25 Vehicle Rescue and Extrication 25 Objectives 1

25 Vehicle Rescue and Extrication

25 Objectives (1 of 2) • Describe the vehicle anatomy. • List the hazards involved in responding to an emergency scene. • List the hazards to look for when arriving on the scene of a vehicle extrication situation. • Describe cribbing. 2

25 Objectives (2 of 2) • Describe the extrication tools that are used for stabilizing, bending, cutting, and disassembling. • Describe how to gain access to the victim. 3

25 Introduction • Beginning fire fighters must understand the process of extrication. – Should have some proficiency in extrication skills – Most fire departments are involved in some part of the extrication process. • Members of special rescue teams should complete a course in rescue techniques. 4

25 Conventional Vehicles • Majority of vehicles on the road • Use internal combustion engines • Burn gasoline or diesel fuel – Hazards • Fuel leaks • Short circuits • Battery acid leaks 5

25 Alternative-Powered Vehicles (1 of 2) • Powered by compressed natural gas (CNG) – Cylinders usually in truck, but can be in any convenient location – City buses and other fleet vehicles – Identified by CNG sticker mounted on front and back of vehicle 6

25 Alternative-Powered Vehicles (2 of 2) • After crash, cylinders or fuel lines could be damaged. – CNG could escape. – Threat of BLEVE 7

25 Electric-Powered Vehicles • Propelled by electric motor powered by batteries • Contains a large number of batteries • Hazards – Large amount of energy stored in batteries – Potential electrical shorts – Leakage from damaged batteries – Voltage higher then 12 -volt car battery 8

25 Hybrid Vehicles • Use battery-powered electric motors and a gasoline-powered engine • Electric power used at low speed, gas power at high speed • When stopped at a traffic light, both sources of power turn off. – Car said to be hibernating • Hazards posed are same as gas- and electric-powered vehicles. 9

25 Vehicle Anatomy (1 of 2) • The front of the vehicle is where the hood is and travels down the road first. • The rear of the car is where the trunk sits and goes down the road last. 10

25 Vehicle Anatomy (2 of 2) • The left side of the car – On your left as you sit in the vehicle – In the United States and Canada, the driver’s seat is on the left side of the vehicle. • The right side of the vehicle is where the passenger’s seat is located. • Always refer to left and right as they relate to the vehicle. 11

25 Vehicle Posts • Connect the body of the car to the roof of the car and are structural supports • “A” post is located nearest the front of the vehicle. • “B” post is located between the front and rear doors. • “C” post is located behind the rear doors. 12

25 Bulkhead • Divides the engine compartment from the passenger compartment – The passenger compartment includes the front and back seats. • Sometimes called the occupant cage or occupant compartment 13

25 Platform Frame • Platform frame uses beams to fabricate the load-bearing frame. – The engine, transmission, and body components connect to the frame. – Provides a sound place for stabilizing the vehicle and an anchor point for attaching cables or extrication tools 14

25 Unibody Frame • Unibody seen in most modern cars • Combines the vehicle frame and body into a single component • Allows manufacturers to develop lighter weight vehicles • Remember that unibody vehicles do not have the frame rails in platform frame vehicles. 15

25 Respond to the Scene • Safe response includes: – Picking the best route of travel for the time of day – Driving in a safe manner – Knowing limits of your vehicle – Keeping seatbelts fastened – Evaluating the dispatch information – Listening carefully for any direction 16

25 Arrival and Size-Up: Traffic Hazards (1 of 3) • Determine where to locate your emergency vehicle. • Take into account the safety of emergency workers, the victims, and the motorists. • Do not hesitate to request the road to be closed. 17

25 Arrival and Size-Up: Traffic Hazards (2 of 3) • Use large emergency vehicles to provide a barrier for motorists who fail to heed emergency warning lights. • Place apparatus at an angle to the crash. • Traffic cones or flares can be placed to direct motorists away from the crash. 18

25 Arrival and Size-Up: Traffic Hazards (3 of 3) • Fire fighters need to be visible at a crash scene. – PPE should be bright. – PPE used at night needs to be equipped with reflective material. • Be alert for any vehicles that might cause you injury. – Do not assume that motorists will always heed your warning lights. • IC should perform a size-up. 19

