Basic Concepts and Techniques

Course ObjectivesCourse Objectives

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

Course ObjectivesCourse Objectives

• Understand and Practice:– the skills needed for the

disentanglement of a patient entrapped in the wreckage of a vehicle crash.

Course ObjectivesCourse Objectives

• Understand and Practice:– The skills related to the Assessment

and Packaging of a patient entrapped in the wreckage of a vehicle crash.

Course ObjectivesCourse Objectives

• Understand and Practice:– Safety features– Precautions– Capabilities

• Of the extrication tools used by this department

Course ObjectivesCourse Objectives

• Understand:– The psychological considerations of

patient care.

Course ObjectivesCourse Objectives

• Understand:– Rapid Extrication/Protocol

Course ObjectivesCourse Objectives

• Demonstrate:– Proper glass removal techniques

• Tempered• Laminated

Course ObjectivesCourse Objectives

• Demonstrate:– Patient access– Interior rescuer duties– Proper protection of patient(s) during

extrication

Course ObjectivesCourse Objectives

• Demonstrate:– Making a purchase point– The forced opening of a door using

hand tools– Proper vehicle stabilization with

cribbing

Course ObjectivesCourse 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

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

1999

RescueService CallFalse CallGood IntentFire/Explosion

Signal 4’s vs all calls

70.30%

10.00%

All othersSignal 4's

• 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

rescuer’s access to other more seriously injured patients in the vehicle

Study of Effectiveness of ALS for MVA’s

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 pt’s 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 StudiesMean 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

A-Post

C-Post Roof

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