Indications: Field Amputation
The context may dictate the need for field amputation. Indications would include the inability to safely extricate the patient, continued environmental toxins that pose a hazard to victims or rescuers, and a grossly prolonged time until definitive treatment is available even after extrication.
Field amputations are best performed by trauma or orthopedic surgeons. Few EMS systems have amputation protocols. If a field amputation is performed, ensure adequate analgesia and anesthesia. Ketamine, a dissociative anesthestic that does not cause cardiorespiratory depression, decreases or only minimally increases serum potassium levels.
Key elements of terrorism
This topic provides a brief history of recent explosions and bombings used by terrorists. The types of explosives used, the characteristics of explosives, and explosive classification are also included.
The emphasis for each topic is the unique characteristics of an explosive event, such as a terrorist bombing, that results in mass casualties. This content is to cover the unique knowledge and skills required to effectively respond to a mass casualty explosive or bombing event. Includes: (1) the uniqueness of blast injury, including blast physics, (2) the most common types of blast injuries, and (3) the appropriate treatment (prehospital and initial hospital) for injures that result from blasts.
Explosive devices are a rather inexpensive and easy method for terrorists to trigger major disruptions to our everyday lives. Terrorists have used everything from a small backpack to large trucks and even commercial jet airliners to deliver the explosive agent. Injuries can vary from various forms of trauma and burns to amputations or even immediate death.
Terrorism can be defined as containing four key elements.
- It is premeditated—planned in advance, rather than an impulsive act of rage.
- It is political—not criminal but designed to change the existing political order.
- It is aimed at civilians—not at military targets or combat ready troops.
- It is carried out by sub-national groups—not by the army of a country.