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Basic Concepts and

Techniques

Course Objectives
Provide insight on Safety,
Teamwork and Technology when
dealing with Modern Vehicle
Extrication

Course Objectives
Understand and Practice:
the skills needed for the
disentanglement of a patient
entrapped in the wreckage of a
vehicle crash.

Course Objectives
Understand and Practice:
The skills related to the Assessment
and Packaging of a patient
entrapped in the wreckage of a
vehicle crash.

Course Objectives
Understand and Practice:
Safety features
Precautions
Capabilities
Of the extrication tools used by this
department

Course Objectives
Understand:
The psychological considerations of
patient care.

Course Objectives
Understand:
Rapid Extrication/Protocol

Course Objectives
Demonstrate:
Proper glass removal techniques
Tempered
Laminated

Course Objectives
Demonstrate:
Patient access
Interior rescuer duties
Proper protection of patient(s) during
extrication

Course Objectives
Demonstrate:
Making a purchase point
The forced opening of a door using
hand tools
Proper vehicle stabilization with
cribbing

Course Objectives
Demonstrate:
Roof displacement procedures using
hydraulic cutters
Door displacement and removal using
powered hydraulic tools
Procedure for dash lift using rams and
spreaders

1999 TOP FIVE CALLS


80.00%
70.00%
60.00%
Rescue
Service Call
False Call
Good Intent
Fire/Explosion

50.00%
40.00%
30.00%
20.00%
10.00%
0.00%

1999

Signal 4s vs all calls


10.00%

All others
Signal 4's

70.30%

The ability to quickly extricate a


critically injured patient and
transport to a trauma center may
help determine his/her outcome.

The Golden Hour


From the time of injury to Bright
Lights and Cold Steel

Rapid Extrication
Shall ONLY be employed in the
following situations:
When the scene is unsafe and clear
danger to the rescuer and/or patient
exists, necessitating rapid removal to
a safe location.

Rapid Extrication
Shall ONLY be employed in the
following situations:
When the patients condition is so
unstable that he needs immediate
intervention which can only be
provided in a supine position and/or
out of the vehicle or when his
condition requires immediate
transport to a hospital without delay.

Rapid Extrication
Shall ONLY be employed in the
following situations:
When the patient blocks the
rescuers access to other more
seriously injured patients in the
vehicle

Study of Effectiveness
of ALS for MVAs

Trauma review committee of ER physicians, trauma surgeons,


neurosurgeons

The committee felt that ALS was helpful


or essential in 85% of cases
Pre-hospital care improved survival of
pts suffering major blunt trauma
Penetrating thoracic/abdominal trauma
mandates rapid transport
The added time of transport to a trauma
center, even if it bypasses another
hospital is justified

If extended extrication
time:
Initiate ALS procedures while pt. is
still inside vehicle
Intubation
IV fluids
O2 via NRB or BVM

Time Studies

Mean scene time studies for all Trauma Alerts

Tuscon
8.1 minutes
Denver
9.8 minutes
Lee County
12.0 minutes
Australia 13.0 minutes
Sacramento
14.5 minutes
New York 17.3 minutes
Milwaukee
21.0 minutes
Washington D.C.
24.9 minutes

Preparation & Response

Preparation & Response


Proper training
This class
Specialties
Trucks, busses, heavy equipment, etc.
Every six months

Preparation & Response


Response considerations

Time of day
Weather conditions
Response routes
Multiple calls reporting
Reports of entrapment

Preparation & Response


Possible entrapment or vehicle
rollover?
Respond with engine and 510

Teamwork
Common Terminology

Anatomy

Right side
Left side
Top
Bottom

Drivers side
Passengers side
Roof
A-post, B-post

C-Post

Roof

A-Post

The Scene Survey

Scene size-up
Look for immediate hazards
Is it safe to exit the vehicle? (traffic)
Call for additional resources (if
needed)

Power company (downed electric lines)


Extrication needs (obvious entanglement)
Additional ambulances (multiple patients)
Hazmat team (vehicle carrying hazmats?)

Outer Circle Survey


Look for patients no longer in cars
Locate other vehicles involved in
accident
Obvious hazards

Inner Circle Survey


Determine number of patients in
vehicles
Conditions of patients
Degree of entrapment

Hazard Control
Control potential fires with hose
line
Cover spilled vehicle fluids
Stabilize vehicles
Chock tires
Make sure motor is off

Action Circle
10-15 feet around crash

Keep clear of trip hazards


Stage unused tools outside of zone
Exclude non-essential personnel
Must be protected if in zone

Tool Staging
Locate just inside
the action circle
Ideally have a tarp
or marked area
Allows rescuers to
see what is
available
Keeps tools clean
and protected from
damage

Safety Issues
Identify existing hazards
Anticipate potential hazards
Eliminate hazards that can be
eliminated
Avoid creating additional hazards

Safety Issues
Stabilization
Disconnect electrical system
Negative side first (< sparks)
Air-bags
Fuel pumps

Safety Issues

Bent and torn metal


Broken glass
Fumes (gas, battery acid, oils)
Fuel leaks
Unstable vehicle
Vehicle cargo (unstable, hazmats)
Power lines
Loaded bumper

Safety Issues

Head protection
Eye protection
Hand protection
Foot protection
Coat & pants
Bloodborne pathogen protection
Hearing protection
Respiratory protection

Scene Safety
Verbalize all activities
Use the term FREEZE to stop all
operations/activities

Safety Priorities

Yourself
Other rescuers
Bystanders
Victim