37-Vehicle Extrication and Special Rescue

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protective gear
turnout gear, helmets, hearing protection, fire extinguisher, gloves (leather over disposable)

shock absorbing bumpers
vehicle protection from low speed impact, may be compressed or loaded following a front or rear end collision, avoid standing directly in front of bumpers, approach vehicles from side

air bags
fill with nonharmful gas, located in steering wheel and dash, deploy when struck in front or rear, additional bags may be present to protect driver and passengers from side impact located in doors or seats, use caution when working in vehicles in which air bags have not inflated, maintain 5” clearance around side impact bags, 10” around driver air bags, 20” around passenger side air bags, cornstarch or talc on air bags to reduce friction looks like smoke and can cause minor skin irritation

extrication
removal from entrapment or from a dangerous situation or position

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

10 phases of extrication
preparation, en route to scene, arrival and scene size up, hazard control, support operations, gaining access, emergency care, removal of patient, transfer of patient, termination

preparation
training, check equipment

en route to scene
similar to ambulance call

arrival and scene size up
position unit in safe location, park uphill and upwind, properly mark scene and protect, road closed to traffic or flow diverted, 360º walk around; look for MOI, downed electrical lines, leaking fuels or fluids, smoke or fire, broken glass, trapped or ejected patients; threats of violence, environmental conditions, flammable substances

size up
ongoing process of information gathering and scene evaluation to determine appropriate strategies and tactics to manage an emergency, pay attention to downed electrical lines, leaking fluids, fire, broken glass, determine what resources will be needed

situational awareness
ability to recognize any possible issues once you arrive on scene and act proactively to avoid a negative impact

additional resources
extrication equipment, fire suppression, law enforcement, HazMat units, utility companies, advanced life support units, aeromedical transport

rescue team
responsible for properly securing and stabilizing the vehicle, providing safe entrance and access to the patients, extricating any patients, ensuring that patients are properly protected during extrication, other rescue activities, adequate room so patients can be removed

EMS personnel
responsible for assessing and providing immediate medical care, triaging and assigning priority, packaging patients, providing additional assessment and care as needed once patient is removed, providing transport to emergency department

law enforcement personnel
responsible for traffic control and direction, maintaining order at scene, investigating crash or crime scene, establishing and maintaining lines so bystanders are kept at safe distance and out of way of rescuers

fire fighters
responsible for extinguishing any fire, preventing additional ignition, ensuring scene safety, removing spilled fuel

power lines
if touching or located in proximity to vehicle instruct patients to remain in vehicle until power is removed

safe zone
outside the danger zone

danger zone (hot zone)
area where individuals can be exposed to sharp metal edges, broken glass, toxic substances, lethal rays, ignition or explosion of hazardous materials, off limits to bystanders

unstable vehicle
on side or roof, rescue personnel can stabilize with jacks or cribbing (wooden blocks), ensure that the vehicle is in park with parking brake and ignition off, battery should be disconnected negative side first to minimize sparks

alternative fuel vehicles
electricity, electricity gasoline hybrid, propane, natural gas, methanol, hydrogen; need to disconnect battery, 40% not located in engine compartment, may be more than one battery, hybrid batteries have higher amperes

support operations
lighting scene, establishing tool and equipment staging areas, marking helicopter landing zones, fire and rescue personnel

gaining access
after scene is safe, up to you to find safest access point, patients may be hard to find, may have multiple patients, triage, scene size up is continuous process; is patient in vehicle or some other structure, is vehicle or structure severely damaged, what hazards pose a risk, what position is vehicle in, what type of surface, is vehicle stable; take into account patient’s injuries and severity, may have to change course; if need CPR may need to use rapid extrication technique (only as last resort), make sure patient remains safe, talk to patient and describe what you are doing, c-spine immobilization, blanket can protect patient, long backboard can be protective shield, keep heat/noise/force to a minimum, minimum necessary to extricate

simple access
trying to get to patient as quickly and simply as possible without any tools or breaking glass, enter through doors when no danger, try to unlock or ask patient to unlock, try every door handle first

complex access
use of special tools (hand, pneumatic, hydraulic devices) and special training, breaking windows, forcible entry, may be too advanced for EMTs

emergency care
manual stabilization of spine, open airway, high flow oxygen, assist or provide adequate ventilation, control significant external bleeding, treat all critical injuries

