Introduction to Extrication

The Patient Handling / Vehicle Extrication Module

EXTRICATION

Defined - The act of removing a wreck from a victim

Vehicle Non-vehicle

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

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

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

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

Stages of Extrication

Scene survey Vehicle Stabilization Gaining access Life-threatening emergencies Disentanglement Preparation for removal Removal

Initial Unit

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

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

Hazards

Airbags• deployed• intact

Loaded Bumpers Downed Power Lines Unstable Vehicle Smokers Fuel Spills

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

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

Can cause injuries and even death Controllers are the ”little black box”

Hazards - Alternative Fuels

LP gas Diesel Fuel Electric Vehicles

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.

Inner circle survey

Check doors Watch for “loaded” bumpers Determine actual count of patients Note type of vehicle stabilization

needed Formulate access plan

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

Gaining Entry

protect self stabilize select route• doors• windows• roof– flap – removal

Disentanglement

Break out all glass Open doors • try handles• cut panel• use power tools

remove door Move seats back Remove roof

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”

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

Dash Roll 1992 Hyundai Excel

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

LOAD & GO CRITERIA

Altered Mental Status Respiratory Compromise Cardiac Arrest Pelvic fractures ( with signs of shock ) Bilateral Femur Fractures Shock or signs of shock

What is a Car ?

Folded metal, glass, and plastic on wheels

Types of Cars

Conventional 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

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

Trucks Vans Buses Trains Airplanes

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

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

Powered Tools (Hi-Tech)

Hurst Tool (Jaws of Life) P-16 Power hawk Life Shear Cutter Band Saw Exothermic Torch Excalibur

SUMMARY