Access and Egress [Explained]

In this micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis discusses access and egress; getting into and getting out of the situation your currently in.

In today’s micro-lecture, we’re going to talk about access and egress. So getting in and getting out. Now getting in and getting out of the situation that you’re currently in, is one of the most important parts of paramedic practice. The reason being is because the thing that makes paramedicine so unique is that we’re working outside of a nice safe traditional hospital setting, and the idea is, that we as practitioners, go out to the patient, we bring the care to the patient, we package them up, and we take them into the hospital.

The reason it’s fraught with challenges, is because it’s unpredictable, and one of the things that’s unpredictable, is the nature of getting in and getting out to your patients. In the workshops you will be taught lots of different things about access and egress. You’ll be given a chance to practice with bits of equipments, rescue boards, scoop stretchers, Stryker chairs and stretchers.

Let’s just talk a little bit about access and egress, now we’re gonna take the typical example of a private dwelling. Now straight away, looking at this address, you can see that you’ve got a grass patch here, and you’ve got some kind of path leading up to the front door, but you can also see that the door’s pretty narrow, and the paving, the path, itself, looks like it’s made up of stones.

When you’re walking into this address, you need to be mindfully thinking, “How are we gonna get out if we need to? Are we gonna be using the carry chair? Are we gonna be using the stretcher? Where are we going to position the carry chair and stretcher? Are we going to put it here, and get the patient to walk, or are we going to put it here and get the patient to walk? Do we take them in? Is there a better way of using this space around here?”

For example, “Does this back gate open?” We can then get the ambulance closer to the back of the house. On this occasion, access and egress is not massively problematic, but it’s not the best, because the ambulance chairs and stretchers, of course, have wheels on. Let’s take a look at this image here, so now we’re comparing the two. Here you immediately see, basically, a no-go area for anything with wheels, because it’s muddy, and it’s messy, so what you’re gonna need to be thinking of, is, “Well, how am I gonna get my patient out of that?”

The choices that you have include rescue boards, scoop stretcher, you can even walk the patient, depending on what the situation is, and sometimes there’s no choice, you do have to walk the patient. Of course, you would always be thinking, “Can I get the ambulance closer to the situation without bogging it down? Can this take the weight of the ambulance?” Because, again, access and egress really does make your life easy or difficult, depending on the situation and how well you work with your crew and actually make decisions.

Of course, there are gonna be occasions when we are not going to private addresses, you’re going to be going to industrial areas, and you’re gonna be working from heights, you’re gonna be going into unit blocks with no lifts, so all of these things are considerations for access and egress. When you’re also thinking access and egress, you also need to be thinking safety to yourself and to your patient. When we say safety, we’re not just talking about people who’ve been taking drugs, and other hazards on the scene, we’re also talking about manual handling errors as well.

That’s the micro-lecture on access and egress, hope you’ve enjoyed it.

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