Knowledge of operations and responsibilities to ensure patient, public, and personnel safety.
Vehicle Extrication
Vehicle Extrication
Safe vehicle extrication
Use of simple hand tools
EMS departments must be prepared to respond to a variety of special rescue situations.
EMS departments must be prepared to respond to a variety of special rescue situations.
Paramedics are often first on the scene.
All EMS providers require training in rescue techniques.
All EMS providers require training in rescue techniques.
Focus of training is awareness.
The paramedic’s function on-scene varies depending on the company.
A technical rescue incident (TRI) is a complex rescue incident.
A technical rescue incident (TRI) is a complex rescue incident.
Three levels of TRI training:
Awareness
Operations
Technician
Be safe.
Be safe.
Follow orders.
Work as a team.
Think.
Follow the golden rule of public service.
Preparation
Preparation
Response
Arrival and scene size-up
Stabilization of the scene
Train with other fire departments and special rescue teams.
Train with other fire departments and special rescue teams.
Assess the following:
Personnel and equipment
Who will respond
Familiarity with hazard area
If your department has its own TRI team, it will respond.
If your department has its own TRI team, it will respond.
Often the rescue squad comes from an outside agency.
Contact utility companies as needed.
Information received from initial dispatch call is critical.
Information received from initial dispatch call is critical.
Responders must:
Identify/mitigate life-threatening hazards.
Inform IC of special resources needed.
Determine whether the situation is a search, rescue, or recovery.
Be sure all hazards are identified.
Be sure all hazards are identified.
First arriving responder assumes command.
Establish objectives.
Coordinate resources.
Unify command between agencies.
Three guidelines to follow:
Three guidelines to follow:
Approach the scene cautiously.
Position apparatus properly.
Assist specialized team members.
Emergency vehicles
Emergency vehicles
Safety is the primary consideration.
Disrupting traffic creates a hazard.
Emergency vehicles can act as a barrier.
Use only essential warning lights.
Control zones
Control zones
An outer perimeter protects against public and media; inner perimeter surrounds incident site
Set up three control zones:
Hot zone
Warm zone
Cold zone
Specific hazards
Specific hazards
Use the DOT’s Emergency Response Guide (ERG) as a resource
Shut off utilities.
Protective equipment
Protective equipment
Considerations include:
Visibility of PPE
Footwear designed for the environment
ANSI-approved safety glasses or goggles
Puncture- or cut-resistant gloves
Flame- or flash-protective clothing
Accountability
Accountability
System tracks personnel on the scene.
Can be used to:
Track resources
Task assignments
Ensure personnel safety
Patient contact
Patient contact
Maintain eye contact.
Be truthful.
Communicate at a level that can be understood.
Be aware of body language.
Patient contact (cont’d)
Patient contact (cont’d)
Speak in laymen’s terms.
Address the patient properly.
Give time to respond to questions.
Make the patient comfortable.
Simple access requires hand tools.
Simple access requires hand tools.
Complex access requires special tools.
Gaining access depends on:
Type of incident
Nature and severity of injuries
Emergency medical care should begin as soon as the patient is accessed.
Emergency medical care should begin as soon as the patient is accessed.
A team member should stay with the patient while they are being disentangled.
Involves freeing a patient from whatever is trapping them
Preparing for removal involves:
Preparing for removal involves:
Controlling life-threatening problems
Dressing wounds
Immobilizing fractures and spinal injuries
Expedite removal if:
Expedite removal if:
Patient is deteriorating rapidly.
Hazards are present.
Packaging: Preparing the patient for movement as a unit
Using a basket stretcher helps move patients to safety.
Using a basket stretcher helps move patients to safety.
Lifted by rope
Carried by vehicles
Hand carried
Transport varies depending on:
Transport varies depending on:
Severity of the patient’s injuries
Distance to the medical facility
Use standardized terminology when describing.
Use standardized terminology when describing.
Roof posts add support to the roof.
There is an engine compartment and a passenger compartment.
There is an engine compartment and a passenger compartment.
Hood covers engine compartment
Bulkhead divides compartments
Firewall protects passengers
Two frame types:
Two frame types:
Body-over-frame construction
Unibody construction
Powered by:
Powered by:
Electricity
Electricity/gasoline hybrid
Fuel
Secure vehicle as soon as possible.
Identified by special markings
A car wreck may have additional hazards.
A car wreck may have additional hazards.
Follow proper size-up and evaluation processes.
Responders trained at awareness level may assist special responders.
Categories include:
Categories include:
Striking tools
Leverage/prying/ spreading tools
Cutting tools
Lifting/pushing/ pulling tools
Cribbing
Cribbing
Designs include:
Step chocks
Wedges
Shims
Vehicles may still move after cribbing.
Vehicles may still move after cribbing.
Horizontal
Vertical
Roll
Pitch
Yaw
Open the door.
Open the door.
Try all doors first.
Ensure locks are released.
