Chapter 48 Vehicle Extrication and Special Rescue

Chapter 48Chapter 48

Vehicle Extrication and Special Rescue

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

EMS Operations

Knowledge of operations and responsibilities to ensure patient, public, and personnel safety.

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

Vehicle Extrication

• Safe vehicle extrication

• Use of simple hand tools

IntroductionIntroduction

• EMS departments must be prepared to respond to a variety of special rescue situations.− Paramedics are

often first on the scene.

AwarenessAwareness

• All EMS providers require training in rescue techniques.− Focus of training is awareness.

− The paramedic’s function on-scene varies depending on the company.

AwarenessAwareness

• A technical rescue incident (TRI) is a complex rescue incident.

• Three levels of TRI training:− Awareness

− Operations

− Technician

Guidelines for Rescue Operations

Guidelines for Rescue Operations

• Be safe.

• Follow orders.

• Work as a team.

• Think.

• Follow the golden rule of public service.

Steps of Special RescueSteps of Special Rescue

• Preparation

• Response

• Arrival and scene size-up

• Stabilization of the scene

• Access

• Disentanglement

• Removal

• Transport

PreparationPreparation

• Train with other fire departments and special rescue teams.

• Assess the following:− Personnel and equipment

− Who will respond

− Familiarity with hazard area

ResponseResponse

• If your department has its own TRI team, it will respond.− Often the rescue squad comes from an outside

agency.

− Contact utility companies as needed.

Arrival and Scene Size-UpArrival and Scene Size-Up

• Information received from initial dispatch call is critical.− Responders must:

• Identify/mitigate life-threatening hazards.

• Inform IC of special resources needed.

• Determine whether the situation is a search, rescue, or recovery.

Stabilization of the SceneStabilization of the Scene

• Be sure all hazards are identified.

• First arriving responder assumes command.− Establish objectives.

− Coordinate resources.

− Unify command between agencies.

Stabilization of the SceneStabilization of the Scene

• Three guidelines to follow:− Approach the scene cautiously.

− Position apparatus properly.

− Assist specialized team members.

Stabilization of the SceneStabilization of the Scene

• Emergency vehicles− Safety is the primary consideration.

• Disrupting traffic creates a hazard.

• Emergency vehicles can act as a barrier.

• Use only essential warning lights.

Stabilization of the SceneStabilization of the Scene

• Control zones− An outer perimeter protects against public and

media; inner perimeter surrounds incident site

− Set up three control zones:• Hot zone

• Warm zone

• Cold zone

Stabilization of the SceneStabilization of the Scene

• Specific hazards− Use the DOT’s

Emergency Response Guide (ERG) as a resource• Shut off utilities.

Stabilization of the Scene Stabilization of the Scene

• Protective equipment− Considerations include:

• Visibility of PPE

• Footwear designed for the environment

• ANSI-approved safety glasses or goggles

• Puncture- or cut-resistant gloves

• Flame- or flash-protective clothing

Stabilization of the Scene Stabilization of the Scene

• Accountability− System tracks personnel on the scene.

− Can be used to:• Track resources

• Task assignments

• Ensure personnel safety

Stabilization of the Scene Stabilization of the Scene

• Patient contact− Maintain eye contact.

− Be truthful.

− Communicate at a level that can be understood.

− Be aware of body language.

Stabilization of the Scene Stabilization of the Scene

• Patient contact (cont’d)− Speak in laymen’s terms.

− Address the patient properly.

− Give time to respond to questions.

− Make the patient comfortable.

AccessAccess

• Simple access requires hand tools.

• Complex access requires special tools.

• Gaining access depends on: − Type of incident

− Nature and severity of injuries

DisentanglementDisentanglement

• Emergency medical care should begin as soon as the patient is accessed.

• A team member should stay with the patient while they are being disentangled.

• Involves freeing a patient from whatever is trapping them

RemovalRemoval

• Preparing for removal involves:− Controlling life-

threatening problems

− Dressing wounds

− Immobilizing fractures and spinal injuries

RemovalRemoval

• Expedite removal if:− Patient is deteriorating rapidly.

− Hazards are present.