25 Arrival and Size-Up: Fire Hazards • Look for spilled fuels and other flammable hazards. • Look for the presence of fire. • Fire may trap the vehicle occupants and require suppression. 20

25 Arrival and Size-Up: Electrical and Other Hazards • Electrical hazards – Look for downed or damaged power lines. • Other hazards – Environmental • Rain, sleet, ice or snow can pose a hazard to rescue workers. • Crashes that occur on hills are harder to stabilize. • Be aware of the possibility of hazardous materials. 21

25 Arrival and Size-Up: Other Hazards • Look for the presence of infectious bodily fluids. • Sharp edges and objects should be identified and when possible covered or removed. • Watch out for violent behavior by vehicle occupants. • Family pets may react protectively when rescuers attempt to gain access to their owner. 22

25 Stabilize the Scene • Consists of reducing, removing, or mitigating the hazards at the scene. – The order in which hazards are stabilized depends on the specific scene conditions and the amount of risk each hazard poses. 23

25 Traffic Hazards • Traffic must be slowed or stopped as motorists approach the scene of an emergency. • Traffic hazards are best handled by the appropriate law enforcement agency. • Work with law enforcement officials to control traffic in a safe manner. • If law enforcement is not on the scene, verify that they have been dispatched. 24

25 Fire Hazards (1 of 2) • It should be SOP to advance a charged hose line close to a damaged vehicle. • At least a 1. 5" hose should be staffed by a fire fighter in PPE. • Hose line can provide protection for rescuers and victims of the crash. 25

25 Fire Hazards (2 of 2) • Crashes that pose large fire hazards or actual fires may require additional fire suppression resources. • Small fuel spills can be handled by using an absorbent material to remove the fuel from the area around the damaged vehicle. 26

25 Electrical Hazards • Disconnecting the vehicle’s power source should be done following your local SOP. • Downed power lines should be handled by the power company. • Do not approach a vehicle and do not let a victim leave the vehicle until the electricity has been controlled. 27

25 Other Hazards • Heat and cold should be dealt with. • Ensure adequate lighting at night. • Prevent slips and falls on wet and icy surfaces. • Wear proper PPE to reduce the risk of injury from sharp objects and infectious bodily fluids. • Remove animals from the scene. 28

25 Cribbing • Used to stabilize a vehicle • Lengths of wood used to prevent a vehicle from moving backward and forward – After cribbing has been placed, a vehicle can still move. 29

25 Step Blocks • Shaped like stair steps and are placed under the side of the vehicle • Place one step block toward the front of the vehicle and a second step block toward the rear of the vehicle. 30

25 Box Crib • Standard cribbing can be used to form a box crib. • Place cribbing at right angles to the preceding layer of cribbing. 31

25 Vehicle Stabilization • A vehicle on its side or roof is very unstable. – Can be stabilized using box cribs or step blocks on each end of the vehicle 32

25 Wedges • Used to snug up loose cribbing or when using lift airbags • Should be the same size width as the cribbing with the taper end no less than 0. 25" thick 33

25 Rescue Lift Airbags (1 of 3) • Pneumatic-filled bladders made of rubber or synthetic material • Used to lift or spread • NEVER use alone to shore or stabilize • Always use cribbing when using rescue lift airbags. 34

25 Rescue Lift Airbags (2 of 3) • Often used to lift a vehicle or object off a victim • Use extreme caution when using rescue lift airbags. • Adhere to all the safety precautions in the owner’s manual. • Cribbing must be used in conjunction with rescue lift airbags. • Top layer of cribbing should be solid underneath the rescue lift airbag. 35

25 Rescue Lift Airbags (3 of 3) • Should not be used without properly blocking the wheels – This is a safety precaution in case of a catastrophic failure of a rescue lift airbag. • Rescue lift airbags can fail as they age. – They should be tested according to manufacturer’s recommendations. – After ten years, they have generally reached their useful life. 36

25 Three Types of Rescue Lift Airbags (1 of 3) • Low-pressure airbags – Often used in recovery operations and sometimes used by departments for vehicle rescue operations – Come in many shapes and sizes; but square airbags offer greater stability. – Can be less stable until fully inflated as compared to high-pressure airbags 37

