Transcript Module 36: Gaining Access & Vehicle Extrication

Gaining Access &
Vehicle Extrication
The Role of EMS During
Patient Extrication or
Rescue
Introduction
The number of transportation,
agricultural, environmental and
residential accidents are increasing
throughout the world, resulting in
higher numbers of serious injuries and
deaths.
Introduction Con’t
In Manitoba we have a vast area to
cover as EMS providers. With accidents
increasing we as EMS providers should
be concerned. Being prepared when
accidents occur throughout our province
takes preparation and dedication from
members of rural EMS.
Introduction Cont’d
Develop loosely defined roles for
responding EMS crew to assess accident
scene and confirm level of response
needed.
EMS crews should be aware of any
responding agencies roles and
responsabilities.
Objectives
Define extrication and goals
Roles of agencies at scene
Placement of vehicles at scene
Scene assessment / Scene size-up
Objectives
Stabilization
Access to patient
Disentanglement of patient
Patient removal
Post call
Objectives
Define extrication and goals
Roles of agencies at scene
Placement of vehicles at scene
Scene assessment / Scene size-up
Extrication
The removal of a person from a building,
vehicle or area of danger. More
specifically the removal from a damaged
vehicle, collapsed structure, or other
position of entrapment.
Simple Definition:
Removal of a
trapped patient
Goal of Extrication
Goal of Extrication
To remove the victim from
entrapment without further injury
or unnecessary movement.
Primary EMS Unit
Crew members responsibilities:
• Safety first for themselves and their partner
• Secondly safety to the patient
• Determine need for addition resources
• Plan of action to complete goals
Crew Safety
 PPE.
 Rescue Helmet
Eye protection
Protective clothing (Jacket, Gloves)
 Position of vehicle(s) in relation to traffic
Hazards!!
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Fire
Fuel Leaks
Downed Power Lines
Hazardous Materials
Unstable Vehicle/Structure
Traffic
Crowds
Communications
Communications:
• Interagency communications must be available
• Important to asses and update potential
resources (Fire Dept., Additional EMS units,
ER.Dept, Law Enforcement)
• Communication between agencies is of the
utmost importance
Communications
Communications con’t:
• Messages, whether sent via radio or in conversation,
must be clear, concise and to the point
• During major incidents members may be required to
change to a different frequency on their radios so as not
to hamper radio transmissions on a department’s primary
channel. Secondary and tertiary channels should be
established before or on arrival at the scene
• Special codes or radio language should be common
between all members (e.g. 10 codes)
Objectives
Define extrication and goals
Roles of agencies at scene
Placement of vehicles at scene
Scene assessment / Scene size-up
Different Agencies
Law Enforcement
Fire Department
Rescue
Hazmat
Hydro
Gas (Natural Gas / Propane)
Role of Law
Enforcement
Investigation of incident
Traffic control
Crowd control
Preserve scene for reconstruction and
investigation
Role of Fire Dept.
Extinguishing fires
Preventing fires
Handling spills or leaks
Vehicle safety
Energy absorbing bumpers
Electrical system
Fuel system
Stabilization
Assist police and EMS
Role of EMS
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(That’s us)
Patient contact throughout incident
Patient assessment(s)
Triage
Patient care
Assess need for disentanglement
Advise rescue of entrapment conditions
Packaging of injuries / patients
Transport patient
Role of Rescue
Rescue may be performed by a separate agency
or may be a part of Fire Dept or EMS Duties.
 Establish incident/scene command
 Assess rescue needs/ ext’n techniques
 Provide patient access
 Disentanglement
 Assist EMS
 Scene safety
Role of Hazmat
Advise command of risk / hazards
Secure scene
Evacuation of area
Removal of patients at contaminated
scene
Decontamination of patients
Role of Hydro / Gas
Advise command of risk / hazards
Assist in securing scene
Scene Size-up
Consists of two surveys.
 Outer circle survey
 Inner circle survey
Scene Size-up
Outer Circle Survey
Starts when arriving, includes
ambulance parking.
Assess hazards
Medical Needs
Number of patients
Location of patients
• Trapped or not
Rollover - search 300 ft or more for
additional patients
Scene Size-up
Assess Rescue needs. Require:
Forcible entry
Tools for disentanglement
Tools for patients egress
Additional lighting
Additional Manpower
Call in other agencies
Vehicle size-up
Inner circle survey
 Close up look at crash
 Initial patient contact
 Approach patient from in front
 Identify patient condition(s)
 Identify degree of entrapment
 Find hidden hazards
(Airbags/Bumpers)
Assess need for stabilization
Stabilization
 Stabilization:
• Safety before approaching the vehicle. (is the
vehicle still running, on fire, hazardous
chemicals present, HYDRO lines downed etc.)
• Vehicle should be stabilized before personnel
enter vehicle using wooden blocks and
deflating the tires, vetter mats, or using jacks
• Personnel should be aware of possible undeployed airbags
• Traffic hazards
 Stabilization Con’t:
• How many vehicles involved
• Scene may require light - if so use intrinsically
safe devices if available
• Make use of vehicles own safety features such
as placing vehicle in park or applying the
emergency brake
Where are airbags?
 Driver side (steering wheel)
 Passenger side (above glove box)
Where are airbags?
 Side impact
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In side of seat
In ‘B’ post
Tubular across window
Curtain (guillotine)
Where are airbags?