Break tempered glass.
Use side and rear windows not in close proximity to the patient.
Break tempered glass (cont’d).
Break tempered glass (cont’d).
Wear proper PPE.
First, lower the windows as far as possible.
Aim for a low corner.
Give other EMS personnel warning.
Provide initial medical care.
Provide initial medical care.
Spine immobilization
Assessment and management of the ABCs
Study the scene before taking action.
Study the scene before taking action.
The order of procedures will be determined by the specifics of the incident.
Main objective = maintain spinal alignment and immobilization
Air bag safety
Air bag safety
Identify undeployed air bags.
Disable airbags by disconnecting power.
Air bag safety (cont’d)
Air bag safety (cont’d)
Most vehicles contain an air bag.
If the air bag has deployed, it is not a hazard.
If it did not deploy, disconnect the battery.
Some newer vehicles have a switch that allows shutting off of the air bags.
Air bag safety (cont’d)
Air bag safety (cont’d)
Do not place a hard object between the patient and an undeployed air bag.
Do not cut a steering wheel if the air bag has not deployed.
Never get in front of an undeployed air bag.
Check for side-mounted air bags or curtains.
Displacing the seat
Displacing the seat
Relieves pressure on the driver
Gives rescuers more room to work
Try simple steps to displace a seat.
Removing the windshield
Removing the windshield
Allows for better communication
Remove in one large piece.
Essential before removing the roof
Removing the roof
Removing the roof
Increases space for care and disentanglement
Protect the patient and rescuers inside the vehicle.
Support the roof when cutting posts.
Displacing the dash
Displacing the dash
Use the dash roll technique.
Requires a hydraulic cutter and ram
Must be done by a trained rescuer
Location surrounded by a structure that is not designed for continuous occupancy.
Location surrounded by a structure that is not designed for continuous occupancy.
Limited ventilation
Oxygen deficiency and poisonous gases
Oxygen deficiency and poisonous gases
Hydrogen sulfide (H2S)
Carbon monoxide (CO)
Carbon dioxide (CO2)
Methane (CH4)
Ammonia (NH3)
Nitrogen dioxide (NO2)
Safe approach
Safe approach
Gather information from bystanders.
Assume IDLH atmosphere.
Assisting other rescuers
Share whatever information is discovered.
Compare conditions with those reported.
Collapse sites are unstable and prone to further collapse.
Collapse sites are unstable and prone to further collapse.
Patients should be dug out after shoring has stabilized the site.
Safe approach
Safe approach
Stay away from the edges of the site.
Shut off all heavy equipment.
Stop or divert nearby traffic if needed.
Avoid disturbing the spoil pile.
Prioritize your personal safety.
Be aware of self-rescue techniques.
Be aware of self-rescue techniques.
Minimum PPE includes:
Personal flotation device (PFD)
Thermal protection
Whistle
If immersed in fast-moving water, adopt the self-rescue position.
Cold water rescue
Cold water rescue
Hypothermia can quickly progress.
Assume the heat-escape-lessening position (HELP).
Patient may survive underwater due to the mammalian diving reflex.
Other water rescue situations
Other water rescue situations
Special hazards of surface water:
Hydraulics
“Strainers”
Dams and hydroelectric sites
Safe approach
Safe approach
Wear appropriate PPE.
Do not exceed your level of training.
Use the reach-throw-row-go approach.
Use specialized equipment for ice rescues.
Suspect spinal injury if:
Suspect spinal injury if:
Diving mishap or fall
Unconscious patient with no information to rule out neck injury
Conscious patient reporting weakness, paralysis, or numbness in arms and/or legs
You have any other reason to suspect spinal injury
Types of rope rescue:
Types of rope rescue:
Low-angle operations: slope of the ground is less than 45°
High-angle operations: slope of the ground is greater than 45°
Safe approach
Safe approach
Set up equipment properly.
Put distance between you and any loose materials.
Move bystanders out of the way.
Two parts to search and rescue (SAR)
Two parts to search and rescue (SAR)
Search (looking for lost persons)
Rescue (removal of patient from environment)
Safe approach
Safe approach
Be aware that factors will vary.
Bring drinking water, food, clothing, and PPE.
Use a handheld strobe light.
Be aware of physical limitations.
Set up a search base.
Set up a search base.
Prepare equipment ahead of time.
Monitor progress via radio.
Safe approach
Distribute equipment among personnel.
Stick together.
Consider relocating ambulance.
Determine route.
Determine route.
The IC will determine an appropriate parking spot for the ambulance.
Determine if there are injured patients or if you are on stand-by.
Safe approach
Safe approach
Stay with the ambulance.
Remain present even after the fire is out.
Unless transporting a patient or released by IC
Visit local farms and industrial plants and learn about:
Visit local farms and industrial plants and learn about:
Equipment that is used
How it operates
How an operator can become entrapped
Over time, protective shields and guards may be damaged or removed.
Safe approach
Safe approach
Master cribbing.
