l B-GA-005-000/FP-D01 1 Canadian Air Division Search and Rescue Technician Pre-Hospital Protocols and Procedures 5th Edition Effective Date 01-01-15 WPO 30889 SAR TECH PLEDGE Without regard for my personal comfort or self-advancement to the best of my ability and to the limits of my physical and psychological endurance, I solemnly pledge to make every effort to return to safety, those victims of disaster entrusted to my care by the assignment of the mission to which I have consented. These things I shall do: “That others may live”. l B-GA-005-000/FP-D01 1 CANADIAN AIR DIVISION SEARCH AND RESCUE TECHNICIAN PRE-HOSPITAL PROTOCOLS AND PROCEDURES 5th Edition (ENGLISH) (Supersedes B-GA-005-000/FP-D01 dated 01 September 2011) NOTICE This documentation has been reviewed by the technical authority and does not contain controlled goods. AVIS Cette documentation a été révisée par l’autorité technique et ne contient pas de marchandises contrôlées. Issued on Authority of the Chief of the Defence Staff Publiée avec l'autorisation du chef d'état-major de la Défense OPI: Fleet Rdns, SO SAR 2015-01-01 LIST OF EFFECTIVE PROTOCOLS Insert latest changed protocols; dispose of superseded protocols in accordance with applicable orders. NOTE On a changed protocol, the portion of the text affected by the latest change is indicated by a vertical line in the margin of the protocol. Changes to illustrations are indicated by miniature pointing hands, or black vertical lines. Dates of issue for original and changed protocols are: Original . 0 . 2015-01-01 Ch . 3 . Ch . 1 . Ch . 4 . Ch . 2 . Ch . 5 . Total number of pages in this manual is 98. A ...............................................0 4 to 4.7.......................................0 i to vi .........................................0 5 to 5.5.......................................0 1 to 1.6 ......................................0 6 to 6.32 ....................................0 2 to 2.3 ......................................0 7 to 7.11 ....................................0 3 to 3.5 ......................................0 8 to 8.10 ....................................0 A FOREWORD B-GA-005-000/FP-D01, Pre-Hospital Protocols and Procedures, Search and Rescue Technician, is issued on authority of the Chief of the Defence Staff. This document is a field manual of medical procedures and proto- cols to be used by operational SAR Techs to provide pre-hospital care in the performance of Search and Rescue operations. The manual has been developed by the 1 Canadian Air Division Surgeon and approved by the Surgeon General. This publication B-GA-005-000/FP-D01, dated 2015-01-01, is effective upon receipt. Inquiries and suggestions for change shall be forwarded through normal channels to the 1 Canadian Air Division Fleet Rdns, SO SAR Tech for ap- proval by the Division Surgeon. i PREFACE This set of medical protocols and procedures is evidence-based and forms the bonafide occupational medical requirement for CF SAR Technicians. It is the result of an extensive review of SAR medical field rescue requirements and suggestions from the field and is based on a review of over 1100 medical pa- tient rescues over the past 10-year period. A formal board including members who are SAR Techs, paramedic instructors, physician specialists in aerospace medicine, anaesthesiology, trauma surgery, intensive care, emergency medicine and medical and paramedical education met together and in subcommittee to produce this manual. The protocols have been colour coded for ease in identifying QL specific tasks. All of the components of the protocols that are not in yellow highlight are trained at the QL5A (Primary Care Paramedic) level. The steps in protocols that are in yellow highlight require more skill and/or experience and they are instructed at the QL6A part 1 level. The portions in blue refer to pediatric patients. The protocols emphasize the use of clinical judgement. This is reflected in both the protocols themselves and especially in the associated curriculum. This is not cookbook medicine and the SAR Flight Surgeons endorse the need for SAR Techs to act and be supported as fellow clinicians making difficult choices based on the specifics (environmental and medical) of each case. A specific example is the fact that these protocols are designed to function with two SAR Techs on scene. In emergencies, where patient numbers and/or condition and/or multiple locations make it necessary for a SAR Tech to act alone, it is understood that slight alterations to these protocols, which do not deviate from the key therapeutic principles (i.e. ABCs, early transport, etc.), may be required due to the environment (e.g. too cold to start an IV) or safety of the patient or SAR team. These protocols have been reviewed by