• Packaging: Preparing the patient for movement as a unit

RemovalRemoval

• Using a basket stretcher helps move patients to safety.− Lifted by rope

− Carried by vehicles

− Hand carried

TransportTransport

• Transport varies depending on:− Severity of the patient’s injuries

− Distance to the medical facility

Vehicle Anatomy and Structural Parts

Vehicle Anatomy and Structural Parts

• Use standardized terminology when describing.

• Roof posts add support to the roof.

Vehicle Anatomy and Structural Parts

Vehicle Anatomy and Structural Parts

• There is an engine compartment and a passenger compartment.− Hood covers engine compartment

− Bulkhead divides compartments

− Firewall protects passengers

• Two frame types:− Body-over-frame construction

− Unibody construction

Vehicle Anatomy and Structural Parts

Vehicle Anatomy and Structural Parts

Alternative Powered VehiclesAlternative Powered Vehicles

• Powered by: − Electricity

− Electricity/gasoline hybrid

− Fuel

• Secure vehicle as soon as possible.

• Identified by special markings

© GIPhotoStock Z/Alamy Images

Hazardous MaterialsHazardous Materials

• A car wreck may have additional hazards.

• Follow proper size-up and evaluation processes.− Responders trained at awareness level may

assist special responders.

Hand ToolsHand Tools

• Categories include:− Striking tools

− Leverage/prying/ spreading tools

− Cutting tools

− Lifting/pushing/ pulling tools

Hand ToolsHand Tools

Courtesy of Dave Sweet

© 2003 Berta A. Daniels

Vehicle StabilizationVehicle Stabilization

• Cribbing− Designs include:

• Step chocks

• Wedges

• Shims

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Vehicle Stabilization Vehicle Stabilization

• Vehicles may still move after cribbing.− Horizontal

− Vertical

− Roll

− Pitch

− Yaw

Vehicle Stabilization Vehicle Stabilization

Vehicle Stabilization Vehicle Stabilization

Gaining Access to the PatientGaining Access to the Patient

• Open the door.− Try all doors first.

− Ensure locks are released.

• Break tempered glass.− Use side and rear

windows not in close proximity to the patient.

Courtesy of AAOS

Gaining Access to the Patient Gaining Access to the Patient

• Break tempered glass (cont’d).− Wear proper PPE.

− First, lower the windows as far as possible.

− Aim for a low corner.

− Give other EMS personnel warning.

Gaining Access to the Patient Gaining Access to the Patient

• Provide initial medical care.− Spine

immobilization

− Assessment and management of the ABCs

Disentangling the PatientDisentangling the Patient

• Study the scene before taking action.− The order of procedures will be determined by

the specifics of the incident.

− Main objective = maintain spinal alignment and immobilization

Disentangling the PatientDisentangling the Patient

• Air bag safety− Identify

undeployed air bags.

− Disable airbags by disconnecting power.

Disentangling the PatientDisentangling the Patient

• Air bag safety (cont’d)− Most vehicles contain an air bag.

− If the air bag has deployed, it is not a hazard.

− If it did not deploy, disconnect the battery.

− Some newer vehicles have a switch that allows shutting off of the air bags.

Disentangling the PatientDisentangling the Patient

• Air bag safety (cont’d)− Do not place a hard object between the patient

and an undeployed air bag.

− Do not cut a steering wheel if the air bag has not deployed.

− Never get in front of an undeployed air bag.

− Check for side-mounted air bags or curtains.

Disentangling the Patient Disentangling the Patient

• Displacing the seat− Relieves pressure

on the driver

− Gives rescuers more room to work

− Try simple steps to displace a seat.

Disentangling the Patient Disentangling the Patient

• Removing the windshield− Allows for better

communication

− Remove in one large piece.

− Essential before removing the roof

Disentangling the Patient Disentangling the Patient

• Removing the roof− Increases space

for care and disentanglement

− Protect the patient and rescuers inside the vehicle.• Support the roof

when cutting posts.

Disentangling the Patient Disentangling the Patient

• Displacing the dash− Use the dash roll

technique.• Requires a

hydraulic cutter and ram

− Must be done by a trained rescuer

Confined SpacesConfined Spaces

• Location surrounded by a structure that is not designed for continuous occupancy.− Limited ventilation

© Joan Stabnaw/ShutterStock, Inc. © Tyler Boyes/ShutterStock, Inc.