Take apart machines made of strong metal (rather than cutting).
Isolate the injury site.
Safe approach (cont’d)
Safe approach (cont’d)
Determine alternative methods of disentangling.
Assess patient while rescue personnel plan disentanglement.
Be aware of differences in industrial and farm settings.
Law enforcement may call in the SWAT team in tactical situations.
Law enforcement may call in the SWAT team in tactical situations.
Tactical paramedics receive additional training.
Tactical paramedics must be able to provide medical care under adverse circumstances.
Tactical paramedics must be able to provide medical care under adverse circumstances.
Provide immediate medical care to persons who become injured during an incident.
Often before the scene is declared safe
Many medical and trauma conditions are assessed during the rescue process.
Many medical and trauma conditions are assessed during the rescue process.
Crush syndrome: Large muscle groups are compressed for a prolonged period of time
High-flow oxygen therapy or positive pressure ventilations
Administration of sodium bicarbonate, calcium chloride, fluid bolus
Use nonpharmacologic methods in the field
Use nonpharmacologic methods in the field
Splinting
Gentle handling
Talking to patients
Basket stretcher (Stokes basket)
Basket stretcher (Stokes basket)
Two types of basket stretchers (Stokes)
Wire basket
Plastic/fiberglass baskets
Packaging obstacles:
Packaging obstacles:
Patients with fractured pelvises
Secure to a full-body vacuum mattress
Spine-immobilized patients
Place the patient in a Kendrick Extrication Device (KED)
Consider all patient needs:
Consider all patient needs:
Portable oxygen tank
IV lines
Warmth
Head and eye protection
KED or KED/SKED
“Rescue” means to deliver from danger or imprisonment.
“Rescue” means to deliver from danger or imprisonment.
The most difficult process in any rescue is the coordination and balance of rescue and treatment.
A technical rescue incident (TRI) is a complex rescue incident that requires specially trained personnel and special equipment.
Technical rescue training occurs on three levels: awareness, operations, and technician.
Technical rescue training occurs on three levels: awareness, operations, and technician.
When assisting rescue team members:
Be safe.
Follow orders.
Work as a team.
Think.
Follow the golden rule of public service.
All rescuers should perform the following steps to perform special rescues safely:
All rescuers should perform the following steps to perform special rescues safely:
Preparation
Response
Arrival and scene size-up
Stabilization of the scene
Access
Disentanglement
Removal
Transport
At a technical rescue incident, it is critically important to slow down and properly evaluate the situation.
At a technical rescue incident, it is critically important to slow down and properly evaluate the situation.
The first arriving officer at a rescue scene should immediately assume command and start using the incident management system.
Whenever possible, park emergency vehicles in a manner that will ensure safety and not disrupt traffic any more than necessary.
Whenever possible, park emergency vehicles in a manner that will ensure safety and not disrupt traffic any more than necessary.
Accountability should be practiced at all emergencies, no matter how small.
Basket stretchers facilitate moving patients to safety and can be used in a variety of situations.
Basket stretchers facilitate moving patients to safety and can be used in a variety of situations.
Vehicle extrication is commonly necessary.
There are many hazards associated with alternative powered vehicles.
You should have a thorough working knowledge of the basic simple hand tools.
Cribbing should be used regardless of the position of the vehicle.
Cribbing should be used regardless of the position of the vehicle.
Simple vehicle extrication techniques include opening the door, breaking tempered glass, and providing initial medical care to the patients.
During disentanglement, responders need to be mindful of undeployed air bags.
Many vehicle extrication techniques require the use of specialized skills and training.
Many vehicle extrication techniques require the use of specialized skills and training.
A confined space is a location surrounded by a structure that is not designed for continuous occupancy.
Confined spaces may have limited ventilation to provide air circulation and exchange.
Trench rescues may become necessary when earth is removed for placement of a utility line or for other construction and the sides of the excavation collapse.
Trench rescues may become necessary when earth is removed for placement of a utility line or for other construction and the sides of the excavation collapse.
You should know how to properly don a personal flotation device as well as how to use the self-rescue position.
Rope rescue incidents are divided into low-angle and high-angle operations.
Rope rescue incidents are divided into low-angle and high-angle operations.
Wilderness search and rescue (SAR) missions consist of two parts: looking for a lost or overdue person and removing a patient from a hostile environment.
During lost person search and rescue, your role is to stand by at the search base until the lost person or people have been found.
You should always stay with your ambulance during a structure fire.
You should always stay with your ambulance during a structure fire.
If an incident develops into a tactical situation, law enforcement agencies may deploy use of specialized law enforcement tactical units or the SWAT team.
Pain control in rescue situations should take the form of nonpharmacologic methods.
A number of special patient packaging tools are available to help extricate patients out of their situation and up, down, or out to the ambulance.
A number of special patient packaging tools are available to help extricate patients out of their situation and up, down, or out to the ambulance.
Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.
