Extrication and Rescue

Temple College

EMS Professions

General Principles

All operations include 7 basic steps Form a mental picture of how the

operation will be carried out

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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

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Safety Are there potential hazards to you? Are bystanders at risk? Is the patient in danger?

Dead Rescuers Don’t Help Anyone!

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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.

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Significant Information What kinds of vehicles? How many? What kind of collision? How many patients? Any potential for hazardous materials? Anyone ejected?

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

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!

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

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

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

Hazard Control

Appropriate Protective ClothingAt least helmet, glovesEye protectionWork bootsTurnout coat

Gaining Access

Objective is to get to patient. Try before you pry! Work from simple to complex.

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

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

Gaining Access

Vehicle on Side Stabilize vehicle Enter through top door If door will not open, break rear window

Gaining Access

Vehicle Upside Down Gain access through windows Doors may be supporting vehicle body Careless opening, removal may cause

vehicle collapse

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.

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

Life-Saving Care

If ABCs compromised, correct problem! If you cannot correct problem:

Support oxygenation, ventilation Extricate patient to long board ASAP Rapidly transport

Disentanglement

Remove vehicle from patient, NOT patient from vehicle!

Disentanglement

Patient-centered Keep someone with patient to:

Monitor condition Ensure that attack on vehicle does not

endanger patient

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

Preparation for Removal

Packaging = Preparing patient for removal as unit All injuries stabilized Patient moves as single unit through route

of egress

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.

Preparation for Removal

Do NOT attempt complete packaging of patients with

compromised ABCs

There in NO value in a well-packaged corpse!

Removal

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

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!

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!