Introduction to Extrication The Patient Handling / Vehicle Extrication Module 1

EXTRICATION Defined - The act of removing a wreck from a victim Vehicle Non-vehicle 2

Terms A,B,C, Posts Safety Glass Tempered glass Laminated glass Uni-body Crumple Zone cribbing dash roll-up roof flap Nader bolt hand tools powered hydraulics 3

Basic Principles of Extrication Patient care precedes mechanical aspects Patients should be packaged and moved carefully C-Spine Injuries should be suspected Load and Go patients require Rapid Extrication 4

The Golden Hour 5

The Role of the EMT Administer patient care Assure that patient is packaged Not allow extrication efforts to endanger patient If rescue crews are not present - Extricate Victim 6

Incident Resource Management Requires integration of EMS, Rescue, Police, Fire and other services Command should be established early Should ensure proper utilization of resources Goal of reducing On Scene Time 7

Stages of Extrication Scene survey Vehicle Stabilization Gaining access Life-threatening emergencies Disentanglement Preparation for removal Removal 8

Initial Unit Size-up scene Set up official incident command Direct scene survey Establish an action circle Begin to gain access 9

Scene Size-up and Scene Safety Mechanics of the accident Number of patients involved Need for additional resources Look for obvious hazards Secure the scene for safety prior to approaching patients 10

Hazards Airbags Loaded Bumpers Downed Power Lines Unstable Vehicle deployed intact Loaded Bumpers Downed Power Lines Unstable Vehicle Smokers Fuel Spills 11

HAZARDS - AIRBAGS Various activation mechanisms Found on Drivers side of most new vehicles Found on Passenger side of some vehicles Are used as side impact protection on some vehicles Deploys in 1/20 of a second Deploys at a speed of approx. 200mph 12

Airbag update New models have airbags in the shoulder harness. Some new models have airbags in the backs of the front seats to protect back passengers Passenger side airbag speed can reach 300+ mph 13

Airbag update Passenger side airbags have been redirected upward New cars have a logic control sensor to activate airbags Can cause injuries and even death Controllers are the ”little black box” 14

Hazards - Alternative Fuels LP gas Diesel Fuel Electric Vehicles 15

Outer circle survey 10- 15 feet around perimeter of vehicle Clear debris / other hazards from area Look around, under, toward and away from vehicle Check and account for any other patients Report findings to I.C. 16

Inner circle survey Check doors Watch for “loaded” bumpers Determine actual count of patients Note type of vehicle stabilization needed Formulate access plan 17

Establish an action circle 1O-15 feet around the vehicle Area should remain free of tools, equipment, stretchers and unnecessary personnel Establish a tool staging area Set up sectors and sector commanders 18

Gaining Entry protect self stabilize select route doors windows roof flap removal 19

Disentanglement Break out all glass Open doors remove door try handles cut panel use power tools remove door Move seats back Remove roof displace pedals Dash Roll - Up displace steering wheel 20

Breaking Glass Select window away from the patients Rear window is preferred to be broken first Roll down all other windows, leave 2-3 inches showing Cover with blanket, then break YELL “ BREAKING GLASS” 21

Dash Roll-up Cut a bottom of both “A” posts Leave rear doors intact unless absolutely necessary Crease front fenders Open or Bend (Both Sides) Hood 22

Dash Roll 1992 Hyundai Excel 23

Removal Maintain c-spine control Look for MOI Treat injuries lmmobilize spine KED Long backboard Other devices Move patient, not device Evaluate need for personnel Choose path of least resistance Watch for Hazards 24

LOAD & GO CRITERIA Altered Mental Status Respiratory Compromise Cardiac Arrest Pelvic fractures ( with signs of shock ) Bilateral Femur Fractures Shock or signs of shock 25

What is a Car ? Folded metal, glass, and plastic on wheels 26

Types of Cars Conventional Frame unibody composite construction IT’S NOT HOW THE CAR IS MADE , BUT RATHER WHAT PEOPLE DO TO THEM THAT MAKES THEM UNSAFE FOR US TO WORK ON. 27

Types of Cars 28

Strength of a car is in its shape Arches , columns , rolls , creases and layers all add to the strength of a car. 29

Side door beams make it stronger A car is strongest end to end 30

Other Vehicles Trucks Vans Buses Trains Airplanes 31

Other Vehicles (Buses) 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 32

Basic hand tools Cribbing pry axe Hacksaw Screw drivers Linoleum knife Come-a-long Center punch Panel cutter Hand jack Wonder bar Air chisel Reciprocating saw Hand hydraulics Rope Duct tape chain 33

Powered Tools (Hi-Tech) Hurst Tool (Jaws of Life) P-16 Power hawk Life Shear Cutter Band Saw Exothermic Torch Excalibur 34

SUMMARY 35