船上消防訓練手冊 - 第十二章 火災傷患照護

船上消防訓練手冊

Shipboard Fire Training Manual

尚作仁船長 編撰 Compiled by Captain David Shang

第十二章 火災傷患照護
Chapter 12 Fire-11 Fire Casualty Care

12. 一般訊息

General Information

本章討論消防的常見醫療方面知識，從對消防員的要求到火災及其他相關緊急情況受害者所需的基本救生技術。

This chapter discusses the common medical aspects of fire fighting, from the demands on the fire fighter to the basic life saving techniques required for victims of fire and other related emergencies.

 

12.1 簡介

Introduction

所有船員都應熟悉基本的急救程序並掌握基本的復甦技術。本節假設您已掌握這些基本知識。

All members of the crew should be familiar with elementary first aid procedures and possess basic resuscitation techniques. This section assumes that you have received that basic required knowledge.

我們將回顧與消防及相關作業相關的最常見緊急醫療情況類型，以及如何向有需要的人提供救生援助。

Here we will review the most common types of medical emergency that occurs in association with fire fighting and related operations, and how to administer life saving assistance to those in need.

本節應被視為複習部分，旨在鞏固您現有針對火災相關事件的急救訓練。我們不會深入介紹任何領域，本節應結合船上配備的相關醫療參考資料進行學習。

This section should be regarded as a revision section reinforcing your existing first aid training specific to fire related incidents. We will not cover any of the areas in great depth and this section should be studied in conjunction with the appropriate medical references carried onboard.

在任何情況下，船員若未經適當的訓練、考試和認證，不得嘗試執行本節詳述的程序。

Under no circumstances must a crew member attempt to conduct the procedures detailed in this section without the appropriate training, examination and certification.

 

12.2 對消防員的要求

Demands on the fire fighter

滅火工作對消防員的精神和體力要求極高。消防隊員不僅必須接受適當的訓練，還必須有足夠強健的體魄，以應付工作要求。

Fire fighting places great mental and physical demands on the fire fighter. Persons on a fire team must not only be properly trained, they must also be physically fit enough to be able to cope with the demands of the job.

在一次平均持續一個呼吸器氣瓶的滅火和救援行動中(對於一個體格健壯、工作負荷高的人而言，大約需要20分鐘)，消防員必須背負一個20磅重的氣瓶，運送平均體重170磅的傷員，還要搬運一根重達150磅的充水皮龍，包括拖拽、對抗皮龍和噴頭後坐力。他將處於非常炎熱、潮濕、能見度通常為零的環境中，必須扛著負重跨越障礙物，並承受極大的精神壓力。這種惡劣、極端和充滿敵意的工作環境會對消防員造成巨大的傷害。

In an average fire fighting and rescue operation lasting the duration of one breathing apparatus air cylinder (about 20 minutes for a fit man under high work load) the fire fighter will have to carry a 20 lb cylinder on his back, carry a casualty weighing on average 170 lb, man handle a charged hose weighing up to 150 lb including drag, battle against hose and jet recoil. He will be in a very hot, humid environment with often zero visibility, have to negotiate obstacles with his load, and be under extreme mental stress. Such adverse, extreme and hostile working environment takes its toll on the fire fighter.

消防員完成任務後經常會感到身體疲憊、脫水和輕度體溫過高，休息十分鐘、冷靜下來並喝大量冷飲和吃一些食物就足夠了，但如果情況更糟，則需要進行特定的急救醫療，這可以挽救生命。

A fire fighter will often complete his task and be physically exhausted, dehydrated and mildly hyperthermic, and a ten minute rest, cool down and plenty of cool drinks and some food will suffice, but when the situation is worse, specific first aid medical treatment is required which can prove life saving.

 

12.3 心肺復甦術(CPR)

Cardiopulmonary resuscitation (CPR)

所有船員都應接受過基本的急救訓練，其中包括基礎心肺復甦術(CPR)。由於這可能是挽救生命最重要的輔助手段，我們現在將花一點時間來複習CPR技術。學習和練習CPR的最佳方法是使用專門設計的人體模型或「復甦安妮」(ResusciAnne)。

All crew members should have received basic first aid training, and this will have included basic CPR. Since this is probably the most important aid to the preservation of life, we will just spend a little time now revising CPR technique. The best way to learn and practice CPR is by using a specially designed manikin or ResusciAnne.

