Extrication and Rescue

1
Extrication and Rescue

• Temple College
• EMS Professions

2
General Principles

• All operations include 7 basic steps
• Form a mental picture of how the operation will
  be carried out

3
Size-Up

• 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

4
Size-Up

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

Dead Rescuers Dont Help Anyone!
5
Size-Up

• 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.

6
Size-Up

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

7
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

8
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!

9
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

10
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

11
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

12
Hazard Control

• Appropriate Protective Clothing
• At least helmet, gloves
• Eye protection
• Work boots
• Turnout coat

13
Gaining Access

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

14
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

15
Gaining AccessVehicles

• 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

16
Gaining Access

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

17
Gaining Access

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

18
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.

19
Life-Saving Care

• Rapidly evaluate patients condition
• Immediate threats are
• Hypoxia
• Shock
• At this point, why patient isnt oxygenating or
  perfusing is irrelevant

20
Life-Saving Care

• If ABCs compromised, correct problem!
• If you cannot correct problem
• Support oxygenation, ventilation
• Extricate patient to long board ASAP
• Rapidly transport

21
Disentanglement

• Remove vehicle from patient, NOT patient from
  vehicle!

22
Disentanglement

• Patient-centered
• Keep someone with patient to
• Monitor condition
• Ensure that attack on vehicle does not endanger
  patient

23
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

24
Preparation for Removal

• Packaging Preparing patient for removal as unit
• All injuries stabilized
• Patient moves as single unit through route of
  egress

25
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.

26
Preparation for Removal

• Do NOT attempt complete packaging of patients
  with compromised ABCs
• There in NO value in a well-packaged corpse!

27
Removal

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

28
Conclusion

• Successful rescues are based on planning,
  practice.
• Know what communitys 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!

29
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!