Spotsylvania Volunteer Rescue Squad - Spotsylvania County, Virginia

AIRWAY

Bag Valve Mask (BVM) – This device is used when a patient cannot correctly breathe for himself/herself. The tube is connected to an oxygen supply, and the mask is placed over the patient's face. The EMT squeezes the bag, forcing oxygen into the patient’s lungs. If some type of advanced airway (ET Tube, Combitube) has been placed, the mask can be removed and the bag connected directly to the airway device.

Portable O2 bag – Portable O2 is a portable oxygen source that can be carried by the EMT. The regulator both reduces the pressure and limits the amount of oxygen delivered. The flow rates most often used are 6 liters/minute, and 15 liters/minute. The truck contains a larger cylinder attached to the permanent piping in the truck, and is called the main O2. The bag also contains several non-rebreathers and nasal cannulas.

Portable Suction bag – The portable suction bag contains the equipment and supplies used remove fluids from a patient’s airway. It contains a battery powered suction unit, a container to receive the liquids removed from the patient, and a suction probe (called a Yankuer). The suction bag also contains a bottle of saline and an assortment of suction catheters, which are soft flexible probes used in certain situations. Like the O2, there is also another suction setup permanently mounted on the truck.

Non-Rebreather mask (NRB) - Like it sounds, a NRB prevents you from rebreathing air that you have just exhaled. A set of valves allows exhaled air to exit the mask, but forces air to be pulled from the reservoir during inhalation. A NRB can deliver almost 100% pure oxygen when the O2 regulator is set to 15 liters/minute (or higher).

Nasal Cannula (NC) – A nasal cannula allow supplemental oxygen to be delivered to the patients nose. When attached to a NC, the oxygen regulator is usually set to 4-6 liters/minute.

Combitube – In the case of severe trauma or serious illness, a patient can lose the ability to "protect" his airway. The process that prevents food from going into your lungs when you swallow fails, allowing food, liquids, and digestive juices to flow into the lungs (aspirate). This is a B-A-D thing! Also, the muscles in the airway can collapse, closing the airway and preventing oxygen from getting through. Advanced airways prevent this problem by creating a secure airway from the lungs to the outside.

A Combitube is a device containing two tubes terminating at different points, and is inserted down the patient’s throat. At the point where the airway separates into the trachea and the esophagus, the tube will go down one of the two openings. Small cuffs attached to the ends of the tube are inflated, holding the tube in place and sealing the openings. Because of the different locations the tubes terminate, one tube will always be connected to the airway with the other to the stomach, no matter which direction the combitube takes when inserted. Because the EMT does not need to look down the airway, the combitube is considered a "blind" device, and is the only advanced airway available to non-ALS providers. ALS providers will also use a combitube when the patient’s airway is clogged and the provider cannot see to insert an ET Tube.

Endotracheal (ET) Tube – A ET Tube is another advanced airway device. The EMT uses a device called a laryngoscope to look down the patient’s throat until the vocal cords are visible. The ET Tube is then inserted between the cords, into the trachea, and a cuff on the end inflated. This seals the airway, allowing oxygen to flow in, and keeping stomach fluids out. Only ALS providers can use ET Tubes.

Intubation Kit – The Intubation kit contains the equipment used to insert ET Tubes. It contains the laryngoscope handle, 4 laryngoscope blades, multiple sizes of ET Tubes, lubricant, and syringes to inflate the cuffs on the ET Tubes.

Oropharyngeal Airways (OPA) – The Oropharyngeal airway is another device used to protect a patient’s airway. In some situations, the tongue will fall to the back of the mouth, blocking the airway. The OPA fits into the mouth and holds the tongue flat against the lower jaw. It can only be used in patients who have lost their gag reflex.

Nasopharyngeal Airways (NPA) – The Nasopharyngeal airway (AKA "Nose Hose") is also used to protect a patient’s airway. It is inserted into the nostril and curves down until it reaches the throat at the back of the mouth. NPAs are used when the patient has either a gag reflex, has oral injuries, or the teeth are clenched.

IMMOBILIZATION

Backboard and Spider Straps – If you’ve ever been in a car accident, it is likely you have had firsthand experience with a backboard and spider straps. If there is any possibility of a spinal injury, the patient is put on a backboard, and secured to the board by spider straps. Being secured on the backboard limits any motion to the back, preventing further injury. Originally, backboards were literally long straight boards, but nowadays they are made from lightweight plastic. Spider straps are basically a set of straps resembling a spider’s web. The ends of the straps are Velcro, allowing patients to be quickly and easily secured to the backboard.

C-Collar – The C-Collar (short for Cervical Spine Collar) protects the upper portion of the spine in case of injury. Usually, these types of injuries occur in automobile accidents, and falls. SVRS carries adjustable collars in adult and pediatric sizes.

Kendricks Extrication Device (KED) – The KED is a specialized device used to help victims of automobile accidents. It is slipped behind the victim, and when fully connected, allows the EMS personnel to lift the victim out in a position as if they were still sitting in the seat. As with all devices, enterprising EMTs have found other uses for the KED, but auto extrications remain its primary use.

Traction Splint – A traction splint is used in one specific situation; when the patient has a broken femur (the bone in the thigh). When a femur is broken, the leg muscles no longer have the bone to hold them in place, and they will tend to pull the two pieces of bone toward each other. If the two pieces do not line up, and move past each other, severe complications can result. Major arteries run next to the femur, and a break has the potential to sever them, resulting in serious internal bleeding. Also, the leg muscles will spasm very painfully. A traction splint allows the EMTs to stretch the leg back to its normal position prior to transport, reducing pain and the danger of internal bleeding.

