STARS

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Vehicle Rescue for Air Medical Providers

• STARS

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Objectives

• The AMC will function safely on the scene where
  extrication is being performed.
• AMC will understand the processes and procedures
  to perform light and heavy extrication of
  patients involved in motor vehicle collisions.

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Personal Protective Gear

• Head protection
• Eye protection
• Hand protection
• Foot protection
• Coat and pants
• Bloodborne pathogen protection
• Hearing protection
• Respiratory protection

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Rescuer Safety Responsibilities

• Responsible for own safety
• Protect against bloodborne pathogens
• Keep fellow rescuers safe
• Keep the patients safe

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Preparation and Response

• Before the mission
• Ensure proper training, safety standards and
  appropriate equipment
• Response Considerations
• Time of day
• Weather
• Availability of ground resources
• Reports of entrapment

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Arrival and Scene Size-up

• Assess the crash scene from the air
• Control traffic
• Assess hazards
• Provide or direct crowd control
• Inner/outer circle surveys

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On-Scene Hazards

• Traffic
• Downed electrical lines
• Underground electrical transmission box
• Severed gas lines, vehicle fluids
• Unstable vehicles

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Outer Circle Survey

• Identify number of patients
• Identify number and types of vehicles
• Identify additional hazards
• Ensure safety of team

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Inner Circle Survey

• Close up look at crash
• Initial patient contact
• Evaluate patient condition
• Identify degree of entrapment
• Do not touch car until confirmed safe

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Hazard Control

• Control hazards immediately
• Access fire extinguishers / water hose
• Cover spilled vehicle fluids
• Stay clear of unstable vehicles
• Chock tires to prevent rolling
• Establish a safe area
• Establish staging areas

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Disconnecting a Battery

• Neutralize electrical system
• Stops undeployed airbags
• Stops electric fuel pump
• Disconnect negative side first

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Stabilizing a Vehicle
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Stabilization Tools

• Step Chocks (4)
• Wood Cribbing (2X4 or 4X4)
• Wedges

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Ensure that the vehicle is stabilized prior to
caring for the patient.
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Check Interior for Signs of Injury

• Any objects that may have struck the patient
• Windshield damage (star)
• Steering wheel deformity
• Broken plastic moldings (dash/door)
• Broken glass (side/sunroof)
• Impaled objects in patient
• Intrusion of engine, door metal or roof into
  patient compartment
• Seatbelts worn? Airbag deployed?

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Airbag Systems
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Deployed Airbag?

• If the airbag is deployed
• Look for signs of chest injury
• Look for friction burns and blunt trauma to the
  arms, face and neck
• Smaller drivers are at greater risk of injury
  from an airbag

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The Patient.

• Assessment, Treatment, Removal

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Initial Patient Assessment

• C-Spine Control
• Airway
• Immediate airway intervention
• Breathing
• Immediate breathing / oxygen intervention
• Circulation
• Bleeding Control
• Overview of obvious injuries
• Determine if sensory or motor deficiencies exist

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Rapid Patient Removal

• Indicators
• Unable to manage airway or breathing
• Profound shock or cardiac arrest
• Patient in immediate danger (fire/chemicals)
• Procedure
• Use four rescuers
• Apply c-collar
• Life patient and slide backboard under
• Rotate patient and align with board
• Lower patient to board and adjust patient
• Remove from vehicle

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Patient Access

• Initial Patient Access
• First physical access to patient
• Usually through window or door
• Sustained Patient Access
• Enter vehicle after it is stabilized
• May involve breaking glass
• Allow for initiation of treatment

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Automobile Glass

• Laminated safety glass
• Two layers
• Windshield glass
• Cut with axe or a saw
• Tempered glass
• Side and rear glass
• Spring-loaded center punch breaks it

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Interior Rescuer Responsibilities

• Turn ignition off
• Pass keys outside
• Unlock all doors
• Open windows
• Assume C-Spine and airway control
• Cover patient with soft or hard protection

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Protecting the Patient

• Soft protection
• Tarp or blanket
• Hard protection
• Plywood board
• Back board
• Protection from broken glass, sharp metal
• Provide psychological support due to noise,
  darkness and small space

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Disentanglement

• Relocate roof
• Force doors
• Third door conversion
• Total side removal
• Dash relocation

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Hand Tools

• Cutting, prying and lifting tools
• Electrically driven tools
• Pneumatic tools
• Manually operated tools

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Examples of Hand Tools

• Pliers, screwdrivers, knives, hammer, pry bar,
  hacksaw
• Air chisel
• Reciprocating saw, power drill
• Come-along, chains, webbing straps
• Airbags
• Port-o-power hydraulics (hand pump)

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Powered Hydraulic Tools

• Power unit
• Spreader
• Cutter
• Ram
• Combi-tool

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Power Unit

• Motor
• Hydraulic Pump
• Hoses attached to manifold
• Hydraulic fluid reservoir

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Hydraulic Spreaders (JAWS)

• Positioning is important
• Use good body mechanics
• Can kick back
• Do not get trapped between spreader and car body
• Used to spread doors open, lift vehicles, push
  dashboards

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Spreader
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Hydraulic Cutters

• Metal cutting tool
• Place blades perpendicular to object being cut
• May rotate during cut
• Keep blades closed when not in use
• Used to cut roof posts, rebar, seat mounts,
  steering wheel rings, make relief cuts in roof
  and floor

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Cutter
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Hydraulic Rams

• Primarily a pushing tool
• Some models can pull
• Used to push dashboards, move seats back, lift
  large items

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Ram
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Hydraulic Combination Tool

• Spreader arms with cutting blades inside arms
• Shorter spread then regular model
• Multiple uses

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Combination Tool
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Patient Removal and Packaging

• Anticipate patient removal
• Keep path clear for egress
• Prepare patient care equipment while extrication
  is underway
• Communicate with team members and the patient

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Removal Through a Roof Opening

• Tilt seat back
• Insert spine board between patient and seat back
• Rescuer at the head is responsible
• Lift under patients legs, armpits and belt (can
  use a sling to assist lift)
• Maintain manual C-spine control
• Bring board level and secure straps
• Carry away from vehicle

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Removal Through a Side Opening

• Usually the best method
• Apply KED if required
• Lift patients hips to insert spine board
• Rotate patient and position on board (feet first
  or head first)
• Secure patient and remove from vehicle

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Removal When Vehicle is on its Side

• Patient on bottom side
• Patient will be against bottom side door
• Get as much access as possible
• Flap or remove roof, depending on car position
• Patient belted on top side
• Use a rescuer to support spine board
• Remove patient via KED or spine board and secure

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Removal When Vehicle is Upside Down

• Legs may be trapped behind dash
• May need to manipulate legs
• Patient may be pinned between headrest and roof
• Spread with ram to clear area
• May need to hold patient in place with straps or
  rope then remove to the board

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Termination of Scene

• Remove tools and equipment safely
• Keep protective gear in place

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Special rescue training may include

• Use of ropes
• Self-contained breathing apparatus (SCBA)
• Water rescue
• Trench rescue
• High-angle rescue
• Heavy extrication

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• Fundamentals of Extrication
• Safety and Equipment
• Accessing the Patient
• Removing the Patient

SUMMARY
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