Chapter 39: Vehicle Extrication and Special Rescue

Objectives

• Understand EMS rescue operations, including vehicle extrication and its 10 phases.
• Describe specialized components of EMS operations: tactical EMS, trench rescue, high-angle rescue, and roles of EMTs.
• Focus on safety in these operations.

Introduction

• EMTs typically assist, not lead, in extrication.
• Rescue requires training beyond EMT level.

Safety Considerations

• Mental/physical preparation is crucial.
• Priority: patient care and personal/team safety.
• Gear depends on expected and observed hazards.

Vehicle Safety Systems

1. Shock-Absorbing Bumpers:
   • Can release and injure after collision.
   • Approach from the side.
2. Airbags:
   • Non-harmful gas, quickly deflate.
   • Maintain clearance: 5" (side), 10" (driver), 20" (passenger) for non-deployed airbags.
   • Haze from cornstarch or talc.

Fundamentals of Extrication

• Definition: Removal from entrapment/dangerous situation.
• Entrapment: Caught in closed area with no exit.
• EMT roles: medical care, triage, transport.

Roles and Responsibilities

• EMS Provider: Medical care, triage, transport.
• Rescue Team: Vehicle stabilization, patient access.
• Law Enforcement: Traffic control, scene order.
• Firefighters: Extinguishing fires, vehicle safety.

10 Phases of Extrication

1. Preparation:
   • Pre-incident training.
   • Routine checks on tools/vehicles.
2. Enroute to Scene:
   • Safety precautions like ambulance calls.
3. Arrival and Scene Size-Up:
   • Position ambulance for traffic blockage.
   • Use PPE, evaluate hazards, number of patients.
4. Hazard Control:
   • Downed electrical lines, unstable vehicles.
   • Disconnect battery, avoid high voltage cables.
5. Alternative Fuel Vehicles:
   • Handle electric/hybrid vehicles cautiously.
6. Support Operations:
   • Scene lighting, equipment staging.
7. Gaining Access:
   • Assess vehicle stability, patient access.
8. Rapid Vehicle Extrication:
   • For threatening environments or CPR needs.
9. Emergency Care:
   • Primary assessment, hemorrhage control.
10. Patient Removal:
    • Plan best removal route, coordinate.

Specialized Rescue Situations

• Technical Rescue: Requires special skills/equipment.
• Trench Rescue: Avoid secondary collapses, 500 feet away.
• Tactical EMS (SWAT): Secure area before EMT entry.
• Structure Fires: Standby command, special gear.

Extrication Techniques

• Simple Access: Quick removal without tools.
• Complex Access: Requires special tools.

Post-Extrication

• Transfer of Patient:
  • Smooth, slow, controlled movement.

Conclusion

• Understanding extrication phases and specialized rescue enhances EMT effectiveness and safety during operations.