Confined SpacesConfined Spaces

• Oxygen deficiency and poisonous gases− Hydrogen sulfide (H2S)

− Carbon monoxide (CO)

− Carbon dioxide (CO2)

− Methane (CH4)

− Ammonia (NH3)

− Nitrogen dioxide (NO2)

Confined SpacesConfined Spaces

• Safe approach− Gather information from bystanders.

− Assume IDLH atmosphere.

• Assisting other rescuers− Share whatever information is discovered.

− Compare conditions with those reported.

TrenchesTrenches

• Collapse sites are unstable and prone to further collapse.− Patients should be

dug out after shoring has stabilized the site.

Courtesy of Captain David Jackson, Saginaw Township Fire Department

TrenchesTrenches

• Safe approach− Stay away from the edges of the site.

− Shut off all heavy equipment.

− Stop or divert nearby traffic if needed.

− Avoid disturbing the spoil pile.

− Prioritize your personal safety.

WaterWater

• Be aware of self-rescue techniques.− Minimum PPE includes:

• Personal flotation device (PFD)

• Thermal protection

• Whistle

• If immersed in fast-moving water, adopt the self-rescue position.

WaterWater

• Cold water rescue− Hypothermia can

quickly progress.

− Assume the heat-escape-lessening position (HELP).

− Patient may survive underwater due to the mammalian diving reflex.

WaterWater

• Other water rescue situations− Special hazards of

surface water:• Hydraulics

• “Strainers”

• Dams and hydroelectric sites

WaterWater

• Safe approach− Wear appropriate PPE.

− Do not exceed your level of training.

− Use the reach-throw-row-go approach.

− Use specialized equipment for ice rescues.

Spinal Injuries in Submersion Incidents

Spinal Injuries in Submersion Incidents

• Suspect spinal injury if:− Diving mishap or fall

− Unconscious patient with no information to rule out neck injury

− Conscious patient reporting weakness, paralysis, or numbness in arms and/or legs

− You have any other reason to suspect spinal injury

Rope RescueRope Rescue

• Types of rope rescue:− Low-angle operations: slope of the ground is

less than 45°

− High-angle operations: slope of the ground is greater than 45°

Rope RescueRope Rescue

• Safe approach− Set up equipment properly.

− Put distance between you and any loose materials.

− Move bystanders out of the way.

Wilderness Search and Rescue Wilderness Search and Rescue

• Two parts to search and rescue (SAR)− Search (looking for lost persons)

− Rescue (removal of patient from environment)

Wilderness Search and Rescue Wilderness Search and Rescue

• Safe approach− Be aware that factors will vary.

− Bring drinking water, food, clothing, and PPE.

− Use a handheld strobe light.

− Be aware of physical limitations.

Lost Person Search and Rescue

Lost Person Search and Rescue

• Set up a search base.− Prepare equipment ahead of time.

− Monitor progress via radio.

− Safe approach• Distribute equipment among personnel.

• Stick together.

• Consider relocating ambulance.

Structure FiresStructure Fires

• Determine route.

• The IC will determine an appropriate parking spot for the ambulance.

• Determine if there are injured patients or if you are on stand-by.

Structure FiresStructure Fires

• Safe approach− Stay with the ambulance.

− Remain present even after the fire is out.• Unless transporting a patient or released by IC

Agricultural and Industrial Rescue

Agricultural and Industrial Rescue

• Visit local farms and industrial plants and learn about:− Equipment that is used

− How it operates

− How an operator can become entrapped

• Over time, protective shields and guards may be damaged or removed.

Agricultural and Industrial Rescue

Agricultural and Industrial Rescue

• Safe approach− Master cribbing.

− Take apart machines made of strong metal (rather than cutting).

− Isolate the injury site.

Agricultural and Industrial Rescue

Agricultural and Industrial Rescue

• Safe approach (cont’d)− Determine alternative methods of disentangling.

− Assess patient while rescue personnel plan disentanglement.

− Be aware of differences in industrial and farm settings.

Tactical Emergency Medical Support

Tactical Emergency Medical Support

• Law enforcement may call in the SWAT team in tactical situations.− Tactical

paramedics receive additional training.

