1. Introduction to Extrication
The Patient Handling / Vehicle Extrication Module 1

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

3. 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

4. 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

5. The Golden Hour 5

6. 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

7. 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

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

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

10. 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

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

12. 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

13. 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

14. 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

15. Hazards - Alternative Fuels
LP gas
Diesel Fuel
Electric Vehicles 15

16. 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

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

18. 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

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

20. 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

21. 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

22. 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

23. Dash Roll 1992 Hyundai Excel23

24. 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

25. 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

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

27. 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

28. Types of Cars 28

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

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

31. Other Vehicles
Trucks
Vans
Buses
Trains
Airplanes 31

32. 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

33. 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

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

35. SUMMARY 35