Kendricks Traction Splint – This item is a newer version of the traction splint. It is significantly smaller, lighter weight, and easier to set up and apply. SVRS carries both types of traction splints on its trucks.

DIAGNOSTIC

Lifepak – The Medtronic Lifepack 12 is a multiple-use piece of diagnostic equipment. The unit contains a defibrillator with manual and automatic modes, an EKG machine to examine heart rhythms, and a SPO2 probe to check the proportion of oxygen in the patient’s blood. Depending on the model, EKG unit will have either 3, 5, or 12 leads. The protocols for the use of 12 lead units have not been set, so Spotsylvania county does not currently have any 12 lead units. Some Lifepacks also contain an automated BP cuff. You need to be an ALS provider to use the defibrillator in manual mode, or to read EKGs.

Automated External Defibrillator (AED) – All SVRS response vehicles contain an AED. The AED will automatically check the rhythms of a patient’s heart, and shock (defibrillate) the heart if there is an abnormal rhythm. Many locations where large numbers of people congregate (i.e. airports, sports arenas, shopping malls, etc) now have AEDs available, and all CPR courses teach the use of them. Most of the fire apparatus in the county also carry AEDs.

Blood Pressure Cuff – The BP cuff is probably the second most basic diagnostic tool available to EMS providers, but it is also the most used. Careful observation of the blood pressure and changes to it, provide some of the best insight into a patients condition. SVRS carries multiple size cuffs on all trucks and response cars.

Stethoscope – If the BP cuff is the second most used diagnostic tool, then the stethoscope is the most used. It is used to listen to heartbeats, lung sounds, and take blood pressures. Stethoscopes can run from $20 basic ones to units over $400 with built in amplification and recording capabilities. Most providers carry their own stethoscopes, but the squad also provides backup stethoscopes in all units.

Glucometer – One of the more common diseases that EMS providers face is diabetes. It is a degenerative disease, with many harmful side effects. A small drop of blood is used by the glucometer to determine the patient’s blood sugar level.

Portable SPO2 meter – A SPO2 meter (also know as a Pulse Ox meter), displays the heart rate of a patient, and the amount of oxygen (as a percentage) carried in the blood. A healthy person will have a pulse oximitry in the 94% - 100% range. Lower numbers are of concern, while anything below 80% is a critical problem. SVRS has portable units in the response cars, and there are also SPO2 units built into the Lifepacks carried on all trucks.

TRANSPORT

Cot – The cot used in SVRS units has more adjustments than most beds. The entire cot can be raised to several different levels, and the head can be adjusted from flat to almost 90 degrees. The lower portion of the cot under the legs can also be raised separately. Part of the head-end can be dropped down to facilitate movement in short spaces. The large wheels allow it to roll over a multitude of surfaces. Depending on the model it can handle from 500 to 650 pounds, and when empty, a single person can raise and lower it.

Stair Chair – The stair chair is a specialized unit designed for bringing patients down stairs. It collapses into a very small shape for storage and carrying. A patient is strapped into the chair, which has wheels on the back legs, and handles at the bottom of the front legs and top of the rear legs. This allows a patient to be maneuvered down stairs safely, even if the stairs have landing and corners in the middle. It cannot be used with an unconscious patient.

Scoop Stretcher – The scoop stretcher is designed for situations when it is not possible to lift or roll the patient. The stretcher splits down the middle and is hinged on one end. The two halves are placed on either side of the patient, and then the stretcher closed, literally scooping the patient from the floor.

Reeves Sleeve – The Reeves Sleeve is another device used for moving patients in areas with limited accessibility. In effect, it’s a heavy-duty sheet with boards sewn lengthwise in it. It can be rolled up for ease of movement and storage. Once the patient has been put on it, there are straps that go over the top, cocooning the patient inside it. With handles on the ends and sides, it can then be lifted up and the patient safely moved.

MEDICAL

Bandages – Bandages are used for covering and protecting wounds, stabilizing injuries, and many other uses. SVRS vehicles carry a variety of sizes, including 4"x4", 5"x7", and 6"x 10". There are also 4" and 6" rolls of kling. Specialized bandages include large trauma dressings, occlusive bandages for torso injuries, and large sterile burn sheets.

Oral Glucose – Glucose is basically a very concentrated form of sugar that is administered orally to diabetics with low blood sugar. It comes in 3-4 different flavors, but it is so sweet that people who have tried it universally dislike the taste. Oral glucose is one of the few medicines that an EMT-B can administer.

Hot Packs & Cold Packs – Single use hot and cold packs can be applied to a multitude of injuries. They are inert until opened, and then a chemical reaction heats (or cools) the package for use.

IV Setup – An IV setup is used to both transport medicine into the body, and add fluids if needed. A normal IV setup contains five, (5) different parts. At the top is a 1000 cc bag of saline solution, with a bowl/tubing/valve combination underneath it called a drip set. SVRS stocks both 15 drip and 60 drip GTTS sets. Next is a PRN adapter that adds additional ports for medication injection, and finally an IV catheter. Each truck is stocked with a number of different size catheters for different situations. Not attached but necessary for use is a "Start Kit". It contains the items necessary to start an IV (elastic strap, alcohol swabs, gauze, tape, and material to protect the IV site). IVs can only be done by ALS providers.

Medications – Each truck contains a multitude of medications, stored in a locked compartment that only ALS providers have access to. The medicines can treat a full range of problems, including asthma attacks, allergic reactions, heart attacks, diabetic emergencies, and others. Several types of pain medications are also available. All drugs are kept under lock and key at all times, and are strictly accounted for.