Courtesy of John Wipfler

Tactical Emergency Medical Support

Tactical Emergency Medical Support

• Tactical paramedics must be able to provide medical care under adverse circumstances.− Provide immediate medical care to persons who

become injured during an incident.• Often before the scene is declared safe

Patient CarePatient Care

• Many medical and trauma conditions are assessed during the rescue process.− Crush syndrome: Large muscle groups are

compressed for a prolonged period of time• High-flow oxygen therapy or positive pressure

ventilations

• Administration of sodium bicarbonate, calcium chloride, fluid bolus

Pain ManagementPain Management

• Use nonpharmacologic methods in the field− Splinting

− Gentle handling

− Talking to patients

Medical SuppliesMedical Supplies

Patient PackagingPatient Packaging

• Basket stretcher (Stokes basket)− Two types of basket stretchers (Stokes)

• Wire basket

• Plastic/fiberglass baskets

Patient Packaging Patient Packaging

• Packaging obstacles:− Patients with fractured pelvises

• Secure to a full-body vacuum mattress

− Spine-immobilized patients• Place the patient in a Kendrick Extrication Device

(KED)

Patient Packaging Patient Packaging

• Consider all patient needs:− Portable oxygen tank

− IV lines

− Warmth

− Head and eye protection

− KED or KED/SKED

SummarySummary

• “Rescue” means to deliver from danger or imprisonment.

• The most difficult process in any rescue is the coordination and balance of rescue and treatment.

• A technical rescue incident (TRI) is a complex rescue incident that requires specially trained personnel and special equipment.

SummarySummary

• Technical rescue training occurs on three levels: awareness, operations, and technician.

• When assisting rescue team members: − Be safe.

− Follow orders.

− Work as a team.

− Think.

− Follow the golden rule of public service.

SummarySummary

• All rescuers should perform the following steps to perform special rescues safely:− Preparation

− Response

− Arrival and scene size-up

− Stabilization of the scene

− Access

− Disentanglement

− Removal

− Transport

SummarySummary

• At a technical rescue incident, it is critically important to slow down and properly evaluate the situation.

• The first arriving officer at a rescue scene should immediately assume command and start using the incident management system.

SummarySummary

• Whenever possible, park emergency vehicles in a manner that will ensure safety and not disrupt traffic any more than necessary.

• Accountability should be practiced at all emergencies, no matter how small.

SummarySummary

• Basket stretchers facilitate moving patients to safety and can be used in a variety of situations.

• Vehicle extrication is commonly necessary.

• There are many hazards associated with alternative powered vehicles.

• You should have a thorough working knowledge of the basic simple hand tools.

SummarySummary

• Cribbing should be used regardless of the position of the vehicle.

• Simple vehicle extrication techniques include opening the door, breaking tempered glass, and providing initial medical care to the patients.

• During disentanglement, responders need to be mindful of undeployed air bags.

SummarySummary

• Many vehicle extrication techniques require the use of specialized skills and training.

• A confined space is a location surrounded by a structure that is not designed for continuous occupancy.

• Confined spaces may have limited ventilation to provide air circulation and exchange.

SummarySummary

• Trench rescues may become necessary when earth is removed for placement of a utility line or for other construction and the sides of the excavation collapse.

• You should know how to properly don a personal flotation device as well as how to use the self-rescue position.

SummarySummary

• Rope rescue incidents are divided into low-angle and high-angle operations.

• Wilderness search and rescue (SAR) missions consist of two parts: looking for a lost or overdue person and removing a patient from a hostile environment.

• During lost person search and rescue, your role is to stand by at the search base until the lost person or people have been found.

SummarySummary

• You should always stay with your ambulance during a structure fire.

• If an incident develops into a tactical situation, law enforcement agencies may deploy use of specialized law enforcement tactical units or the SWAT team.

• Pain control in rescue situations should take the form of nonpharmacologic methods.

SummarySummary

• A number of special patient packaging tools are available to help extricate patients out of their situation and up, down, or out to the ambulance.

CreditsCredits

• Chapter opener: © Corbis

• Backgrounds: Green—Jones & Bartlett Learning; Red—© Margo Harrison/ShutterStock, Inc.; Lime—© Photodisc; Purple—Courtesy of Rhonda Beck.

• Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.