Extrication and Rescue

1. Extrication and Rescue Temple College EMS Professions

2. General Principles • All operations include 7 basic steps • Form a mental picture of how the operation will be carried out

3. Size-Up • Begins at moment of dispatch; continues throughout rescue • In route: • Think through the steps • Decide what you are going to do first • When you arrive: • Avoid being caught up in the situation • Step back, survey scene

4. Size-Up • Safety • Are there potential hazards to you? • Are bystanders at risk? • Is the patient in danger? Dead Rescuers Don’t Help Anyone!

5. Size-Up • Outside Help • Is additional assistance needed? • If you need something, call for it! • Stay ahead. • If you routinely work with other agencies, have plan of operations worked out in advance.

6. Size-Up • Significant Information • What kinds of vehicles? • How many? • What kind of collision? • How many patients? • Any potential for hazardous materials? • Anyone ejected?

7. Hazard Control • Traffic • Park on same side of highway as collision • Park up highway, beyond scene if possible • Have someone spotting traffic at all times • Wear reflective clothing at night • Provide clear visual signals to drivers well in advance of reaching scene

8. Hazard Control • Power Lines • Consciously look for lines on ground • Use particular caution when vehicle has struck utility pole or tree • Tell patients to stay in vehicle • Call the power company!

9. Hazard Control • Gasoline or Fuel Spillage • Shut off vehicle ignition keys • Remove all ignition sources from area • Ask Fire Department to get a charged hose line on the ground • Disconnect battery cable (+)—weigh risks vs. benefits

10. Hazard Control • Unstable Vehicles • Any vehicle that does not have all 4 wheels touching the pavement is unstable! • Never push back into position • Stabilize as found • Maximize number of contact points with ground; spread over as wide an area as possible

11. Hazard Control • Hazardous Materials • Assume presence at all incidents until proven otherwise • Base decision to attempt rescue on best available information about product(s) and on expert advice

12. Hazard Control • Appropriate Protective Clothing • At least helmet, gloves • Eye protection • Work boots • Turnout coat

13. Gaining Access • Objective is to get to patient. • Try before you pry! • Work from simple to complex.

14. Gaining Access: Residences • Check for open windows, doors • Ask if anyone else (neighbors, relatives) has key • If a window is open, cut through screen • If no windows are open, break smallest window through which access can be obtained

15. Gaining Access:Vehicles • Upright vehicle • Enter through doors • When you open door, be sure patient is not against it • If door is locked, ask patient if he can open it • If door will not open, break furthest window away from patient to gain access

16. Gaining Access • Vehicle on Side • Stabilize vehicle • Enter through top door • If door will not open, break rear window

17. Gaining Access • Vehicle Upside Down • Gain access through windows • Doors may be supporting vehicle body • Careless opening, removal may cause vehicle collapse

18. Gaining Access Glass can be broken quickly and effectively with a sharp blow to the corner of a window about 2 inches from the edge of the glass.

19. Life-Saving Care • Rapidly evaluate patient’s condition • Immediate threats are: • Hypoxia • Shock • At this point, why patient isn’t oxygenating or perfusing is irrelevant

20. Life-Saving Care • If ABCs compromised, correct problem! • If you cannot correct problem: • Support oxygenation, ventilation • Extricate patient to long board ASAP • Rapidly transport

21. Disentanglement Remove vehicle from patient, NOT patient from vehicle!

22. Disentanglement • Patient-centered • Keep someone with patient to: • Monitor condition • Ensure that attack on vehicle does not endanger patient

23. Disentanglement • Do NOT do anything to vehicle unless you know EXACTLY what result will be • Protect patient at all times • Cover blanket for protection • Talk to him • Explain what is happening

24. Preparation for Removal • Packaging = Preparing patient for removal as unit • All injuries stabilized • Patient moves as single unit through route of egress

25. Preparation for Removal • Any lower extremity injury can be stabilized temporarily by securing it to other extremity • Any upper extremity injury can be stabilized temporarily by securing it to the chest • KEDs are used to keep head-neck-torso in line during extrication; patient must be extricated onto a long board.

26. Preparation for Removal Do NOT attempt complete packaging of patients with compromised ABCs There in NO value in a well-packaged corpse!

27. Removal • Through doors if vehicle is upright. • Through roof if vehicle is on side. • Through window if vehicle is overturned.

28. Conclusion • Successful rescues are based on planning, practice. • Know what community’s target hazards are. • Have plan for managing them. • Know who you will be working with; train with them. • Know what kinds of help are available. • Do NOT be afraid to call for help if you need it!

29. Conclusion The challenge is NOT to be innovative in a crisis. The challenge is to be well-trained and well-disciplined enough to FOLLOW THE RULES!