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Gaining Access & Vehicle Extrication

Gaining Access & Vehicle Extrication. The Role of EMS During Patient Extrication or Rescue. Introduction. The number of transportation, agricultural, environmental and residential accidents are increasing throughout the world, resulting in higher numbers of serious injuries and deaths.

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Gaining Access & Vehicle Extrication

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  1. Gaining Access & Vehicle Extrication The Role of EMS During Patient Extrication or Rescue

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

  3. Introduction Con’t • 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.

  4. Introduction Cont’d • 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.

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

  6. Objectives • Stabilization • Access to patient • Disentanglement of patient • Patient removal • Post call

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

  8. 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.

  9. Simple Definition: Removal of a trapped patient

  10. Goal of Extrication

  11. Goal of Extrication To remove the victim from entrapment without further injury or unnecessary movement.

  12. 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

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

  14. Hazards!! • Fire • Fuel Leaks • Downed Power Lines • Hazardous Materials • Unstable Vehicle/Structure • Traffic • Crowds

  15. 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

  16. Communications • Communications con’t: • 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 department’s 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)

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

  18. Different Agencies • Law Enforcement • Fire Department • Rescue • Hazmat • Hydro • Gas (Natural Gas / Propane)

  19. Role of Law Enforcement • Investigation of incident • Traffic control • Crowd control • Preserve scene for reconstruction and investigation

  20. 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

  21. Role of EMS (That’s 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

  22. 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/ ext’n techniques • Provide patient access • Disentanglement • Assist EMS • Scene safety

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

  24. Role of Hydro / Gas • Advise command of risk / hazards • Assist in securing scene

  25. Scene Size-up Consists of two surveys. • Outer circle survey • Inner circle survey

  26. 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

  27. 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

  28. 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

  29. 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

  30. Stabilization Con’t: • 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

  31. Where are airbags? • Driver side (steering wheel) • Passenger side (above glove box)

  32. Where are airbags? • Side impact • In side of seat • In ‘B’ post • Tubular across window • Curtain (guillotine)

  33. Where are airbags? • Side impact A Post C Post B Post

  34. Anatomy of the airbag

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

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

  37. 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

  38. Cold Zone • Outer circle • Where equipment and manpower staged • Command post • Cordoned off

  39. 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

  40. 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 doesn’t work, you must try complex access.

  41. 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)

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

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

  44. 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!”

  45. 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.

  46. 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.

  47. Extrication • What’s happening around you! • Dash roll / dash lift / steering wheel lift • Cut steering wheel • Roof removal / Roof flap • Side takedown • “Pop” doors

  48. Side Flap

  49. Roof RemovalDash Lift

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