25.10.2
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Outreach Rescue

Bariatric Rescue 2 Day Training

PDF

Kevin Garvey

Complex Casualties - Bariatric Rescue 

Skills / Knowledge

  • Bariatric Rescue Theory:- Patient recognition - weight, BMI, situation. Types of incident - medical emergency, routine appointments, fire/flood, RTC, entrapments. Legal responsibilities - FRS Act 2004 (Section 9 emergencies0, NHS role, Care providers, police, undertakers, coroner, emergencies Act
  • Physiology & Medical considerations:- Body types - apple, pear, aprons. Co-morbidities - cardiac, diabetes, cancers, hypertensions. ABC's - airways(tongue, supporting, separating, shoulder blades, recovery position), Breathing (diaphragmatic pressure, abdominal pressure, sitting up), Circulation - ( hypertension, venous return constriction, heart conditions). Skin complications - pressure sores, thin skins, sweat rashes.
  • Patient movement considerations:- Patient Assessment - take vitals to establish baseline, repeat Obs on each move, medical professional present. Trapped skin, clothing, items- cut items not skin, awareness of trapped items, checking for issues. Warmth - awareness of chilled stretchers, considerations when windows out, effects of medical conditions. Body position - sat-up position, avoid lying flat, ideally places at 30-35c, support with towels/pillows etc. Conversation & Language - professionalism, dignity, correct terminology. Informed of Process - Justify PPE, Tyvex Gloves, describe journey, instil confidence. Patient Dignity - Working time (night), neighbours and bystanders, cover up, use police & Barriers.
  • Risks & Hazards:- Structural Assessments - Materials, conditions, loads, rescue loads, flooring. Patient Weight - ask, last weigh, ask carer, add 10% for error, load cell. Patient condition - impact on rescue, medical professional present. Partner Agencies - KESIP, M/ETHANE, NHS, Police, FRS, Highways, structural engineers, council, health boards, scaffolders, housing associations, USAR, morgues, undertakers, coroners, SAR, Voluntary sector, other. Biohazards - Urine, Faeces, Food, Rot, Ulcers, Room Contents, PPE. Manual Handling - Considerations, use of equipment, cribbing beds, consideration of collapse, footwear. Bariatric Rescue Hierarchy - Self mobilise, powered, mechanical, manual.
  • Shoring:- Requirements - floor load limits, expected loading, rescue loading, weight spreading. Shoring equipment - Paratech, Arco's, wood, Trench props. Shoring Methods - Across joists, shoring high anchors, multiple story shoring, stair shoring, boarding of stairs.
  • Anchors, Force & Belays:- Shoring Methods - Across joists, shoring high anchors, multiple story shoring, stair shoring, boarding of stairs. Inclined Planes - angles, boarding, friction, stairs. High anchors - Tensionless hitch, lashing pulleys, rigging plates and grillons, shoring anchors.
  • ISC Pin anchor - long/short, flooring types, load spreaders, shoring for vertical load(fix to roof). Backup systems - LOLER, WAH regs, Load limits. Improvised Anchors - scaffold poles, wood, AKRO-props, windows (doorjam), between widows, existing anchors(hoists, chairlifts etc). Lifting vs Micro Lift - Backup considerations, legislation, Practicalities, organisational policies.
  • Equipment:- Pro-move - ratings, usage, attachments. Lifting Aids - Limb lifters, slide sheets, lifting strops, extension handles. Stretchers - Loading, facilitating being sat-up, ratings, bridles, attachments. Powered lifting devices- High Ab, Cranes, ALP, Loads, Levers, Donkey engines, bleed down, person-rated, organisational policies for lifting with ALP/crane etc, pulley effect. Mechanical lifting devices - chain blocks, level hoists, ratchet straps, ratings, LOLER, person-riding, Limitations. Powered Ascenders - V-rigs, Loading, backup, fuel sources. Hauler pulleys (R-ALF and twin release) - ratings, longer length, fragging and sliding, use as backup, use as main haul system. High Deviations - Bi-pods, paratech, hobbling, guying, attachment points, footprints, forces, pinning feet.
  • Journey Planning:- Assess - Casualty condition, urgency, safety, equipment requirements, required destination, necessity to move. Plan - partner agencies, every step of journey, Every movement, equipment, anchors, structures, resources, communications, contingency, timings. Confirm - Plans in place for each component of the journey. Review - at each stage, any changes, plan again, communicate.
  • Exercises (* will be covered time permiting):- Toilet/small spaces- Lifting, anchors, pendulum, tag lines, manual handling. Bath - Pro-move, stretcher packaging, Anchor location, raising, pendulums. Stairways - inclined planes, sliding, forces, anchor choice, lifting equipment, backup, 90' turn. From Bed - Structural capacity, shoring, anchor selection, pro-move, stretcher packaging. Up & Out of Window (simulated high-ab) Longer length systems, backup systems, tag lines, powered ascenders. *From HGV - bipod, hobbling, anchors, raise and lower. *From flat-roof- high deviation creation, floor loading, shoring, tag lines, lowering. * From hole - Bipod, H-frame, hobbling, Tirfor to stabilise head, horizontal movement of casualty with bipod.

Issued on

May 13, 2024

Expires on

May 7, 2027