representative(s) of the Standing Com- mittee on Operational Medicine in Ottawa before being sent to the Surgeon General for approval. The Clinical Council and Surgeon General have reviewed the final product and have sanctioned these protocols for field use. H Wright MD, MPH, ABPM(AM), CCFP, CD Lieutenant-Colonel 1 Canadian Air Division Surgeon P (Ben) Wahl, MD, Dip AVMED, CCFP, CD Lieutenant-Commander Aerospace Medical Programs Flight Surgeon R Hannah BPE, MD, MPH, ABPM(AM), CCFP, CD Major Aerospace Standards and Clinical Services Flight Surgeon and SAR Medical Director ii TABLE OF CONTENTS Page List of Effective Pages .....................................A Foreword. .i Preface ................................................ ii Table of Contents .........................................iii SAR Tech Contact # ......................................vi SECTION 1 – CARDIOVASCULAR (CV) PROTOCOLS ........ 1.1 Cardiac Chest Pain .................................... 1.2 Cardiac Arrest – AED .................................. 1.3 Post-Arrest Stabilization ................................ 1.4 Discontinue Resuscitation ............................... 1.5 Do Not Resuscitate .................................... 1.6 Stroke .............................................. SECTION 2 – RESPIRATORY PROTOCOLS ................ .Suggestive of Asthma/COPD ................ 2.2 Tension/Symptomatic Pneumothorax ...................... 2.3 anaphylaxis/anaphylactic shock – adult and Child . .......... SECTION 3 – TRAUMA PROTOCOLS ..................... 3.1 Hemorrhagic Shock .................................... 3.2 Tranexamic Acid (TXA) ................................. 3.3 Burns ............................................... 3.4 Fluid Replacement Requirements for Burn Victims ............ 3.5 Pain. SECTION 4 – MEDICAL PROTOCOLS ..................... 4.1 altered LoC – nYd .................................... 4.2 Hypoglycemic Emergency ............................... 4.3 narcotic overdose – Adult (Suspected) .................... 4.4 Seizure ............................................. 4.5 Antibiotic ............................................ 4.6 Agitated Patient ....................................... 4.7 HIV Post Exposure Prophylaxis (PEP) ..................... iii CONTENTS (continued) SECTION 5 – ENVIRONMENTAL PROTOCOLS .............. 5.1 Hypothermia ......................................... 5.2 Hyperthermia ......................................... 5.3 High Altitude Illness .................................... 5.4 Decompression Illness ................................. 5.5 Motion Sickness ...................................... SECTION 6 – DRUG MONOGRAPHS ...................... 6.1 Acetaminophen ....................................... 6.2 Acetazolamide ........................................ 6.3 Acetylsalicylic Acid .................................... 6.4 Bacitracin & Polymyxin B ............................... 6.5 Cefoxitin ............................................ 6.6 Clindamycin .......................................... 6.7 Dexamethasone ...................................... 6.8 Dextrose ............................................ 6.9 Dimenhydrinate ....................................... 6.10 Diphenhydramine ..................................... 6.11 Epinephrine .......................................... 6.12 Glucagon ............................................ 6.13 Glucose Gel ......................................... 6.14 Haloperidol .......................................... 6.15 Ibuprofen ............................................ 6.16 Ipratropium Bromide ................................... 6.17 Ketorolac ............................................ 6.18 Lidocaine ............................................ 6.19 Lorazepam .......................................... 6.20 Midazolam ........................................... 6.21 Morphine ........................................... 6.22 Moxifloxacin ......................................... 6.23 Naloxone ........................................... 6.24 Nifedipine ........................................... 6.25 Nitroglycerin ......................................... 6.26 Normal Saline ........................................ 6.27 Oxygen ............................................. 6.28 PEP ................................................ 6.29 Ringers Lactate ....................................... iv CONTENTS (continued) 6.30 Salbutamol .......................................... 6.31 Thiamine ............................................ 6.32 Tranexamic Acid (TXA) ................................. SECTION 7 – STANDARD MEDICAL PROCEDURES ......... .............................. 7.2 Advanced Airway Insertion .............................. 7.3 Assessment of Suspected Spinal Injuries