EMT Chapter 39 - Vehicle Extrication and Special Rescue

[Ch 39 Review] You must always be prepared, mentally and physically, for any incident that requires rescue or _____.

Answer: extrication. Full statement: You must always be prepared, mentally and physically, for any incident that requires rescue or extrication.

[Ch 39 Review] As an EMT, your first priority in a rescue incident is _____.

Answer: personal safety. Full statement: As an EMT, your first priority in a rescue incident is personal safety.

[Ch 39 Review] EMS personnel are responsible for the assessment, care, _____, packaging, and transport of patients.

Answer: triage. Full statement: EMS personnel are responsible for the assessment, care, triage, packaging, and transport of patients.

[Ch 39 Review] The rescue team secures and stabilizes the vehicle, provides safe _____ to patients, and safely extricates patients.

Answer: access. Full statement: The rescue team secures and stabilizes the vehicle, provides safe access to patients, and safely extricates patients.

[Ch 39 Review] _____ control traffic, maintain order at the scene, establish and maintain a perimeter, and ultimately investigate the crash or crime scene.

Answer: Law enforcement officers. Full statement: Law enforcement officers control traffic, maintain order at the scene, establish and maintain a perimeter, and ultimately investigate the crash or crime scene.

[Ch 39 Review] Firefighters extinguish fire, prevent _____ scene safety, and remove spilled fuel.

Answer: additional ignition, ensure. Full statement: Firefighters extinguish fire, prevent additional ignition, ensure scene safety, and remove spilled fuel.

[Ch 39 Review] Variations in _____ are possible, depending on jurisdictional protocols.

Answer: responsibilities. Full statement: Variations in responsibilities are possible, depending on jurisdictional protocols.

[Ch 39 Review] Vehicle safety systems, such as _____-absorbing bumpers and airbags, protect your patients but also have the potential to injure you.

Answer: shock. Full statement: Vehicle safety systems, such as shock-absorbing bumpers and airbags, protect your patients but also have the potential to injure you.

[Ch 39 Review] _____ is easily achieved without the use of tools or force.

Answer: Simple access. Full statement: Simple access is easily achieved without the use of tools or force.

[Ch 39 Review] _____ requires heavy-duty tools and special training.

Answer: Complex access. Full statement: Complex access requires heavy-duty tools and special training.

[Ch 39 Review] The 10 phases of extrication are: Preparation En route to the scene Arrival and _____ Hazard control Support operations Gaining access Emergency care Removal of the patient Transfer of the patient Termination In some situations, the patient can only be reached by teams trained in special technical rescues.

Answer: scene size-up. Full statement: The 10 phases of extrication are: Preparation En route to the scene Arrival and scene size-up Hazard control Support operations Gaining access Emergency care Removal of the patient Transfer of the patient Termination In some situations, the patient can only be reached by teams trained in special technical rescues.

[Ch 39 Review] Situations requiring specialized teams include: Cave rescue Confined space rescue Cross-field and trail rescue (park rangers) Dive rescue Missing person search and rescue Mine rescue Mountain-, rock-, and ice-climbing rescue Ski slope and cross-country or trail snow rescue (ski patrol) Structural collapse rescue _____ Technical rope rescue (low-and high-angle rescue) Trench rescue Water and small craft rescue White water rescue

Answer: Special weapons and tactics (SWAT) team. Full statement: Situations requiring specialized teams include: Cave rescue Confined space rescue Cross-field and trail rescue (park rangers) Dive rescue Missing person search and rescue Mine rescue Mountain-, rock-, and ice-climbing rescue Ski slope and cross-country or trail snow rescue (ski patrol) Structural collapse rescue Special weapons and tactics (SWAT) team Technical rope rescue (low-and high-angle rescue) Trench rescue Water and small craft rescue White water rescue

[Ch 39 Words of Wisdom] A vehicle crash scene can present many hazards to

A vehicle crash scene can present many hazards to emergency responders and patients, including fuel spills that pose fire and explosion risks, downed power lines that pose electric hazards, broken glass and torn metal, and exposure to potentially infectious body fluids. Your safety at every type of emergency scene begins with, and depends on, your scene size-up. What you see at the scene helps you determine which personal protective equipment to use and whether to call for additional resources or specialized assistance.

[Ch 39 Street Smarts] After an airbag deploys the powder from the airbag

After an airbag deploys, the powder from the airbag may trigger medical conditions such as asthma. Patients may also be anxious, mistaking the powder from the bag for smoke and thinking their vehicle is on fire. Be thorough in your assessment, and reassure patients.

