Module 36: Gaining Access & Vehicle Extrication

1
(No Transcript)
2
Gaining Access Vehicle Extrication

• The Role of EMS During Patient Extrication or
  Rescue

3
Introduction

• The number of transportation, agricultural,
  environmental and residential accidents are
  increasing throughout the world, resulting in
  higher numbers of serious injuries and deaths.

4
Introduction Cont

• In Manitoba we have a vast area to cover as EMS
  providers. With accidents increasing we as EMS
  providers should be concerned. Being prepared
  when accidents occur throughout our province
  takes preparation and dedication from members of
  rural EMS.

5
Introduction Contd

• Develop loosely defined roles for responding EMS
  crew to assess accident scene and confirm level
  of response needed.
• EMS crews should be aware of any responding
  agencies roles and responsabilities.

6
Objectives

• Define extrication and goals
• Roles of agencies at scene
• Placement of vehicles at scene
• Scene assessment / Scene size-up

7
Objectives

• Stabilization
• Access to patient
• Disentanglement of patient
• Patient removal
• Post call

8
Objectives

• Define extrication and goals
• Roles of agencies at scene
• Placement of vehicles at scene
• Scene assessment / Scene size-up

9
Extrication

• The removal of a person from a building, vehicle
  or area of danger. More specifically the removal
  from a damaged vehicle, collapsed structure, or
  other position of entrapment.

10
Simple Definition Removal of a trapped patient
11
Goal of Extrication
12
Goal of Extrication

• To remove the victim from entrapment without
  further injury or unnecessary movement.
  

13
Primary EMS Unit

• Crew members responsibilities
• Safety first for themselves and their partner
• Secondly safety to the patient
• Determine need for addition resources
• Plan of action to complete goals

14
Crew Safety

• PPE.
• Rescue Helmet
• Eye protection
• Protective clothing (Jacket, Gloves)
• Position of vehicle(s) in relation to traffic

15
Hazards!!

• Fire
• Fuel Leaks
• Downed Power Lines
• Hazardous Materials
• Unstable Vehicle/Structure
• Traffic
• Crowds

16
Communications

• Communications
• Interagency communications must be available
• Important to asses and update potential resources
  (Fire Dept., Additional EMS units, ER.Dept, Law
  Enforcement)
• Communication between agencies is of the utmost
  importance

17
Communications

• Communications cont
• Messages, whether sent via radio or in
  conversation, must be clear, concise and to the
  point
• During major incidents members may be required to
  change to a different frequency on their radios
  so as not to hamper radio transmissions on a
  departments primary channel. Secondary and
  tertiary channels should be established before or
  on arrival at the scene
• Special codes or radio language should be common
  between all members (e.g. 10 codes)

18
Objectives

• Define extrication and goals
• Roles of agencies at scene
• Placement of vehicles at scene
• Scene assessment / Scene size-up

19
Different Agencies

• Law Enforcement
• Fire Department
• Rescue
• Hazmat
• Hydro
• Gas (Natural Gas / Propane)

20
Role of Law Enforcement

• Investigation of incident
• Traffic control
• Crowd control
• Preserve scene for reconstruction and
  investigation

21
Role of Fire Dept.

• Extinguishing fires
• Preventing fires
• Handling spills or leaks
• Vehicle safety
• Energy absorbing bumpers
• Electrical system
• Fuel system
• Stabilization
• Assist police and EMS

22
Role of EMS (Thats us)

• Patient contact throughout incident
• Patient assessment(s)
• Triage
• Patient care
• Assess need for disentanglement
• Advise rescue of entrapment conditions
• Packaging of injuries / patients
• Transport patient

23
Role of Rescue

• Rescue may be performed by a separate agency or
  may be a part of Fire Dept or EMS Duties.
• Establish incident/scene command
• Assess rescue needs/ extn techniques
• Provide patient access
• Disentanglement
• Assist EMS
• Scene safety

24
Role of Hazmat

• Advise command of risk / hazards
• Secure scene
• Evacuation of area
• Removal of patients at contaminated scene
• Decontamination of patients

25
Role of Hydro / Gas

• Advise command of risk / hazards
• Assist in securing scene

26
Scene Size-up

• Consists of two surveys.
• Outer circle survey
• Inner circle survey

27
Scene Size-up

• Outer Circle Survey
• Starts when arriving, includes ambulance parking.
• Assess hazards
• Medical Needs
• Number of patients
• Location of patients
• Trapped or not
• Rollover - search 300 ft or more for additional
  patients

28
Scene Size-up

• Assess Rescue needs. Require
• Forcible entry
• Tools for disentanglement
• Tools for patients egress
• Additional lighting
• Additional Manpower
• Call in other agencies
• Vehicle size-up

29
Inner circle survey

• Close up look at crash
• Initial patient contact
• Approach patient from in front
• Identify patient condition(s)
• Identify degree of entrapment
• Find hidden hazards (Airbags/Bumpers)
• Assess need for stabilization

30
Stabilization

• Stabilization
• Safety before approaching the vehicle. (is the
  vehicle still running, on fire, hazardous
  chemicals present, HYDRO lines downed etc.)
• Vehicle should be stabilized before personnel
  enter vehicle using wooden blocks and deflating
  the tires, vetter mats, or using jacks
• Personnel should be aware of possible un-deployed
  airbags
• Traffic hazards

31

• Stabilization Cont
• How many vehicles involved
• Scene may require light - if so use intrinsically
  safe devices if available
• Make use of vehicles own safety features such as
  placing vehicle in park or applying the emergency
  brake

32
Where are airbags?

• Driver side (steering wheel)
• Passenger side (above glove box)

33
Where are airbags?

• Side impact
• In side of seat
• In B post
• Tubular across window
• Curtain (guillotine)

