Chapter 40, Highway Safety and Vehicle Extrication. As always, you can find additional information in the textbook, including great illustrations and charts to support this presentation. Let's start off by talking about highway emergency operations.
Our biggest hazard on the highway operations is the traffic. People do not see the emergency responders on the roadway. They're easily distracted. or they're just not paying attention in general so we need to be aware of all these hazards out there traffic being the biggest hazard we're going to deal with the biggest thing we can do to reduce our risk of being hit by oncoming traffic is limit the number of people that are there if you do not need to have extra personnel on a busy highway reduce that number and get them off out of the way and out of harm's way.
So the one thing we can do is use our vehicles as a blocking force. The biggest vehicle on the scene is typically your fire apparatus. They can be placed at an angle across several lanes of traffic to create a safe zone.
But just be aware that they can still get hit and pushed into responders. So we need to be always on the lookout to make sure our traffic patterns are clear and we're safe. When looking at this scene here, we can see there's lots of hazards, including the vehicles, the danger from anything to do with the extrication process.
But being a two-lane road with no sides, your traffic is completely blocked, which creates an impatience hazard with our other drivers. They may want to try to push through. So be aware of your hazards. Always have somebody on the lookout. Try to make sure you're safe there.
When we have limited access highways such as an interstate or a major highway across the state, gives us a little bit more protection, but the hazard we create on our own on these is when we decide to drive against the flow, assuming or hoping that the traffic's been stopped on the other end. If you are asked to drive against the flow of traffic on an interstate, make sure you have confirmation that there is no traffic coming at you. All exits have been blocked off and no traffic is there because that creates another hazard. When parking at the scene, try to keep the impact on the drive lanes minimal. We want to keep the roads open because that's part of our commerce, that's part of our society.
But we also have to remember that we need to provide a safe location for us to work. First arriving unit tries to block off traffic as much as possible and then establish instant command. They will need to let everybody know where instant command is so you can use the command structure.
Typically that's identified by a green flashing light. That's a common tool used in EMS. We will try to block off as much traffic as we can, but just remember we need to have an exit path for our transport units and we need to have the ability to get the rescue units as close as possible to the scene.
Typically a fire department will either have a truck company or a rescue company that comes in. They have heavy, very specialized tools that need to be taken to the scene. So the better access we can provide them, the quicker we can access our patients for transport.
When you're blocking traffic, make sure we try to get at least one to one and a half lanes, maybe up to two lanes. block to give us room to move around and to load our patients and to properly assess and treat and keep our employees safe. We want to have the vehicle parked at an angle with the wheels, the front wheels turned away from the incident so if they are struck from the rear it doesn't roll into the responders it rolls either down into the ditch or away from the unit the responders.
You also want to provide any type of chalking under the wheels so they don't move with their head also. When you're parked in the area, make sure you have plenty of space for entrance and exit. At one time I was on a scene where a highway patrol parked too close to my vehicle.
When I was leaving, I caught his front bumper and caused a little bit of damage, which is not good to do to highway patrol vehicles. But make sure you have plenty of safe space. Before you exit the vehicle, look for a parking spot. both ways. Make sure you're in a safe place before you step out of the vehicle.
Make sure you have good communication with everybody on scene. They know you're there, you know where they are, and then be careful as you're walking out of the vehicle. A new feature they've added to some of the ambulances is the back passenger door. It's a sliding door now like a minivan would be versus the standard door which opens out into traffic. Hopefully that reduces some of our hazards, but we will see when as that one goes through the process.
You need to be able to be seen and make sure you're warning oncoming traffic of what's there. To do this, we need an ANSI approved safety vest. Safety vests come in class two and class three.
Class two is for your regular roadways. In the city, class 3 is for anything 55 miles and over. My recommendation is always go class 3. You can always be better. Do anything you can to make yourself visible. Road flares, traffic cones, lights, anything you can to alert the oncoming traffic that there's a hazard.