12.4 熱痙攣、熱衰竭和中暑

Heat cramps, heat exhaustion & heat stroke

這些情況通常統稱為中暑。中暑的嚴重程度如下：

These conditions are often collectively referred to as heat illness. Heat illness has a spectrum of severity:

熱痙攣     →   熱衰竭    →    中暑
Heat Cramps → Heat Exhaustion → Heat Stroke

飲酒者、心臟病患者、服用某些藥物者、老年人和幼兒通常易患中暑。所有中暑都是由體內複雜的體液和鹽平衡失調引起的，進而影響身體調節體溫的能力。

Heat illness is often predisposed in people who drink alcohol, have heart problems, taking certain medication, in the elderly and the very young. All the heat illnesses are caused by a complicated disturbance in the body's fluid and salt balance which in turn affects the body's ability to control its temperature.

熱痙攣常發生在消防員、過度勞動後以及在炎熱潮濕環境(例如機艙或密閉空間)工作的船員身上。當炎熱晴朗的日子裡在甲板上勞動後也會出現熱痙攣。熱痙攣並不嚴重，通常是由於高強度工作時攝取的水分和食物不足所造成的。

Heat cramps often occur in fire fighters, after over zealous exercise and in crew members working in hot, humid environments such as an engine room or within an enclosed space. It is also seen after activity on deck during a hot sunny day. Heat cramps are not serious and often result from insufficient intake of water and food when working hard.

症狀可能包括：

Symptoms can include:

1. 大量流汗

Excessive sweating

2. 肌肉僵硬或短暫痙攣

Stiff muscles or brief cramps

3. 患者會覺得發燒不適

Patient appears hot and uncomfortable

4. 核心體溫37°C ~ 39°C

Core temperature 37°C ~ 39°C

治療：

Treatment:

1. 建議患者休息

Advise patient to take a rest break

2. 多喝水(不含酒精飲料)並進食

Drink plenty of fluids (non-alcoholic) and have some food

 

熱衰竭比單純的熱痙攣更為嚴重，因此必須及時發現。熱衰竭通常是由於熱痙攣被忽視而導致的。

Heat exhaustion is more serious than simple heat cramps and it is important that it is recognised promptly. Heat exhaustion is often the result of heat cramps being ignored.

症狀可能包括：

Symptoms can include:

1. 皮膚出汗、發熱

Sweaty, hot skin

2. 脈搏加快

Rapid pulse rate.

3. 嗜睡

Drowsiness

4. 頭暈

Dizziness

5. 噁心嘔吐

Nausea and vomiting

6. 昏厥

Fainting

7. 體溫39°C ~ 40°C

Body core temperature 39°C ~ 40°C

 

治療：

Treatment:

1. 離開高溫環境

Remove from hot environment

2. 脫掉外衣

Remove outer clothes

3. 用冷水擦拭和扇風，直到體溫接近正常

Sponge with cool water and fan until core temperature is near normal

4. 口服補液鹽(re-hydration)，並鼓勵和幫助患者。在第一個小時內給予1公升補液鹽，然後重新評估。

Give re-hydration solution by mouth, encourage and help patient. Give 1 litre within first hour then re-assess

5. 讓患者休息

Rest patient

上述治療在大多數情況下是有效的，但如果患者病情沒有好轉，則應尋求無線電醫療協助。

The above treatment proves adequate in most cases, but if the patient shows no improvement radio for medical assistance.

 

中暑是一種嚴重的、會危及生命的疾病，如果不及時發現和治療，它會自然地從熱衰竭發展而來。快速識別和治療中暑對於患者生存至關重要。

Heat stroke is a serious, life threatening condition which is a natural progression from heat exhaustion if not recognized and treated. Speed in recognising heat stroke and treating it is critical if the patient is to survive.

