Transcript Introduction to Extrication - Hatzalah of Miami-Dade

Introduction to Extrication
The Patient Handling / Vehicle
Extrication Module
EXTRICATION
Defined - The act of removing a wreck
from a victim
 Vehicle
 Non-vehicle
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Terms
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A,B,C, Posts
Safety Glass
Tempered glass
Laminated glass
Uni-body
Crumple Zone
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cribbing
dash roll-up
roof flap
Nader bolt
hand tools
powered hydraulics
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
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The Golden Hour
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
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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
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Stages of Extrication
Scene survey
 Vehicle Stabilization
 Gaining access
 Life-threatening emergencies
 Disentanglement
 Preparation for removal
 Removal
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Initial Unit
Size-up scene
 Set up official incident command
 Direct scene survey
 Establish an action circle
 Begin to gain access
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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
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Hazards
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Airbags
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deployed
intact
Loaded Bumpers
 Downed Power Lines
 Unstable Vehicle
 Smokers
 Fuel Spills
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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
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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
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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”
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Hazards - Alternative Fuels
LP gas
 Diesel Fuel
 Electric Vehicles
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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.
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Inner circle survey
Check doors
 Watch for “loaded” bumpers
 Determine actual count of patients
 Note type of vehicle stabilization
needed
 Formulate access plan
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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
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Gaining Entry
protect self
 stabilize
 select route
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doors
windows
roof
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flap
removal
Disentanglement
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Break out all glass
Open doors
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try handles
cut panel
use power tools
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remove door
Move seats back
Remove roof
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displace pedals
Dash Roll - Up
displace steering
wheel
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”
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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
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Dash Roll 1992 Hyundai Excel
Removal
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Maintain c-spine
control
Look for MOI
Treat injuries
lmmobilize spine
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KED
Long backboard
Other devices
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Move patient, not
device
Evaluate need for
personnel
Choose path of
least resistance
Watch for Hazards
LOAD & GO CRITERIA
Altered Mental Status
 Respiratory Compromise
 Cardiac Arrest
 Pelvic fractures ( with signs of shock )
 Bilateral Femur Fractures
 Shock or signs of shock
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What is a Car ?
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Folded metal, glass, and plastic on wheels
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.
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Types of Cars
Strength of a car is in its shape
Arches , columns , rolls , creases and layers all
add to the strength of a car.
Side door beams make it stronger
A car is strongest end to end
Other Vehicles
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Trucks
Vans
Buses
Trains
Airplanes
Other Vehicles (Buses)
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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
Basic hand tools
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Cribbing
pry axe
Hacksaw
Screw drivers
Linoleum knife
Come-a-long
Center punch
Panel cutter
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Hand jack
Wonder bar
Air chisel
Reciprocating saw
Hand hydraulics
Rope
Duct tape
chain
Powered Tools (Hi-Tech)
Hurst Tool (Jaws of Life)
 P-16 Power hawk
 Life Shear Cutter
 Band Saw
 Exothermic Torch
 Excalibur
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SUMMARY