Overview
This lecture covers chapter 39: Vehicle Extrication and Special Rescues, focusing on EMS roles, safety, phases of extrication, and types of rescue scenarios.
EMS Roles and Priorities in Extrication
- EMTs' main priority is patient care during vehicle extrication while ensuring personal and team safety.
- Most extrications are handled by fire departments or specialized rescue teams with advanced training and equipment.
- EMTs may assist in extrication but must not attempt complex rescues without proper training.
Vehicle and Scene Safety
- Always use appropriate personal protective equipment (PPE), such as gloves, eye protection, and masks.
- Approach vehicles from the side to avoid hazards like shock-absorbing bumpers and undeployed airbags.
- Be aware of risks from hybrid/electric vehicle batteries, which may require special handling and may emit toxic fumes.
- Secure and stabilize vehicles before attempting patient access, especially if the vehicle is on its side or roof.
Phases and Procedures of Extrication
- The phases of extrication are: preparation, en route, arrival, scene size-up, hazard control, support operations, gaining access, emergency care, patient removal, transport, and termination.
- Ongoing scene size-up and hazard identification (e.g., power lines, leaking fluids, fire, unstable vehicles) are critical.
- The rescue team stabilizes the vehicle and creates access; EMTs focus on patient triage, assessment, and emergency care.
Patient Care During Extrication
- Provide care such as spine stabilization, airway management, oxygen administration, and bleeding control during extrication.
- Communicate with and reassure the patient throughout the process.
- Use heavy blankets or backboards to shield patients during cutting or breaking operations.
- Move patients smoothly and as a unit, minimizing spinal manipulation unless immediate removal is required.
Special Rescue Scenarios
- Special rescues include situations like cave-ins, trench collapse, water rescue, building collapse, and SWAT operations.
- Only trained personnel should perform technical rescues; EMTs should not enter hazardous areas without training.
- Coordinate with incident commanders and be prepared to provide psychological support to patients and families.
Review Questions & Key Takeaways
- First phase of extrication is preparation.
- Do not approach vehicles with downed power lines until they are de-energized.
- Breaking a window for access is complex access.
- Always perform primary assessment and emergency care before extrication when possible.
- The rescue team should determine the safest extrication method while EMTs assess the patient.
- Move critically injured patients smoothly and as a unit.
- Confined space rescue teams handle grain silo entrapments.
- Leave unnecessary equipment, like the backboard, in the ambulance during long searches.
- Park 500 feet away from trench collapses to avoid causing further collapse.
Key Terms & Definitions
- Extrication — Removal of a person from entrapment or a dangerous situation.
- Entrapment — Condition where a person cannot exit a closed space or has a limb/body part trapped.
- Complex Access — Entry requiring tools or breaking parts of a structure/vehicle.
- Simple Access — Gaining entry without the use of tools (e.g., opening a door).
- Incident Commander — Person responsible for overall scene management and coordination.
Action Items / Next Steps
- Review chapter 39 in the textbook.
- Ensure understanding of extrication phases and EMS roles.
- Prepare for questions on scene safety, extrication phases, and technical rescue scenarios.