 

症狀可能包括：

Symptoms can include:

1. 可能不流汗，皮膚可能看似冰涼

Sweating may not be present, the skin may be deceptively cool

2. 意識模糊與譫妄

Confusion and delirium

3. 震顫

Tremor

4. 抽搐

Convulsions

5. 昏迷

Coma

6. 瞳孔散大

Dilation of the pupils

7. 體溫超過41°C+

Body core temperature of 41°C+

治療：

Treatment:

1. 離開高溫環境

Remove from hot environment

2. 脫掉所有衣物

Remove all clothes

3. 用冷水海綿擦拭和扇風

Sponge with cool water and fan

4. 如有條件，冰袋放在頭部、胸部中間、腹股溝和頸後。如果患者意識清醒且能夠自主活動，請給予飲水或補液鹽。

If available, place ice packs on head, mid-chest, groin and back of neck If patient is conscious and able, give water or preferably rehydration solution by mouth

5. 透過無線電呼叫緊急醫療救助 - 切勿拖延！

Radio for urgent medical assistance - don't delay!

船長或其他合格人員應給患者上氧氣面罩，如果患者失去意識，應插入口咽氣道(Guedal airway)。如果呼吸停止，請做好心肺復甦術的準備。為任何中暑患者降溫時，請務必使用直腸溫度計(肛溫計)定期測量核心體溫。

The ship's master or other qualified person should also give oxygen by mask and insert a Guedal airway if the patient is unconscious. Be ready to give CPR if breathing stops. When cooling a patient with any heat illness, it is important to take regular core temperature readings with a rectal thermometer.

Figure 12-1 口咽氣道(Guedal airway)

請記住，如果不小心，過度冷卻可能會導致體溫過熱的患者出現體溫過低的情況。

Remember, over-cooling can result in a patient with hyperthermia developing hypothermia if care is not taken.

 

12.5 燒傷

Burns

燒傷可由濕熱(例如熱水和蒸氣)或乾熱(例如熱表面、火焰和熱空氣)引起。

Burns can be caused by wet heat such as hot water and steam, or by dry heat such as hot surfaces, flame and hot air.

燒傷的嚴重程度可根據受傷組織的深度進行分級。

The severity of a burn can be graded by the depth of tissue it has affected.

一級燒傷

First degree burns

應注意的症狀包括：

Signs to look for include:

1. 輕度至中度疼痛

Mild to moderate pain

2. 皮膚紅腫

Redness and tender skin

3. 按壓皮膚時皮膚會變白

Skin will blanch on pressure

治療：

Treatment:

1. 將患者移離熱源

Remove patient from heat source

2. 用流動的冷水沖洗患處至少十分鐘

Apply running cool water to the affected area for at least ten minutes

3. 輕輕脫去患處未沾黏的衣物。如果燒傷部位是手，請取下所有有戒指

Gently remove any clothing from the area which is not adhered. If burn is to hands, remove any rings

4. 用無菌乾敷料覆蓋

Cover with a sterile dry dressing

5. 如果燒傷面積較大，請立即尋求無線電醫療協助

Radio for medical assistance if extensive

6. 讓患者休息並保持溫暖，並儘可能抬高雙腿

Keep patient rested and warm with legs elevated if possible

二級燒傷

Second degree burns.

應注意的症狀包括：

Signs to look for include:

1. 中度至重度疼痛

Moderate to severe pain

2. 起泡和脫皮

Blistering and peeling

3. 皮膚變色

Skin discoloured

4. 按壓皮膚時皮膚不會變白

Skin does not blanch on pressure

治療：

Treatment:

1. 同一級燒傷

As for first degree burns

2. 如果傷勢非輕度，請尋求無線電醫療協助

Radio for medical assistance if anything but minor

三級燒傷

Third degree burns

需要注意的徵象包括：

Signs to look for include:

1. 輕微疼痛或無痛

Little or no pain

2. 皮膚呈蠟狀或皮革狀

Skin looks waxy or leathery

3. 顏色呈白色、棕色或黑色

White, brown or black in colour

4. 無水泡

No blister formation

治療：

Treatment:

1. 同二級燒傷

As for second degree burns

2.  所有情況均需透過無線電尋求醫療協助

Radio for medical assistance in all cases

船長或其他合格人員還可以給患者上氧氣，並採取強效止痛措施，以及在最嚴重的情況下採取其他挽救生命的措施。任何三級燒傷，或除最輕微的一級或二級燒傷以外的任何燒傷，都需要醫生或專科醫生的診治。

The ships master or other qualified person may also administer oxygen by mask and give powerful pain relief and other measures to preserve life in the most serious of cases. Any third degree burn or anything apart from the most minor of first or second degree burns will require attention from a doctor or medical specialist.