25 Three Types of Rescue Lift Airbags (2 of 3) • Medium-pressure airbags – Have either two or three cells inside their design – Best when used in aircraft or truck rescue 38

25 Three Types of Rescue Lift Airbags (3 of 3) • High-pressure airbags – Most common airbags used by the fire service for rescue work – Heavily constructed – Generally made of vulcanized rubber mats that are reinforced by steel or other material woven into a fiber mat and covered with rubber 39

25 Principles of Gaining Access and Disentangling the Victim (1 of 2) • Use four techniques • Stabilize – Stabilize by using cribbing • Bend, distort, or displace – Bending a vehicle door back to get it out of the way 40

25 Principles of Gaining Access and Disentangling the Victim (2 of 2) • Cut or sever – Cutting a roof • Disassemble – Removing a vehicle door by unbolting the door hinges 41

25 Tools Used in Extrication (1 of 5) • Stabilizing tools – Cribbing – Rescue lift airbags – Step blocks • Be certain that they are placed firmly under the vehicle and that vehicle is stable before attempting to enter it. 42

25 Tools Used in Extrication (2 of 5) • Bending tools – Hand tools such as pry axe, short pry bars, long pry bars, and Halligan tools • Can be used to bend sheet metal – Power tools such as hydraulic rams and hydraulic spreaders 43

25 Tools Used in Extrication (3 of 5) • Cutting tools – Hand tools used for cutting are axes, bolt cutters, cable cutters, hacksaws, and manual hydraulic cutters. – Use the power tool to cut the proper material. – Power tools for cutting can be powered by air, electricity, or hydraulics. – Some examples are air chisels, rotary or reciprocating saws, hydraulic cutters. 44

25 Tools Used in Extrication (4 of 5) • Air chisels can cut metal posts. • Hydraulic cutter can cut through the roof posts of a vehicle. 45

25 Tools Used in Extrication (5 of 5) • Tools for disassembling – Mechanic’s tools such as wrenches and screwdrivers • Specialized equipment includes the come along. 46

25 Gain Access to the Victim • Open the door. – Easiest and simplest way to gain access – Try all doors even if they appear badly damaged. – Make sure door is unlocked and try the door with the least damage first. – Try the outside and inside handles at the same time if possible. 47

25 Break Tempered Glass (1 of 3) • Consider breaking a window if victim’s condition is serious and doors will not open. • Do not try to break and enter through the windshield. – Made of laminated windshield glass – Difficult to break 48

25 Break Tempered Glass (2 of 3) • Side and rear windows are made of tempered glass. – Will easily break into small pieces – Can be your primary access route • If possible break a window away from the victim to avoid further injury. • After breaking glass, use a gloved hand to remove as much of the broken glass as possible to avoid injuring rescuers. 49

25 Break Tempered Glass (3 of 3) • Aim for a low corner if using something other than a spring-loaded punch. • When the window is broken and glass removed, try to unlock door. • Breaking the rear window will sometimes provide an opening large enough to enable a rescuer to gain access to the victim. 50

25 Force the Door (1 of 4) • Door displacement – May be difficult and somewhat unpredictable • Choose door that will not endanger the safety of the victim. • Use hand tools to bend the sheet metal away from the edge of the door where the hydraulic tool is to be inserted. 51

25 Force the Door (2 of 4) • Place the spreader in a position so that it is not in the pathway of the door. • Do not stand in a position that might put you in danger. • Activate the hydraulic tool to push apart the outer sheet metal skin of the vehicle to expose the hinges or door latch. 52

25 Force the Door (3 of 4) • Once the outer sheet metal has been exposed, close the tips of the spreader and remove them. • Insert the closed tips onto the inner skin of the door and the doorjamb just above the latch or above the hinges. 53

25 Force the Door (4 of 4) • Activate the spreader. – Separating a door at the latch side • Place a 4" x 4" cribbing under the bottom of the door first. • Some hydraulic tools can cut door hinges. • Separating a door from hinge side – Place the spreader on top of the bottom hinge and separate door from hinge. – Place 4" x 4" cribbing underneath the door to hold it in place. 54

25 Provide Initial Medical Care • As soon as you have secured access, begin to provide emergency medical care. – A qualified emergency medical provider should do this. • Provide emotional as well as physical care. • Care can be provided while extrication is taking place. • Work toward the goal of getting the victim stabilized and removed from the vehicle as quickly and safely as possible. 55