[Ch 39 Words of Wisdom] Extended entrapment of a limb or other body part

Extended entrapment of a limb or other body part can lead to crush syndrome in a patient. Crush syndrome requires specific and specialized care. This is discussed in greater detail in Chapter 27, Soft-Tissue Injuries.

[Ch 39 Words of Wisdom] Your dispatcher may be busy fielding multiple calls and

Your dispatcher may be busy fielding multiple calls and assigning resources to separate events. If you identify the need for additional resources early in your response, ensure that those resources are en route. This is a team sport, and your vigilance can help identify information that may have slipped through the cracks. Early recognition and mobilization of resources can make a huge difference for the patient.

[Ch 39 Words of Wisdom] When responding to incidents at night use your headlights

When responding to incidents at night, use your headlights and spotlights to illuminate the scene. Wear a high-visibility reflective safety vest so that you will be seen by fellow emergency responders and motorists.

[Ch 39 Words of Wisdom] Practice situational awareness Situational awareness is the ability to

Practice situational awareness. Situational awareness is the ability to understand and react to the threats around you. Remember that scenes are dynamic; you always should be alert for changing situations. Consider weather and environmental conditions, and be aware of traffic, patients, and bystanders.

[Ch 39 Words of Wisdom] Remember that scene size-up is a dynamic and ongoing

Remember that scene size-up is a dynamic and ongoing process, because the situation often changes. As a result, you may need to change your plans for gaining access and providing treatment.

[Ch 39 Street Smarts] Always try before you pry Just like when resuscitating

Always try before you pry. Just like when resuscitating a patient, start with the basics. Try to open the door before resigning to the idea that it must be removed using large hydraulic devices.

[Ch 39 Street Smarts] There are often several different ways a patient can

There are often several different ways a patient can be extricated from a vehicle or other entrapment. The team leader must determine the appropriate method. Team members should listen to determine their individual roles; offer closed-loop communication, acknowledging they understand their roles; and bring to the team leader's attention any circumstance that could injure the team or further injure the patient.

[Ch 39 Street Smarts] Remember bystanders may use the cameras on their phones

Remember, bystanders may use the cameras on their phones to record the extrication. Be respectful of your patient's privacy as you transfer the patient from the entrapment into the back of the ambulance.

[Ch 39 Words of Wisdom] The topic of active shooter and mass-casualty incidents has

The topic of active shooter and mass-casualty incidents has received a great deal of attention in recent years. In response, some EMS providers are being trained to enter the area directly around the hazard (the warm zone) with appropriate law enforcement cover. Their role is to identify patients, provide targeted lifesaving interventions, and perform extraction. Because it is impractical for EMS providers to carry large bags or heavy equipment, they generally provide only essential, specific care, including applying a tourniquet for hemorrhage control or maintaining an open airway with basic airway adjuncts and maneuvers. Such policies should only be implemented in collaboration with local law enforcement and must include appropriate training. Training related to shooting incidents is an excellent resource for you; take advantage of these opportunities. However, traditional continuing education that focuses on high-quality CPR and other skills that have the greatest potential to save lives on a regular basis should receive the highest emphasis.

[Ch 39 Words of Wisdom] F-A-I-L-U-R-E The reasons for rescue failure can be summarized

F-A-I-L-U-R-E The reasons for rescue failure can be summarized by the mnemonic FAILURE: F Failure to understand the environment or underestimating it A Additional medical problems not considered I Inadequate rescue skills L Lack of teamwork or experience U Underestimating the logistics of the incident R Rescue versus recovery mode not considered E Equipment not mastered

[Ch 39 Table 39-1] Ten Phases of Extrication

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

[Ch 39 Table 39-2] Vehicle Extrication Techniques (Complex

Access); Brake and gas pedal displacement; Dashboard roll-up; Door removal; Roof opening and removal; Seat displacement; Steering column displacement; Steering wheel cutting

command

In incident command, the position that oversees the incident, establishes the objectives and priorities, and develops a response plan.

command post

The designated field command center where the incident commander and support staff are located.

communication

The transmission of information to another person—verbally or through body language.

container

Any vessel or receptacle that holds material, including storage vessels, pipelines, and packaging.

extrication

Removal of a patient from entrapment or a dangerous situation or position, such as removal from a wrecked vehicle, industrial incident, or collapsed building.