 

12.6 吸入煙霧和窒息

Smoke inhalation and asphyxia

吸入煙霧或缺氧環境是火災相關傷亡中僅次於燒傷的第二大殺手。

Inhalation of smoke or oxygen deficient atmospheres is the second biggest killer in fire related casualties next to burns.

火災燃燒產物通常溫度過高，充滿煙灰，缺氧，並含有有毒氣體(取決於燃燒物)。

The products of combustion from a fire will often be super heated, laden with soot, deficient in oxygen and contain toxic gases depending on what is burning.

吸入煙霧的人通常會被灼傷喉嚨和肺部，這本身就可能致命，通常是瞬間致命的，同時還會被煙灰和刺激性煙霧嗆住。煙霧中的有毒氣體，例如一氧化碳、二氧化硫，甚至在一些涉及塑膠和泡棉家具的火災中，甚至會含有氰化氫，使情況更加複雜。

A person inhaling smoke often will receive burns to their throat and lungs which in its own right can be fatal, often instantly, as well as being choked by soot and irritant fumes. Toxic gases in smoke such as carbon monoxide, sulphur dioxide and even hydrogen cyanide in some fires involving plastics and foam furnishings, add to further complicate the situation.

當船員進入缺氧區域時，例如被滅火系統充滿二氧化碳的機艙，或被惰性氣體處理過的油箱或貨艙，通常會發生窒息。當救援人員看到船員倒在圍欄內，並在未評估情況的情況下嘗試救援時，自己往往也會成為傷亡者，許多雙重傷亡都是這樣發生的。

Asphyxia often occurs when crew members enter an area deficient in oxygen such as an engine room which has been flooded with carbon dioxide from a fire extinguish system or a tank or hold which has been inerted. Rescuers often become casualties themselves when they see a crew member collapsed in an enclosure and attempt rescue before evaluating the situation first, many double casualties have occurred this way.

 

窒息

Asphyxia

應注意的症狀包括：

Signs to look for include:

1. 呼吸困難、費力

Difficult, laboured breathing

2. 意識喪失

Loss of consciousness

3. 皮膚呈灰藍色至青紫色

Grey to bluish skin

4. 抽搐

Convulsions

5. 呼吸和心臟驟停

Respiratory and Cardiac arrest

治療：

Treatment:

1. 迅速配戴正壓呼吸器和繫上安全救生索

Quickly don positive pressure breathing apparatus and a safety life line

2. 將患者從惰性氣體環境中移出

Remove victim from inert environment

3. 如有呼吸，移至空氣新鮮處，使其保持恢復姿態並觀察

If breathing, remove to fresh air, place in recovery position and observe

4. 如果呼吸停止，立即開始心肺復甦

If not breathing start CPR without delay

5. 在所有情況下，應尋求無線電醫療救助

Radio for medical assistance in all cases

對於有呼吸的患者，船長或其他合格人員應給患者上氧氣。如果患者沒有呼吸，合格人員應使用氣囊和面罩為患者通氣或使用氧氣復甦器。

In the patient who is breathing, the ships master or other qualified person should administer oxygen by mask. If the patient is not breathing, a qualified person should ventilate the patient using a bag and mask with oxygen reservoir or use an oxygen resuscitator.