25 Disentangle the Victim (1 of 3) • Purpose is to remove the parts of the vehicle that are trapping the victim • Remove the sheet metal and plastic from around the victim. • It is not “cutting the victim out of the vehicle. ” 56

25 Disentangle the Victim (2 of 3) • Before beginning disentanglement, study the situation. – What is trapping the victim in the vehicle? – Perform only necessary procedures. – The order in which procedures are performed is dictated by scene conditions. 57

25 Disentangle the Victim (3 of 3) • Protect the victim at all times. • Use backboards and blankets to shield victim. • Explain procedures to victims to reassure them. 58

25 Displace the Seat (1 of 5) • In frontal and rear end crashes, the driver may be trapped between the steering wheel and the back of the front seat. • Displacing the seat can: – Relieve pressure on the driver – Give rescuers more space for removal 59

25 Displace the Seat (2 of 5) • Attempt simplest steps first. – Attempt to move seat back on its track either manually or engaging power seats. – Attempt to lower adjustable seat. – Perform a dash displacement if moving the seat back does not work. 60

25 Displace the Seat (3 of 5) • As a last resort, use a manual hydraulic spreader or a powered hydraulic tool to move the seat back. – Place one tip of the tool on the bottom of the seat. – Avoid pushing on the seat channel that is attached to the floor of the vehicle. 61

25 Displace the Seat (4 of 5) • Place the other tip of the spreader at the bottom of the “A” post doorjamb. • Support the victim. • Engage the seat adjustment lever on manual seats and open the spreader in a careful fashion. • Seat should move backward in a controlled fashion. 62

25 Displace the Seat (5 of 5) • Remove seatback in some cases. – Cut the upholstery away from the bottom of the seatback. – A reciprocating saw or a hydraulic cutter can be used to cut the supports for the seatback. – Be certain that the victim is supported and protected during this procedure. 63

25 Remove the Windshield (1 of 5) • Removing windows provides better communication between personnel inside and outside the vehicle. • Try and roll down windows first. • Side and rear windows are tempered glass that can be removed by striking in a lower corner. – Protect victims from glass by covering them. 64

25 Remove the Windshield (2 of 5) • Windshield made of laminated glass • Cannot be broken by spring-loaded center punches • Consists of plastic laminated glass and designed like a sandwich • When struck by sharp stone or springloaded center punch, a small mark is formed, but remains intact. • Remove the windshield in one large piece. 65

25 Remove the Windshield (3 of 5) • Most common technique is removing the windshield by using an axe. – Protect victim. – Begin cutting at the top of windshield at the middle using short strokes of the axe. 66

25 Remove the Windshield (4 of 5) – Cut down the side next to the “A” post. – Finish by cutting the bottom of the windshield. 67

25 Remove the Windshield (5 of 5) • Second rescuer starts at the top of the windshield and cuts second half of the windshield. • When the second rescuer is finished, lift window out of the frame. – Place it in a safe area. • A saw can be used to accomplish this technique as well. 68

25 Remove the Steering Wheel (1 of 3) • During a crash, the steering wheel may be pushed back into the victim’s abdomen or chest. • Removing the steering wheel can help in disentangling a victim from the vehicle. 69

25 Remove the Steering Wheel (2 of 3) • Removal of the entire steering wheel is possible using hand or power tools. – Hand tools include hacksaws or bolt cutters. – Power tools include hydraulic cutters and reciprocating saws. 70

25 Remove the Steering Wheel (3 of 3) • One method of removal is to cut the spokes as close to the hub as possible. • Second method is to cut the hoop or ring. • Can be removed completely or one section can be cut or removed. • Cutting the hoop or spokes leaves sharp edges. – Sharp edges need to be covered. 71

25 Displace the Dash (1 of 5) • During frontal crashes, the dash will get pushed down or backward. • If victim is trapped by dash it must be removed. 72

25 Displace the Dash (2 of 5) • Technique is called dash displacement or a dash roll-up. – Objective is to lift the dash up and move it forward. 73

