Introduction to Extrication

1. Introduction to Extrication The Patient Handling / Vehicle Extrication Module

2. EXTRICATION • Defined - The act of removing a wreck from a victim • Vehicle • Non-vehicle

3. A,B,C, Posts Safety Glass Tempered glass Laminated glass Uni-body Crumple Zone cribbing dash roll-up roof flap Nader bolt hand tools powered hydraulics Terms

4. Basic Principles of Extrication • Patient care precedes mechanical aspects • Patients should be packaged and moved carefully • C-Spine Injuries should be suspected • Load and Go patients require Rapid Extrication

5. The Golden Hour

6. The Role of the EMT • Administer patient care • Assure that patient is packaged • Not allow extrication efforts to endanger patient • If rescue crews are not present - Extricate Victim

7. Incident Resource Management • Requires integration of EMS, Rescue, Police, Fire and other services • Command should be established early • Should ensure proper utilization of resources • Goal of reducing On Scene Time

8. Stages of Extrication • Scene survey • Vehicle Stabilization • Gaining access • Life-threatening emergencies • Disentanglement • Preparation for removal • Removal

9. Initial Unit • Size-up scene • Set up official incident command • Direct scene survey • Establish an action circle • Begin to gain access

10. Scene Size-up and Scene Safety • Mechanics of the accident • Number of patients involved • Need for additional resources • Look for obvious hazards • Secure the scene for safety prior to approaching patients

11. Hazards • Airbags • deployed • intact • Loaded Bumpers • Downed Power Lines • Unstable Vehicle • Smokers • Fuel Spills

12. HAZARDS - AIRBAGS • Various activation mechanisms • Found on Drivers side of most new vehicles • Found on Passenger side of some vehicles • Are used as side impact protection on some vehicles • Deploys in 1/20 of a second • Deploys at a speed of approx. 200mph

13. Airbag update • New models have airbags in the shoulder harness. • Some new models have airbags in the backs of the front seats to protect back passengers • Passenger side airbag speed can reach 300+ mph

14. Airbag update • Passenger side airbags have been redirected upward • New cars have a logic control sensor to activate airbags • Can cause injuries and even death • Controllers are the ”little black box”

15. Hazards - Alternative Fuels • LP gas • Diesel Fuel • Electric Vehicles

16. Outer circle survey • 10- 15 feet around perimeter of vehicle • Clear debris / other hazards from area • Look around, under, toward and away from vehicle • Check and account for any other patients • Report findings to I.C.

17. Inner circle survey • Check doors • Watch for “loaded” bumpers • Determine actual count of patients • Note type of vehicle stabilization needed • Formulate access plan

18. Establish an action circle • 1O-15 feet around the vehicle • Area should remain free of tools, equipment, stretchers and unnecessary personnel • Establish a tool staging area • Set up sectors and sector commanders

19. Gaining Entry • protect self • stabilize • select route • doors • windows • roof • flap • removal

20. Break out all glass Open doors try handles cut panel use power tools remove door Move seats back Remove roof displace pedals Dash Roll - Up displace steering wheel Disentanglement

21. Breaking Glass • Select window away from the patients • Rear window is preferred to be broken first • Roll down all other windows, leave 2-3 inches showing • Cover with blanket, then break • YELL “ BREAKING GLASS”

22. Dash Roll-up • Cut a bottom of both “A” posts • Leave rear doors intact unless absolutely necessary • Crease front fenders • Open or Bend (Both Sides) Hood

23. Dash Roll 1992 Hyundai Excel

24. Maintain c-spine control Look for MOI Treat injuries lmmobilize spine KED Long backboard Other devices Move patient, not device Evaluate need for personnel Choose path of least resistance Watch for Hazards Removal

25. LOAD & GO CRITERIA • Altered Mental Status • Respiratory Compromise • Cardiac Arrest • Pelvic fractures ( with signs of shock ) • Bilateral Femur Fractures • Shock or signs of shock

26. What is a Car ? • Folded metal, glass, and plastic on wheels

27. Types of Cars • Conventional Frame • unibody • composite construction • IT’S NOT HOW THE CAR IS MADE , BUT RATHER WHAT PEOPLE DO TO THEM THAT MAKES THEM UNSAFE FOR US TO WORK ON.

28. Types of Cars

29. Strength of a car is in its shape Arches , columns , rolls , creases and layers all add to the strength of a car.

30. Side door beams make it stronger A car is strongest end to end

31. Other Vehicles Trucks Vans Buses Trains Airplanes

32. Other Vehicles (Buses) • Built on a frame • Body slides on frame • Seats support the sides • Entry through the floor not an option • Many types of buses • Driver is expendable

33. Cribbing pry axe Hacksaw Screw drivers Linoleum knife Come-a-long Center punch Panel cutter Hand jack Wonder bar Air chisel Reciprocating saw Hand hydraulics Rope Duct tape chain Basic hand tools

34. Powered Tools (Hi-Tech) • Hurst Tool (Jaws of Life) • P-16 Power hawk • Life Shear Cutter • Band Saw • Exothermic Torch • Excalibur

35. SUMMARY