Introduction to Extrication The Patient Handling Vehicle Extrication

Introduction to Extrication The Patient Handling / Vehicle Extrication Module

EXTRICATION Defined - The act of removing a wreck from a victim n Vehicle n Non-vehicle n

Terms n n n A, B, C, Posts Safety Glass Tempered glass Laminated glass Uni-body Crumple Zone n n n cribbing dash roll-up roof flap Nader bolt hand tools powered hydraulics

Basic Principles of Extrication Patient care precedes mechanical aspects n Patients should be packaged and moved carefully n C-Spine Injuries should be suspected n Load and Go patients require Rapid Extrication n

The Golden Hour

The Role of the EMT Administer patient care n Assure that patient is packaged n Not allow extrication efforts to endanger patient n If rescue crews are not present Extricate Victim n

Incident Resource Management Requires integration of EMS, Rescue, Police, Fire and other services n Command should be established early n Should ensure proper utilization of resources n Goal of reducing On Scene Time n

Stages of Extrication Scene survey n Vehicle Stabilization n Gaining access n Life-threatening emergencies n Disentanglement n Preparation for removal n Removal n

Initial Unit Size-up scene n Set up official incident command n Direct scene survey n Establish an action circle n Begin to gain access n

Scene Size-up and Scene Safety Mechanics of the accident n Number of patients involved n Need for additional resources n Look for obvious hazards n Secure the scene for safety prior to approaching patients n

Hazards n Airbags • • deployed intact Loaded Bumpers n Downed Power Lines n Unstable Vehicle n Smokers n Fuel Spills n

HAZARDS - AIRBAGS Various activation mechanisms n Found on Drivers side of most new vehicles n Found on Passenger side of some vehicles n Are used as side impact protection on some vehicles n Deploys in 1/20 of a second n Deploys at a speed of approx. 200 mph n

Airbag update New models have airbags in the shoulder harness. n Some new models have airbags in the backs of the front seats to protect back passengers n Passenger side airbag speed can reach 300+ mph n

Airbag update Passenger side airbags have been redirected upward n New cars have a logic control sensor to activate airbags n Can cause injuries and even death n Controllers are the ”little black box” n

Hazards - Alternative Fuels LP gas n Diesel Fuel n Electric Vehicles n

Outer circle survey 10 - 15 feet around perimeter of vehicle n Clear debris / other hazards from area n Look around, under, toward and away from vehicle n Check and account for any other patients n Report findings to I. C. n

Inner circle survey Check doors n Watch for “loaded” bumpers n Determine actual count of patients n Note type of vehicle stabilization needed n Formulate access plan n

Establish an action circle 1 O-15 feet around the vehicle n Area should remain free of tools, equipment, stretchers and unnecessary personnel n Establish a tool staging area n Set up sectors and sector commanders n

Gaining Entry protect self n stabilize n select route n • • • doors windows roof – – flap removal

Disentanglement n n Break out all glass Open doors n try handles cut panel use power tools n • • • n n n remove door Move seats back Remove roof n displace pedals Dash Roll - Up displace steering wheel

Breaking Glass Select window away from the patients n Rear window is preferred to be broken first n Roll down all other windows, leave 2 -3 inches showing n Cover with blanket, then break n YELL “ BREAKING GLASS” n

Dash Roll-up Cut a bottom of both “A” posts n Leave rear doors intact unless absolutely necessary n Crease front fenders n Open or Bend (Both Sides) Hood n

Dash Roll 1992 Hyundai Excel

Removal n n Maintain c-spine control Look for MOI Treat injuries lmmobilize spine • • • KED Long backboard Other devices n n Move patient, not device Evaluate need for personnel Choose path of least resistance Watch for Hazards

LOAD & GO CRITERIA Altered Mental Status n Respiratory Compromise n Cardiac Arrest n Pelvic fractures ( with signs of shock ) n Bilateral Femur Fractures n Shock or signs of shock n

What is a Car ? n Folded metal, glass, and plastic on wheels

Types of Cars Conventional Frame n unibody n composite construction n IT’S NOT HOW THE CAR IS MADE , BUT RATHER WHAT PEOPLE DO TO THEM THAT MAKES THEM UNSAFE FOR US TO WORK ON. n

Types of Cars

Strength of a car is in its shape Arches , columns , rolls , creases and layers all add to the strength of a car.

Side door beams make it stronger A car is strongest end to end

Other Vehicles n n n Trucks Vans Buses Trains Airplanes

Other Vehicles (Buses) n n n Built on a frame Body slides on frame Seats support the sides Entry through the floor not an option Many types of buses Driver is expendable

Basic hand tools n n n n Cribbing pry axe Hacksaw Screw drivers Linoleum knife Come-a-long Center punch Panel cutter n n n n Hand jack Wonder bar Air chisel Reciprocating saw Hand hydraulics Rope Duct tape chain

Powered Tools (Hi-Tech) Hurst Tool (Jaws of Life) n P-16 Power hawk n Life Shear Cutter n Band Saw n Exothermic Torch n Excalibur n

SUMMARY