突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座

CombatFirstAid突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第1頁ToIntroducethestudentswithdataregardingtheimportanceofquicktreatmentofinjuriesduringconflict介紹關(guān)于戰(zhàn)火下快速救護主要性數(shù)據(jù)Tointroducethestudenttothesightsandmechanismsofsometraumainjuries介紹一些創(chuàng)傷樣子以及原理Totrainthestudentswithfasttechniquesfortreatingbattleinjuries訓練快速戰(zhàn)地搶救技巧突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第2頁LogicFirsttraininglearnedTacticalFieldCare學習戰(zhàn)地救護Firstaidintimeofemergencyisdifferentfromwhatisthuoghtinmostregulartraining不一樣于普通搶救Pressure(Shooting,screaming,sightofblood,rain,mustrunawayetc)壓力環(huán)境（射擊、尖叫、血腥場景、下雨、必需逃脫等等）Possiblethatnofirstaidequipment可能沒有裝備The

fateofthewoundedlayswiththosewhoapplythefirstdressing.傷員命運取決于最先救助他人-Col.NicholasSenn,1844-1908突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第3頁ImportanceoftheFirstResponder

第一個救助者主要性75-90%ofallcombatdeathsoccurbeforethecasualtyreachesaMedicalTreatmentFacility(MTF)75%-90%戰(zhàn)傷死亡都出現(xiàn)在傷員抵達醫(yī)療搶救設(shè)施前路上Thefateoftheinjuredoftenliesinthehandsoftheonewhoprovidesthefirstcaretothecasualty.傷員命運依賴于最先為他們施與援手人四肢出血氣胸呼吸阻塞突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第4頁Whatfactorsmustwethinkaboutincombattraumacare?戰(zhàn)傷搶救需要考慮原因Hostilefire敵人火力Darkness黑暗Environmentalextremes極端環(huán)境Differentwoundingepidemiology不一樣傷情Limitedequipment缺乏設(shè)備器材Needfortacticalmaneuver需要作出戰(zhàn)術(shù)動作Longdelaystohospitalcare長時間到不了醫(yī)院Differentmedictrainingandexperience不一樣訓練和經(jīng)驗突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第5頁TacticalCombatCasualtyCare

戰(zhàn)斗傷患照料規(guī)范突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第6頁6StepsofBasicFirstAid基本搶救6個步驟Ensureareaissafeandgethelp確定環(huán)境安全Opentheairwayandrestorebreathing打開氣道恢復呼吸Stopbleedingandprotectwounds止血并保護傷口Checkforotherinjuriesandtreat檢驗并治療其它傷GiveagoodreporttoMedical向醫(yī)生（醫(yī)療者）正確匯報突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第7頁Movetosafety安全移動RecallThreatslesson回顧威脅課Buildingonfire?Vehicleonfire,Vehicleunderfire?Smoke?Enemyapproaching?建筑起火？車輛起火？車輛遭遇射擊？煙？敵人靠近中？CanImovetheinjuredwithoutharminghim?我能在不傷害傷員前提下搬運他嗎？CanImovehim?我能移動他嗎？Usecoverorconcealment利用掩蔽或掩護突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第8頁FirstDilemma第一個困境ScoopandRunVsStayandPlay“搶時間和跑”與“停下和施救”ScoopandRuntakethepatientwithoutprimarytreatmentandhurryhimtothenexthospital“搶時間和跑”：將未受處理傷員緊急送往醫(yī)院(movieinKidnaplesson)StayandPlayfirstaid：停下和施救進行搶救突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第9頁AIRWAY氣道突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第10頁Airway氣道Checkforairwayobstruction/choking檢驗氣道阻塞、抑制UseHeimlichmaneuver,backblows,orfingersweeptoclearobstruction采取Heimlich操作法，或用手指去除障礙Openairway打開氣道Head-tilt/chin-lift頭部傾斜、下巴上抬Jaw-thrust推下顎突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第11頁BREATHING突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第12頁NoBreathing沒有呼吸Ifavictimofablastorpenetratinginjuryisfoundwithoutapulse,respirations,orothersignsoflife,DONOTattemptCPR假如傷員因為爆炸或穿透傷而沒有脈搏、呼吸或其它生命體征，不要作心肺復蘇Tiltheadbackandpinchnose向后提頭，捏住鼻子Give2full,slowbreaths慢慢吹兩口氣Ifnotgoingin,checkforobstruction假如吹不進去，檢驗氣道是否受阻Repositionheadifneeded需要話復位頭1breathevery5seconds每5秒吹一次突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第13頁AirwayAdjunctsandControl氣道輔助和控制RecoveryPosition恢復體位半臥式體位突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第14頁膝蓋抬到腹部高度，支撐身體手支撐住頭突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第15頁CIRCULATION循環(huán)系統(tǒng)

STOPTHEBLEEDING止血

突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第16頁Stopvisiblebleeding止住可見流血傷口CheckforChestwounds(alsobackside)檢驗胸口傷（以及后背）Checkforbleedingyouhavenotseenyet檢驗有沒有你忽略流血傷口突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第17頁Removesomeclothes脫掉部分衣服CheckforClotheswithblood檢驗有血衣服對應(yīng)身體部分Entryandexitwounds穿透傷突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第18頁BattleDressings戰(zhàn)地繃帶StandardBattleDressingTearopenplasticwrap.Twisttoopenpaperwrapperandremovedressing扭開紙包裝取出繃帶標準軍用搶救包撕開塑料包裝突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第19頁BattleDressings戰(zhàn)地繃帶Unfoldbandageandapplytowound.打開繃帶蓋住傷口Wraptailsaroundandtietogether.包扎好，系住尾部固定帶突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第20頁EmergencyBandage(IsraeliPressureDressing)