25 Displace the Dash (3 of 5) • Requires a cutting tool such as hacksaw, reciprocating saw, an air chisel, or hydraulic cutter to cut “A” post. – A mechanical high lift jack or hydraulic ram is needed to push the dash forward. – Cribbing is needed to protect the opening made from displacing dash. 74

25 Displace the Dash (4 of 5) • Sequence for displacing dash. – Open or remove both front doors. – Place backboard between victim and bottom part of the “A” post. – Cut the bottom of the “A” post perpendicular to where it meets the sill or the floor of vehicle. 75

25 Displace the Dash (5 of 5) • Place the base of the tool at the base of the “B” post. • Place the tip of the tool at the bend in the “A” post. • Extend the tool in a controlled fashion to push the dash up and off the victim. • Build a crib to hold the sill in position. • Carefully monitor victim during the dash displacement. 76

25 Displace the Roof (1 of 4) • Removing the roof has several advantages. – Allows equipment to be passed to the emergency medical provider – Increases the amount of space available to perform emergency medical care – Visibility and fresh air supply are improved. – Helps reduce feeling of panic caused by the confined space – Provides a large exit route for the victim 77

25 Displace the Roof (2 of 4) • One method is to cut the “A” posts and fold the roof back toward the rear of the vehicle. – Provides limited space – Takes same time as removing the entire roof • Roof displacement can be accomplished with hand tools and power tools. – Hand tools include hacksaws, air chisels, or manual hydraulic cutters. – Power tools include reciprocating saws and powered hydraulic cutters. 78

25 Displace the Roof (3 of 4) • Steps for roof displacement – Assure safety. – As roof is cut, rescuers have to support roof. – Remove all glass. 79

25 Displace the Roof (4 of 4) • Cut the posts farthest away from the victim. • Cut the posts to ensure that the least amount of post will remain after roof removal. • When cutting the wider rear posts, cut them at the narrowest point in the post. • As each post is cut, a rescuer needs to support that post. • Cut the post closest to the victim last. 80

25 Remove and Transport the Victim (1 of 3) • Victim needs to be stabilized and packaged in preparation for removal. • Definitive treatment of trauma victims needs to be done at a hospital. • Amount of stabilization on the victim while in the vehicle should be limited to steps needed to prevent further injury. 81

25 Remove and Transport the Victim (2 of 3) • Develop a plan for victim removal. • Be sure that a clear exit pathway is available. • Removal needs to be directed by a designated person. • Use clear commands. • Assure adequate number of rescuers. • Make sure that everyone involved understands the commands that will be given. 82

25 Remove and Transport the Victim (3 of 3) • Try to make removal process as seamless as possible. – Locate the ambulance cot close by. • Follow directions of EMS personnel in charge of victim care. • Transport patient to appropriate medical facility for care as soon as initial stabilization is complete. • If your department uses a helicopter service, become familiar with procedures. 83

25 Secure the Scene and Prepare for the Next Call (1 of 2) • Final step is to secure the scene and prepare for the next call. • Gather all of the equipment used, inspect it, clean it, sharpen it, refuel it, and place it back in the proper location. • Sometimes this can be done at the scene. 84

25 Secure the Scene and Prepare for the Next Call (2 of 2) • After major incidents, may be necessary to return to the station to clean and restock the apparatus. • Personnel need to prepare for the next call. – Rehabilitation may be necessary. – Personnel may need to shower, change, and eat before another call. • Maintain safe practices. 85

25 Summary (1 of 4) • Most fire departments are involved in extricating victims from vehicles. • Extrication should follow logical steps. • It is important to prepare equipment and personnel for extrication emergencies. • Respond safely and efficiently to an extrication incident. 86

25 Summary (2 of 4) • Size-up needs to evaluate all of the hazards that are present. • Stabilizing the hazards is essential to assuring safety for all people at an emergency scene. • Tools used for gaining access and disentanglement work by stabilizing, bending, cutting, or disassembling. 87

25 Summary (3 of 4) • You gain access to victims by opening doors, breaking tempered glass, or forcing doors. • Techniques for disentangling victims include displacing a seat, removing the windshield, removing the steering wheel, displacing the dash, or displacing the roof. 88

25 Summary (4 of 4) • Victims need to be properly packaged and carefully removed to prevent further pain and injuries. • Equipment needs to be cleaned and returned to apparatus to be ready for the next call. 89