Rescate Vehicular
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Transcript of Rescate Vehicular
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