Introduction to Extrication

The Patient Handling / Vehicle

Extrication Module
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EXTRICATION
efined - The act of removing a wreck
from a victim
Vehicle
Non-vehicle
Terms
Posts
Safety Glass
Tempered glass
Laminated glass
Uni-body
rumple Zone
cribbing
dash roll-up
roof flap
Nader bolt
hand tools
powered hydraulics
asic Principles of Extrication
Patient care precedes mechanical
aspects
Patients should be packaged and
moved carefully
-Spine Injuries should be suspected
Load and Go patients require Rapid
Extrication
The Golden Hour
The Role of the EMT
dminister patient care
ssure that patient is packaged
Not allow extrication efforts to endanger
patient
If rescue crews are not present -
Extricate Victim
Incident Resource Management
Requires integration of EMS Rescue
Police Fire and other services
ommand should be established early
Should ensure proper utilization of
resources
Goal of reducing On Scene Time
$tages of Extrication
Scene survey
Vehicle Stabilization
Gaining access
Life-threatening emergencies
isentanglement
Preparation for removal
Removal
Initial Unit
Size-up scene
Set up official incident command
irect scene survey
Establish an action circle
egin to gain access
$cene $i:e-up and $cene $afety
Mechanics of the accident
Number of patients involved
Need for additional resources
Look for obvious hazards
Secure the scene for safety prior to
approaching patients
Ha:ards
irbags
W deployed
W intact
Loaded umpers
owned Power Lines
Unstable Vehicle
Smokers
Fuel Spills
HAZARD$ - AIRAG$
Various activation mechanisms
Found on rivers side of most new
vehicles
Found on Passenger side of some
vehicles
re used as side impact protection on
some vehicles
eploys in 1/20 of a second
eploys at a speed of approx. 200mph
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
Airbag update
Passenger side airbags have been
redirected upward
New cars have a logic control sensor to
activate airbags
an cause injuries and even death
ontrollers are the "little black box"
Ha:ards - Alternative Fuels
LP gas
iesel Fuel
Electric Vehicles
Outer circle survey
10- 15 feet around perimeter of vehicle
lear debris / other hazards from area
Look around under toward and away
from vehicle
heck and account for any other
patients
Report findings to I..
Inner circle survey
heck doors
Watch for "loaded" bumpers
etermine actual count of patients
Note type of vehicle stabilization
needed
Formulate access plan
Establish an action circle
1O-15 feet around the vehicle
rea should remain free of tools
equipment stretchers and unnecessary
personnel
Establish a tool staging area
Set up sectors and sector commanders
Gaining Entry
protect self
stabilize
select route
W doors
W windows
W roof
flap
removal
Disentanglement
reak out all glass
Open doors
W try handles
W cut panel
W use power tools
remove door
Move seats back
Remove roof
displace pedals
ash Roll - Up
displace steering
wheel
reaking 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
over with blanket then break
YELL " REING GLSS"
Dash Roll-up
ut a bottom of both "" posts
Leave rear doors intact unless
absolutely necessary
rease front fenders
Open or end (oth Sides) Hood
Dash Roll 1992 Hyundai Excel
Removal
Maintain c-spine
control
Look for MOI
Treat injuries
lmmobilize spine
W E
W Long backboard
W Other devices
Move patient not
device
Evaluate need for
personnel
hoose path of
least resistance
Watch for Hazards
OAD & GO CRITERIA
ltered Mental Status
Respiratory ompromise
ardiac rrest
Pelvic fractures ( with signs of shock )
ilateral Femur Fractures
Shock or signs of shock
hat is a Car ?
Folded metal glass and plastic on wheels
Types of Cars
onventional Frame
unibody
composite construction
IT'S NOT HOW THE CAR IS MADE , IT'S NOT HOW THE CAR IS MADE ,
BUT RATHER WHAT PEOPLE DO TO BUT RATHER WHAT PEOPLE DO TO
THEM THAT MAKES THEM UNSAFE THEM THAT MAKES THEM UNSAFE
FOR US TO WORK ON. FOR US TO WORK ON.
Types of Cars
$trength of a car is in its shape
rches columns rolls creases and layers all
add to the strength of a car.
$ide door beams make it stronger
car is strongest end to end
Other Jehicles
Trucks
Vans
uses
Trains
irplanes
Other Jehicles (uses)
uilt on a frame
ody slides on
frame
Seats support the
sides
Entry through the
floor not an option
Many types of buses
river is expendable
asic hand tools
ribbing
pry axe
Hacksaw
Screw drivers
Linoleum knife
ome-a-long
enter punch
Panel cutter
Hand jack
Wonder bar
ir chisel
Reciprocating saw
Hand hydraulics
Rope
uct tape
chain
Powered Tools (Hi-Tech)
Hurst Tool (Jaws of Life)
P-16 Power hawk
Life Shear utter
and Saw
Exothermic Torch
Excalibur
$UMMARY
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