緊急繃帶（以色列式）突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第21頁EmergencyBandage緊急繃帶突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第22頁PressurePoints按壓止血點Usefingerpressureonthesepointstostopbleeding指壓止血Also,placetourniquetbandoverthesepoints(arteries)在這些點扎止血帶（動脈傷）壓力點止血突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第23頁WhentouseTourniquet什么時間用止血帶Amputation截肢Shrapnel彈片ProbleminAirway氣道問題Morethenonepatient不止一個傷員Nighttime晚上PressureDressingsdidn’thelp壓力繃帶無法止血Underfire火力下..\Movies\FirstaidBulletentrytolegs.wmv突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第24頁Penetratingtrauma穿透傷突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第25頁SplinterPenetratingtrauma穿透傷傷員頭部方向肚臍身體右側(cè)尖銳物突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第26頁Penetratingtrauma穿透傷突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第27頁Tensionpneumothorax氣胸Airleakthroughlungorchestwall空氣滲進胸腔或肺里“One-way”valvelungcollapse”單向閥“----肺衰竭

Mediastinumshiftstooppositeside縱隔膜轉(zhuǎn)到反向Inferiorvenacava“kinks”ondiaphragmdecreasedvenousreturncardiovascularcollapse降低靜脈回流心血管瓦解突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第28頁Tensionpneumothorax氣胸..\Movies\Pneomothorax.wmv突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第29頁Openpneumothorax打開氣胸Initialtreatment:sealdefectandsecureonthreesides(totalocclusionmayleadtotensionpneumothorax初治：封閉傷口，按住3個角留一個（完全封閉會造成張力性氣胸）DefinitiverepairofdefectinO.R.只有在手術(shù)室才能最終封閉MoviesuckingChestwound突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第30頁Openpneumothorax打開氣胸..\Movies\FirstAidPhnemutoraxA.wmv突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第31頁NeedleThoracentesis胸腔穿刺術(shù)Emergentlydecompressaffectedhemithoraxwith14-gaugeneedleinsertedover3rdribin2ndinter-costalspaceatmid-clavicularline緊急情況下為半胸減壓，使用14-gauge針從2、3肋骨間，正對鎖骨中間位刺入突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第32頁THETARGET:PREVENTABLECOMBATDEATH

目標：防止戰(zhàn)斗死亡

突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第33頁Mainpoints關(guān)鍵點Trytokeepyourselffromgettingshot

首先要確保自己不要被擊中Trytokeepthecasualtyfromsustaininganyadditionalwounds

要確保傷員不要再受傷AirwaymanagementisgenerallybestdeferreduntiltheTacticalFieldCarephase

氣道處理要等戰(zhàn)術(shù)搶救開始時再實施Stopanylife-threateninghemorrhagewithatourniquet

對任何威脅生命出血用止血帶進行止血Reassurethecasualty

為傷員打氣突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第34頁evacuation撤離Causeofinjury?Fallinvolved?受傷原因？跌落？Typeofevacuation?Underfire?撤離種類？火力下撤離？Reassurethecasualty給傷員打氣..\Movies\VeryIntenseInjuryTransportFromKorengalValley,Afghanistan.wmv突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第35頁Evacuation撤離Causeofinjury?Fallinvolved?受傷原因？跌落？Typeofevacuation?Underfire?撤離種類？火力下撤離？Reassurethecasualty給傷員打氣Movie“veryintense”突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第36頁Firststage第一步Onepersoncarry單人搬運突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第37頁Blanketdrag毯子拖拽突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第38頁突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第39頁突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第40頁Vehicle車輛Releasethelegsfromdebris將腿從車輛殘骸中退出Casualtyheadleanonyourshoulder傷員頭靠在你肩上Yourarmunderarmpit你手穿到他腋下Firmfooting,rigidneckanddrag踩實，挺直脖子，然后拖拽突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第41頁Secondstage第二步AirAmbulanceavailable(Helicopter)假如有搶救直升機Sufficientspacemustbeprovidedforhoveringandmaneuvering必需為直升機提供足夠懸停和機動空間selectapproachzonesthatpermitthehelicoptertolandandtakeoffintotheprevailingwind選擇著路場要考慮直升機降落和起飛時主風Theminimumrequirementforlighthelicoptersisaclearedarea30metersindiameterwithapproachanddeparturezonesclearofobstructions對于輕型直升機來講，最少要清理出直徑30米沒有障礙起降場突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第42頁Removeanyobjectlikelytobeblownaboutbythewindfromtherotor去除任何可能會被旋翼風吹起物體Clearlymarkobstacles(AntennaEtc)清楚標識出障礙物（比如天線等）突發(fā)事件應(yīng)對之戰(zhàn)地救護專家講座第43頁IdentifyingtheLandingSite標志降落場Markalandingsitewiththeletter"H"or"Y,”在地面用“H”或“Y”來書寫indicatethewinddirection(rragtiedtotheendofastickattheedgetheLZ/Manstandingat