extrication
participate in preparation for patient removal, determine how urgently patient must be extricated, where you should be positioned to protect patient, how to move patient after, determine extent of injury to exposed area of limb that is trapped, check for possibility of hidden bleeding, evaluate sensation in trapped area so you will know whether increased pain indicates object is pressing on or impaled in patient, choose whether manual stabilization and rapid extrication or extrication vest before removal, impractical to properly apply extremity splints within the vehicle (secure injured limb to uninjured body part), wear protective clothing, cover with thick fire resistant canvas or blanket, warn patient of noise, let rescuers know if they need to stop

vehicle extrication techniques
brake and gas pedal displacement, dash roll up, door removal, roof opening and removal, seat displacement, steering column displacement, steering wheel cutting

transfer of patient
assess any other patients previously inaccessible, primary assessment, critical interventions, cervical collar, spine stabilization, move patient in series of smooth slow controlled steps with stops to allow for repositioning, choose path that requires least manipulation of patient and equipment, make sure everyone knows to move on your command and as a unit, protect patient from hazards, if cold/hot/raining/snowing load patient on ambulance before continuing assessment and treatment

termination
returning emergency units to service, all equipment used on scene must be checked, check ambulance thoroughly, complete all necessary reports

specialized skills
cave rescue, confined space rescue, cross field and trail rescue (park rangers), dive rescue, lost person search and rescue, mine rescue, mountain, rock, ice climbing rescue, ski slop/cross country/trail snow rescue (ski patrol), structural collapse rescue, special weapons and tactics (SWAT), technical rope rescue (low and high angle rescue), trench rescue, water and small craft rescue, white water rescue

technical rescue situation
contain hidden dangers, need special skills

technical rescue group
made up of individuals who are trained and on call for certain types of technical rescues, many trained as EMRs or EMTs, nothing but essential care is provided, will be met by member of the group and led to rescue site (may be away from road and ambulance), use long backboard/basket stretcher, identify stable location where they will bring patient, perform primary assessment, treatment, package without delay, cooperative effort to carry patient to ambulance, consider medivac

incident commander
check with them if technical rescue group is not present when you arrive, individual who has overall command of the scene in the field

lost person search and rescue
ambulance summoned to staging area, each search team will include an EMR or EMT who carries essential equipment and provides simple immediate care, as soon as you arrive at scene isolate and prepare equipment to carry if patient is found or member of search team is injured, leave equipment in ambulance so protected from weather, portable radio to monitor progress of search, stay with relatives of lost individual (find out history and pass on to those in charge), only incident commander should communicate progress to family (set radio at discreet volume), evenly distribute carry in equipment among personnel

trench rescue
often have poor outcomes, dirt weighs 100 lbs/cubic foot, cannot breathe and become hypoxic, risk of secondary collapse, response vehicles park at least 500′ away, turn off all vehicles to prevent vibrations, divert road traffic, identify any witness to the incident, do not enter a trench deeper than 4′ without proper shoring

special weapons and tactics team
hostage incidents, barricaded subjects, snipers; high potential for injury, EMS personnel often on SWAT units who have different training (they do not immobilize spine)

command post
location of incident commander, report to for instructions, cannot be seen by suspect, out of range of possible gunfire, do not roam beyond this site

tactical emergency medical support
report to command post, turn off lights and sirens, do not use outside radio speakers, have incident commander identify specific location, determine safe location where you can meet SWAT should an injury occur, determine safe route to this meeting point, designate primary and secondary helicopter landing zones, identify closest hospital/burn center/trauma center

FAILURE
reasons for rescue failure: failure to understand environment or underestimating it, additional medical problems not considered, inadequate rescue skills, lack of teamwork or experience, underestimating logistics of incident, rescue versus recovery mode not considered, equipment not mastered

structure fires
ambulance dispatched automatically; fire in a house, apartment, office, school, plant, warehouse, other building; determine if special route will be necessary, ask incident commander where ambulance should be staged, ensure ambulance will not block or hinder equipment, ambulance close enough to be visible and patients can be brought to, determine whether injured patients or stand by, do not leave ambulance, do not leave scene after because may need to treat fire fighter, only leave scene if transporting patient or incident commander has released it, may involve hazardous materials

search and rescue fire
teams of fire fighters wearing full turnout gear, self-contained breathing apparatus (SCBA), carrying tools, fully charged hose lines, will bring patients out to ambulance

hazardous materials
any substance that is toxic, poisonous, radioactive, flammable, explosive, can cause injury or death with exposure

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