Chapter 40: Highway Safety and Vehicle Extrication

Introduction

• Additional information can be found in the textbook; includes illustrations and charts.

Highway Emergency Operations

Main Hazards

• Traffic is the largest hazard.
  • People do not see emergency responders.
  • Drivers can be easily distracted.
  • Reducing risk: Limit the number of personnel on the highway.

Using Vehicles as a Blocking Force

• Fire apparatus: Largest vehicle to create a safety zone.
  • Place at an angle across lanes.
• Always be vigilant for oncoming traffic.

Scene Management on Two-Lane Roads

• Hazards include complete traffic blockage causing impatience among drivers.
• Assign lookout personnel for safety.

Limited Access Highways

• Provides more protection but can create hazards if driving against traffic flow.
• Confirm full traffic stoppage if needed to drive against flow.

Parking at the Scene

• Minimize impact on drive lanes while ensuring a safe workspace.
• First unit arriving blocks traffic and establishes incident command.
• Command is usually marked by a green flashing light.
• Ensure an exit path for transport and access for rescue units.
• Park vehicles at an angle with wheels turned away from the incident.

Safety Tips

• Ensure space for entrance and exit of vehicles.
• Look both ways before exiting vehicles.
• Use communication to ensure safety.
• New ambulance feature: Sliding back door to reduce hazards.

Visibility and Safety Equipment

• Wear ANSI-approved safety vests (Class 2 for regular roads, Class 3 for 55mph or over).
• Use road flares, traffic cones, and lights to alert oncoming traffic.
• Prefer red and blue lights at nighttime; avoid using white lights.
• Utilize traffic directional boards and highway notification signs.

Vehicle Extrication

EMS Role

• Focus on patient care.
• Understand phases of extrication to interact with fire/rescue departments.
• Preparation includes training and maintaining equipment.

Extrication Phases

1. Scene Size-Up: Recognize and manage hazards before stabilizing the vehicle.
2. Stabilize the Vehicle: Ensure it doesn’t move unexpectedly.
3. Gain Access to Patient: Perform a rapid primary assessment.
4. Disentangle Patient: Remove vehicle components from around the patient.
5. Immobilize and Extricate Patient: Transport to hospital.
6. Debrief: Review the call and learn from the experience.

Protection and Equipment

• Use proper PPE: Helmets, safety glasses, face shields.
• Practice on different types of vehicles, including electric and farm equipment.

Scene Size-Up Needs

• Determine number of patients and required resources.
• Protective gear: Fire-resistant clothing, helmets, gloves.
• Care during extrication: Protect the patient with blankets, backboards, etc.
• Emotional support for patients: Keep them calm.

Traffic Management

• Prefer closing highways entirely if possible.
• Fire trucks can be converted to blocking vehicles.
• Use flares with caution: Avoid starting fires.
• Avoid using flares as traffic wands.

Supplemental Restraint Systems

• Protects patients by dissipating kinetic energy.
• Risk of injury if seatbelts are not worn properly.
• Beware of undeployed airbags and compressed bumpers.

Electrical Hazards

• Treat all wires as live and stay clear.
• Electrical energy in downed wires can travel through the ground.
• Maintain a safe distance from broken poles and ground transformers.
• Use specialized utility worker equipment for handling electrical hazards.

Vehicle Fires

• EMTS are not firefighters; only manage very small fires.
• Use dry chemical extinguishers; avoid opening hoods manually.
• Electric vehicle fires: Evacuate and watch from a distance.
• Truck tire fires: Risk of explosion; maintain distance.
• For fires under vehicles: Sweep extinguisher side to side.

Stabilizing Vehicles

• Turn off engine, use step chocks, cut valve stems to flatten tires.
• Cribbing blocks or stabilizer bars can be used.
• Ensure vehicle stabilization before entering.

Gaining Access and Disentanglement

• Always try to open the door first; use tools if necessary.
• To minimize further harm, break glass away from the patient.
• Expand exits to facilitate patient removal.
• Avoid cutting steering columns because of airbag risks.

Conclusion & Debrief

• Ensure proper equipment and preparation.
• Follow safety protocols and support the patient emotionally.
• Review and learn from each extrication event.

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Hopefully, these notes will aid in your journey to become an EMT. For any questions or additional information, refer to the textbook or ask your instructor.