Chapter 39- Vehicle Extraction & Special Rescue

Vehicle Safety

• Shock absorbing bumpers

• Airbags

Extraction

removal from entrapment or from a dangerous situation/position

Entrapment

when a person is caught within a closed area with no way out or has a limb or other body part trapped

Access

ability to reach the pts

10 Phases of Extraction

1. Preparation

2. En route to the scene

3. Arrival and scene size-up

4. Hazard control

5. Support operations

6. Gaining access

7. Emergency care

8. Removal of the patient

9. Transfer of the patient

10. Termination

Preparation

• Pre-incident training

• checking the tools used in an extraction

En Route to the Scene

• Review dispatch info

• Ensure resources needed have been assigned

• Assign initial duties and scene management tasks

• Determine equipment needed

Arrival & Scene Size Up

• First On scene → position ambulance to block traffic & create safety barrier

• No first → location that allows see access to scene

• Park upwind from hazardous materials

• PPE

• Make sure scene is properly marked and protected

• Scene size up

• Evaluate need for additional resources

• Report to commander upon arrival

Hazardous Materials

Any substances that are toxic, poisonous, radioactive, flammable, or explosive and cause injury or death with exposure

Size-Up

ongoing process of information gathering and scene evaluation to determine appropriate strategies and tactics to manage an emergency

What to look for in a car accident scene size up

• MOI

• Downed power lines

• Leaking Fuels/fluids

• Smoke/fire

• Broken glass

• Trapped/Ejected pts

• # of pts and vehicles involved

Safe Zone

• An area of protection providing safety from the danger zone (hot zone)

• where Ems personnel and the ambulance should be

Danger Zone (Hot Zone)

• An area where people can be exposed to hazards such as electric wires, sharp metal edges, broken glass, toxic substances, radiation, or fire

• off-limits to bystanders

• Enforce the zone

• Coordinate with law enforcement for crowd control if EMS arrived before rescue team does

Vehicles as Hazards

• stabilize with jacks or cribbing

• set in parking gear

• ignition turned off

• battery disconnected → negative side first

Simple Access

Access that is easily achieved without the use of tools or force.

Gaining Simple Access to pt at a MVC

• try using the doors first

• Try to roll down windows

• Use tools to gain other methods of entry

Complex Access

Entry that requires special tools and training and includes the use of force

Complex Access in a MVC

• Brake and gas pedal displacement

• dashboard roll-up

• door removal

• roof opening/removal

• seat displacement

• steering column displacement

• steering wheel cutting

Emergency Care in a MVC

1. Address any exsanguinating hemorrhage with direct pressure or a tourniquet if appropriate.

2. Provide manual stabilization to protect the cervical spine, as needed.

3. Open the airway.

4. Provide high-flow oxygen, if indicated.

5. Assist or provide for adequate ventilation.

6. Control any significant external bleeding.

7. Treat all critical injuries.

Removal of a Pt in a MVC

• Determine the urgency

• Figure out the best method

• Re-evaluate if pt needs to be extracted urgently

• Extraction team gets to work → EMS observes

Transfer of Pt

• Assess inaccessible pts

• C-spine if needed

• Postion EMTs to smoothly transfer pts

• Transfer to stretcher and continue to assess pt

• Transport

Termination

• Emergency units returned to service

• check/clean all emergency equipment used on scene

• Complete Reports

Technical Rescue Situation

A rescue that requires special technical skills and equipment in one of many specialized rescue areas, such as technical rope rescue, cave rescue, and dive rescue

Technical Rescue Group

A team of emergency responders from one or more departments in a region who are trained and on call for certain types of technical rescue

Incident Commander

• The individual who has overall command of the incident in the field

• usually a senior medical official

Command Post

Location of Incident Commander

Search and Rescue

• EMTs summoned to command post

• Prepare equipment needed

• EMTs get assigned to search team

• Talk to Relatives to get a pt history

• Connect with group that found theft

Trench Collapse

• Emergency vehicles 500. ft from scene

• Turn off vehicle

• Divert traffic 500 ft from safety area

• Identify witnesses

• Don’t enter a trench deeper that 4 ft without proper shoring

Tactical Emergency Medical Support

• Some medical incidents EMTs report to require a SWAT Team

• Determine location of command post

• Turn off lights/sirens

• No outside radio speakers used

• Do not leave command post

• Commander identifies incident location, safe location, safe route

• Designate primary/secondary helicopter landing zones

• Identify nearest hospital/burn/trauma center

Special Weapons and Tactics (SWAT) Team

• A specialized law enforcement tactical unit

• SWAT teams usually have medical personnel

• Techniques may seem inappropriate/inadequate

Tactical Situation

A hostage, robbery, or other situation in which armed conflict is threatened or shots have been fired and the threat of violence remains.

Structure Fire

fire in a house or other building

Responding to a Structure Fire

• Determine whether a special route is needed

• Ask incident commander where to stage ambulance

• Check for any injured patients

• Always stay with ambulance unless ordered to move