 Side impact
A Post
B Post
C Post
Anatomy of the
airbag
Control Zones
Hot, Warm, Cold
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Reduce congestion
More efficient
Less confusion
Circular
Size depends on accident scene
Hot Zone
 Closest to extrication
 Access only to those performing
 Patient care
 Extrication
 Keep unused equipment out of hot
zone
Warm Zone
 Just outside of hot zone
 Access only to those
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Helping workers in hot zone
Handling charged lines
Handling scene lighting
Treating patients
 Treat patients prior to transport in
warm zone if safe to do so
Cold Zone
 Outer circle
 Where equipment and manpower
staged
 Command post
 Cordoned off
Patient Access
When safe access the patient
 If possible make the car safer / easier
to access
 Secure the keys
 Remove or cut seatbelt if safe
 Unlock doors and roll down windows
 Assess patient injuries and entrapment
 Cover patient
Patient Access
“Try before you pry!”
First try simple access: attempt access
without using tools. Open a door or go
through an open window.
If this doesn’t work, you must try
complex access.
Complex Access
Tools are required to access patient
 Break a window, open a door
 Break a window, crawl in
 Use hand tools to make a pathway
through wreckage to patient
 Have TOOL personnel create a
pathway using hand tools or heavy
hydraulics (jaws of life)
Laminated glass
 Formed of a layer of plastic between 2
layers of glass
 Shatters, but glass stays in place
 Found on vehicle windshields (front)
Tempered glass
 Single piece of hardened glass
 Shatters into thousands of small pieces
 Found on vehicle side and rear
windows
Removing Laminated
Glass
 Try pulling out rubber seal around
window, remove window intact
 Cut windshield with saw, axe, or
specialized tool
 If cutting, USE DUST MASKS ON
RESCUERS AND PATIENT! Let patient
and other rescuers know you are
“CUTTING GLASS!”
Removing Tempered
Glass
 Try rolling down side windows, try
pulling rubber out around rear windows
 Break window with a center punch
(bottom corner) or pointed object
 When possible, use farthest window
 Pull glass out, possibly into tarp or
sheet, then roll it up
 Make sure patient and rescuers know
you are “BREAKING GLASS!”, cover Pt.
Disentanglement
Always use soft and hard
protection
EMS must maintain patient
contact
EMS must maintain contact
with rescuers
Continue re-assessing patient
Treat patient accordingly,
Ccollar, KED, Splints, etc.
Extrication
 What’s happening around you!
Dash roll / dash lift / steering wheel lift
 Cut steering wheel
 Roof removal / Roof flap
 Side takedown
 “Pop” doors
Side Flap
Roof Removal
Dash Lift
Caring For The
Patient
 Safety while treating the patient is paramount. If
available, a safety officer should be established along
with the IC. Safety can also be another roll the IC
and his crew members, leaving the IC with the
overall command.
 Personnel should establish direct communication link
between EMS involved with Pt. care and those
performing extrication.
 Always communicate to ensure safety of all involved
Caring For The
Patient
 Once the EMS has gained access, he
or she acts as the eyes and ears. He or
she must communicate with the
extrication members, Pt., and additional
EMS resources during extrication.
 EMS also decides (and must recognize)
load and go situations or stay and play
situations.
Caring For The
Patient
 For patient safety, here are a few tips:
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Ensure the Pt’s airway and control C-spine
Assess the Pt’s breathing and pulse
Establish the Pt’s L.O.C. and re-evaluate
Scan the Pt. starting at the head
Control hemorrhage as you encounter severe bleeding
Treat for shock
Provide emotional first aid as well as physical first aid
» Personnel should explain what is
happening around the Pt.(e.g. we are
going to be breaking the window across
from you)
Patient removal
 May require more disassembly,
distortion, displacement or severing
 Communicate with rescue team
 Communicate with patient
 Maintain spinal immobilization
Patient removal
 Out door, feet first onto long board
 Out door, head first onto long board
 Out top, tilt seat back slide patient up
onto long board
 Improvise!
 Secure to board
 Treat patient
Advise receiving facility of Pt. condition
Post call
 Determine need for CISM
 Collect equipment, pick up people you
left behind
 Clean, test and restock equipment
 Critique
Some info on non powered hand
tools
 Screwdrivers can be used to break glass, open trunks
& remove vehicle’s cosmetics.
 Socket set w/ratchet to remove nuts & bolts that hold
seats, doors, etc.
 Pliers to cut wires, remove cosmetics or pull valve
stems.
 Spring loaded center punch to break glass.
 Bolt cutters to cut bolt & steering wheel ring.
 Long & short board for pt’s protection, stabilization &
packaging.
Non powered tools (continued)
Pike pole to help flop the roof
Pry bar to make a purchase point & force doors
Flat headed axe to cut windshield
Halligen to make a purchase point, remove trunk locks & break
tempered glass
 Pry axle can opener to cut windshield, make purchase point &
cut sheet metal
 2 X 4 & 4 X 4 cribbing & wedges to stabilize vehicle (used with
come along)
 Come along with chains to pull dashes & seats, displace doors,
pull roof & stabilize vehicle
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Non powered tools (continued)
 Chains to wrap dashboard & seats, pull roof or
displace doors
 Pneumatic tools (air powered) to cut roof, make relief
cuts, third door conversion & cut windshield
 Air bags used for lifting, pulling & stabilizing
 Reciprocating electric or air operated saw
 Hand operated hydraulic tools
 Spreader used to force doors, seats & pedals
 Cutter used to cut posts, make relief cuts, cut
steering wheel & roof.