吸入煙霧

Smoke Inhalation

應注意的症狀包括：

Signs to look for include:

1. 呼吸困難和費力

Difficult and laboured breathing

2. 聲音沙啞或失聲

Hoarseness or loss of voice

3. 喘息和咳嗽

Wheezing and coughing

4. 流口水

Drooling

5. 口腔和鼻孔有煙灰

Soot in mouth and nostrils

6. 意識模糊，可能失去意識

Confusion and possible loss of consciousness

治療：

Treatment:

1. 迅速配戴正壓呼吸器和繫上安全救生索

Quickly don positive pressure breathing apparatus and a safety life line

2. 將傷者轉移到開放場所

Remove casualty into open air

3. 如果呼吸停止，按窒息處理

If not breathing, treat as for Asphyxia

4. 如有呼吸，移至空氣新鮮處，使其保持恢復姿態並觀察

If breathing, place in recovery position and observe

5. 尋求無線電醫療救助

Radio for medical assistance

船長或其他合格人員應給患者上氧氣。如果傷者失去意識且沒有呼吸，應插入口咽氣道(Guedal airway)並透過氣囊和面罩進行通氣，或使用手動氧氣復甦器。

The ships master or other qualified person should administer oxygen. If the patient is unconscious and not breathing, a Guedal airway should be inserted and ventilation via a bag and mask with an oxygen reservoir, or a manual oxygen resuscitator.

 

12.7 暴露在有毒氣體和化學物質

Toxic gas and Chemical exposure

在船上滅火和其他緊急行動中，可能會接觸到有毒物質，無論是火災本身還是貨物，例如有毒氣體從油艙中逸出。我們將概述此類事件的緊急急救程序。

During fire fighting and other emergency operations on board ship exposure to toxic substances can occur weather from the fire its self, or the cargo, such as a toxic gas escape from a tank, and we will now give a basic overview of the emergency first aid procedures for such incidents.

大多數因火災而接觸到的有毒氣體都是燃燒的產物並與煙霧混合，應視為上一節所述的「煙霧吸入」。

Most toxic gas exposures as a result of fire are products of combustion, and are mixed with smoke, and should be regarded as 'smoke inhalation' as dealt with in the previous section.

 

吸入有毒腐蝕性氣體：

Inhalation of toxic corrosive gases:

這些氣體通常溶於水，形成強酸或強鹼化合物。這些氣體會對呼吸道(喉嚨和肺部)造成嚴重刺激和損傷，並可能導致嚴重不適甚至死亡。

These are gases that generally dissolve in water to form strong acidic or alkaline compounds. These gases will cause severe irritation and damage to the respiratory tract (throat and lungs) and can cause severe distress or death on exposure.

接觸這些氣體可能會產生延遲效應，嚴重的肺部刺激會在幾天後導致肺炎，如果不及時治療，可能會致命。因此，即使患者看起來狀況良好，在接觸任何氣體後尋求醫療救助也至關重要。腐蝕性氣體也會嚴重刺激皮膚和眼睛。

Exposure to these gases can have delayed effects, with the severe lung irritation resulting in pneumonia days later which may prove fatal if not treated. This is why it is important to seek medical assistance after any gas exposure, even if the patient appears well. Corrosive gases will also irritate the skin and eyes severely.

 

二氧化硫、氯化氫、二氧化氮和氨

Sulphur dioxide, hydrogen chloride, nitrogen dioxide and ammonia

其他有毒氣體吸入後會直接引起中毒，並可能產生各種不同的影響；接觸這些氣體後會導致嚴重中毒甚至死亡。

Other toxic gases will directly cause poisoning when inhaled and can display a variety of different affects; these gases can produce severe poisoning and death after exposure.

 

一氧化碳、氰化氫和硫化氫

Carbon monoxide, hydrogen cyanide and hydrogen sulphide

本手冊並不涵蓋這些氣體的徵兆、症狀和治療方法，但一般而言，任何懷疑接觸過有毒氣體的人都應接受以下緊急護理：

The signs, symptoms and treatments for exposure to these gases are beyond the scope of this manual, but in general, anyone who you suspect has been exposed to a toxic gas should receive the following emergency care:

1. 配戴正壓式呼吸器、防護衣及安全救生索

Don positive pressure breathing apparatus and protective clothing and a safety lifeline

2. 將患者移離接觸點

Remove the patient from exposure

3. 必要時進行心肺復甦術(CPR)

Perform CPR as necessary.

