWR-related medical conditions. A flow diagram reliant upon incident history, chief complaint and observational exam rather than interpretation of vital signs was created to guide medical decision-making. Results: Every SWR victim should receive a medical screening exam focused on six clinical categories—drowning, hypothermia, hazmat exposure, physical trauma, psychological trauma and exacerbation of pre-existing disease. Drowning potential is identified by dyspnea, new cough or a history of (even brief) submersion. Shivering SWR victims and those with altered mental status but no shivering are assumed to be hypothermic. Any victim with open skin lesions/wounds who was immersed in floodwater and anyone who has swallowed floodwater is contaminated; these victims require decontamination and possible antibiotic therapy. SWR victims injured upon entering the water or from contact with either water-borne stationary or floating objects require trauma evaluation. Distraught victims and those who exhibit exacerbation of pre-existing organ-system disease also require ED evaluation. Discussion: Most SWR course curricula are oriented towards technical rescue; they do not address comprehensive medical decision-making. We present a rapid medical screening exam designed to determine which SWR victims require an ED evaluation. Such a triage tool will assist rescuers to simultaneously honor patient autonomy and avoid risky and uninformed refusals of medical aid. Simplified medical decision-making should enable application of this tool worldwide.

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© Copyright 2019 Morressier GmbH.
All rights reserved.