34
Where are airbags?

• Side impact

A Post
C Post
B Post
35
Anatomy of the airbag
36
Control Zones

• Hot, Warm, Cold
• Reduce congestion
• More efficient
• Less confusion
• Circular
• Size depends on accident scene

37
Hot Zone

• Closest to extrication
• Access only to those performing
• Patient care
• Extrication
• Keep unused equipment out of hot zone

38
Warm Zone

• Just outside of hot zone
• Access only to those
• Helping workers in hot zone
• Handling charged lines
• Handling scene lighting
• Treating patients
• Treat patients prior to transport in warm zone
  if safe to do so

39
Cold Zone

• Outer circle
• Where equipment and manpower staged
• Command post
• Cordoned off

40
Patient Access

• When safe access the patient
• If possible make the car safer / easier to
  access
• Secure the keys
• Remove or cut seatbelt if safe
• Unlock doors and roll down windows
• Assess patient injuries and entrapment
• Cover patient

41
Patient Access

• Try before you pry!
• First try simple access attempt access without
  using tools. Open a door or go through an open
  window.
• If this doesnt work, you must try complex access.

42
Complex Access

• Tools are required to access patient
• Break a window, open a door
• Break a window, crawl in
• Use hand tools to make a pathway through
  wreckage to patient
• Have TOOL personnel create a pathway using hand
  tools or heavy hydraulics (jaws of life)

43
Laminated glass

• Formed of a layer of plastic between 2 layers of
  glass
• Shatters, but glass stays in place
• Found on vehicle windshields (front)

44
Tempered glass

• Single piece of hardened glass
• Shatters into thousands of small pieces
• Found on vehicle side and rear windows

45
Removing Laminated Glass

• Try pulling out rubber seal around window,
  remove window intact
• Cut windshield with saw, axe, or specialized
  tool
• If cutting, USE DUST MASKS ON RESCUERS AND
  PATIENT! Let patient and other rescuers know you
  are CUTTING GLASS!

46
Removing Tempered Glass

• Try rolling down side windows, try pulling
  rubber out around rear windows
• Break window with a center punch (bottom corner)
  or pointed object
• When possible, use farthest window
• Pull glass out, possibly into tarp or sheet,
  then roll it up
• Make sure patient and rescuers know you are
  BREAKING GLASS!, cover Pt.

47
Disentanglement

• Always use soft and hard protection
• EMS must maintain patient contact
• EMS must maintain contact with rescuers
• Continue re-assessing patient
• Treat patient accordingly, C-collar, KED,
  Splints, etc.

48
Extrication

• Whats happening around you!
• Dash roll / dash lift / steering wheel lift
• Cut steering wheel
• Roof removal / Roof flap
• Side takedown
• Pop doors

49
Side Flap
50
Roof RemovalDash Lift
51
Caring For The Patient

• Safety while treating the patient is paramount.
  If available, a safety officer should be
  established along with the IC. Safety can also be
  another roll the IC and his crew members, leaving
  the IC with the overall command.
• Personnel should establish direct communication
  link between EMS involved with Pt. care and those
  performing extrication.
• Always communicate to ensure safety of all
  involved

52
Caring For The Patient

• Once the EMS has gained access, he or she acts
  as the eyes and ears. He or she must communicate
  with the extrication members, Pt., and additional
  EMS resources during extrication.
• EMS also decides (and must recognize) load and
  go situations or stay and play situations.

53
Caring For The Patient

• For patient safety, here are a few tips
• Ensure the Pts airway and control C-spine
• Assess the Pts breathing and pulse
• Establish the Pts L.O.C. and re-evaluate
• Scan the Pt. starting at the head
• Control hemorrhage as you encounter severe
  bleeding
• Treat for shock
• Provide emotional first aid as well as physical
  first aid
• Personnel should explain what is happening around
  the Pt.(e.g. we are going to be breaking the
  window across from you)

54
Patient removal

• May require more disassembly, distortion,
  displacement or severing
• Communicate with rescue team
• Communicate with patient
• Maintain spinal immobilization

55
Patient removal

• Out door, feet first onto long board
• Out door, head first onto long board
• Out top, tilt seat back slide patient up onto
  long board
• Improvise!
• Secure to board
• Treat patient
• Advise receiving facility of Pt. condition

56
Post call

• Determine need for CISM
• Collect equipment, pick up people you left
  behind
• Clean, test and restock equipment
• Critique

57
Some info on non powered hand tools

• Screwdrivers can be used to break glass, open
  trunks remove vehicles cosmetics.
• Socket set w/ratchet to remove nuts bolts that
  hold seats, doors, etc.
• Pliers to cut wires, remove cosmetics or pull
  valve stems.
• Spring loaded center punch to break glass.
• Bolt cutters to cut bolt steering wheel ring.
• Long short board for pts protection,
  stabilization packaging.

58
Non powered tools (continued)

• Pike pole to help flop the roof
• Pry bar to make a purchase point force doors
• Flat headed axe to cut windshield
• Halligen to make a purchase point, remove trunk
  locks break tempered glass
• Pry axle can opener to cut windshield, make
  purchase point cut sheet metal
• 2 X 4 4 X 4 cribbing wedges to stabilize
  vehicle (used with come along)
• Come along with chains to pull dashes seats,
  displace doors, pull roof stabilize vehicle

59
Non powered tools (continued)

• Chains to wrap dashboard seats, pull roof or
  displace doors
• Pneumatic tools (air powered) to cut roof, make
  relief cuts, third door conversion cut
  windshield
• Air bags used for lifting, pulling stabilizing
• Reciprocating electric or air operated saw
• Hand operated hydraulic tools
• Spreader used to force doors, seats pedals
• Cutter used to cut posts, make relief cuts, cut
  steering wheel roof.