4. 尋求無線電醫療救助

Radio for urgent medical assistance.

在所有接觸有毒氣體的情況下，船長或其他合格人員應給患者上氧氣。在接觸有毒氣體(尤其是氰化氫)的情況下，應避免口對口人工呼吸，而應使用「俯臥壓背人工呼吸法」(Holger Nielsen method)、氣囊面罩或手動人工呼吸器。高流量供氧可以挽救生命。

In all cases of toxic gas exposure the ships master or other qualified person should administer oxygen by mask or via a resuscitator, mouth-to-mouth resuscitation should be avoided in cases of toxic gas exposure, especially in the case of hydrogen cyanide, and the Holger Nielsen method or a bag and mask or manual resuscitator should be used. The administration of high flow oxygen can be life saving.

 

皮膚和眼睛接觸化學物質

Chemical exposure to the skin and eyes

許多化學物質，無論是固體還是液體，都可以透過皮膚吸收並導致中毒。此外，許多化學物質具有腐蝕性，會灼傷皮膚。化學物質進入眼睛非常嚴重，必須用清水徹底沖洗並立即就醫。

Many chemicals, solid or liquid, can be absorbed through the skin and result in poisoning. Also many chemicals are corrosive and can burn the skin. Chemicals in the eyes are very serious and must be flushed well with water and immediate medical advice sought.

 

12.8 觸電事故

Electrical accidents

船上主電源電壓為單相110伏特、220伏特或三相440伏特。雖然普通的電源和照明插座對消防員的威脅很小，但在劇烈火災中，電線可能會從支架上脫落或暴露在外，絕緣層燒毀，從而暴露帶電導體。如果消防員接觸到這些裸露的電線，可能會發生危險的電擊事故。

Mains electricity runs throughout the vessel as either single phase 110 volts、220 volts, or three phase 440 volts. While normal electrical socket outlets and lighting pose little threat to the fire fighter, during an intense fire, electrical wiring can break free from its supports or other wise become exposed and the insulation burnt away exposing the live conductors. If the fire fighter comes into contact with these exposed wires, a dangerous electric shock can follow.

在大多數情況下，這種低壓電只會讓消防員經歷令人不適麻木感，但若是440伏特的高壓電，可能會導致消防員被拋出、失去意識，甚至心臟驟停。

In most cases, this low voltage electricity will only cause firefighters to experience an uncomfortable numbness, but if it is a high voltage of 440 volts, it can cause firefighters to be thrown, lose consciousness, or even suffer cardiac arrest.

此外，由於電流的影響，電燒傷也可能發生在兩個部位：一是電流進入身體的部位，二是電流離開身體的部位。這些燒傷通常看起來很小，但可能很深且嚴重。

Also, due the current effects, an electrical burn can also occur at two points, one where the current enters the body and the second where it leaves the body. These burns can often appear small but can be deep and serious.

在接觸受害者之前，務必先隔離電流源，或使用乾燥的絕緣工具(例如掃帚的木柄)將受害者從接觸點移開。

It is essential that the source of the electrical current is isolated before touching the victim, or the victim moved from contact using a dry non conducting implement such as the wooden handle of a broom.

作為額外的安全預防措施，站在絕緣材料上也是明智之舉，例如厚厚的乾燥紙板、橡膠墊或乾燥厚實的衣物。

As an extra safety precaution, it is also wise to stand on a non-conducting material such as a thick pile of dry cardboard, rubber matting or dry, thick clothing.

務必記住，受害者接觸電源的時間越長，生存的可能性就越小，因此必須立即採取行動。

It is important to remember that the longer the victim is in contact with the power source the less chance there is of them surviving so prompt action is essential.

如前所述，如有需要，必須立即對觸電受害者進行心肺復甦術(CPR)。觸電受害者或被電燒傷的受害者必須接受醫療救治，並透過無線電尋求醫療援助。

CPR must be administered to victims of electric shock if required without delay as detailed earlier. Victims of electric shock or those who have received electrical burns must receive medical attention, radio for medical assistance.