We typically shy away from flares because of the... Explosion hazards when you drop them down into leaking gasoline, but use whatever your system allows you to use. Nighttime operations.
You want to shut off your headlights so that you aren't blinding oncoming traffic. Red and blue lights work really good at night time. They can see those. The white lights tend to blind them. So red, amber, headlights off, fog lights off.
Some services are even using traffic directional boards. You can also reach out to your dispatch centers, ask them to change the highway notification signs to alert that there's traffic. Sometimes there's a barricade company that you can reach out to, the local highway department. The Department of Transportation or utility companies typically have barricading processes that they can help you if it's going to be a long-term scene. So use all the resources you have.
Make sure you know all the resources and don't be afraid to ask for help when you need it. For vehicle extrication, our part in EMS is to provide patient care. We need to understand the different phases of the extrication so that we can interact with the fire department or the rescue squad who is doing the extrication or if you're a dual function EMT and part of a fire department or rescue operation you will need to know all this but just remember for testing purposes you are a EMT responsible for patient care. The initial phase of your extrication is always preparing, taking classes, making sure your equipment's up to date, making sure your equipment's in good working order, preparing for the rescue is key.
When you get on the scene, we do a scene size up. That is part of extrication. We are looking to see what we need to do to extricate our patient.
Need to recognize and manage the hazards that we identified in the scene size up. Before you get into the vehicle, you need to stabilize it. We don't want it taking off on you.
And then we need to gain access to the patient so we can actually assess our patient and treat life threats. After we have access to our patient, we do our rapid assessment, our primary assessment, we find their life threats and treat them. Then we start to disentangle our patient, taking them out of the vehicle, removing the vehicle from around them.
immobilize extricate the patient then we provide additional assessment care and transport to the hospital once you're done with all that we do a debrief and go over the call make sure we got everything identified that we wanted to and learn from our our event that we just had and then we can terminate the rescue Like I said, preparing for the rescue, you're taking training, practicing, making sure you have all the right equipment. Make sure you have the right PPE, the right type of helmet, safety glasses, face shields. Practice. Practice on different types of cars.
When there's newer cars coming out, practice on those. Learn the difference between a regular car and electric cars. If you have any specialized rescue operations, make sure you're practicing on those.
There's some great tools called farm rescue where you go out and actually practice doing extrication on farm equipment which is totally different than vehicles. Motor vehicles on the roadway are built to absorb energy. Vehicles on the farm are built to be absorbed punishment so they will stay in one piece a lot longer but that gives us the added difficulty of trying to cut them apart to get to our patients.
Get your good scene size up. Try to figure out how many patients are there, how many resources we're going to need if we need any specialized rescue equipment. Do we need additional ambulances? Do we need to call in any type of air support, helicopters, or do we need maybe even a bus that we can transport non-injured mobile patients on? How bad are our patients entrapped?
Is it something simple like opening the door or do we need to get a rescue team in to cut roofs off and pry doors apart? Is it a bus that's on its side that you have to do a little bit of extra extrication and cutting the roof off? Try to figure out what resources you need and start calling for that help.
Protective gear you're going to want to have. Make sure you have the proper fire resistant. Get gear on if you're going to be in close next to an area that could catch on fire. If you don't get this gear from your service, maybe you want to buy your own. Buy you a jumpsuit that's fire rated.
Buy you bunker gear like the firefighters wear. Use whatever you think is necessary to make sure you are safe. Get you the right helmet.
that you can wear in and out of vehicles if that's where you're going to be. If you're not suited up and you're not dressed appropriately, you don't go in. If you're working in traffic, make sure you have that ANSI vest on that gives you that extra visibility.
It's good, it's safe, and it's the law. It's covered under OSHA. You have to have it on. Wear the appropriate helmet, something that's going to give you good face protection. Back of your head protection, top of your head protection, something that's going to be visible too.
During the extrication process, if you're in assessing your patient, trying to take care of your patient, you're going to be exposed to possibly flames, glass, fluids, sharp objects. Make sure you have the right gear, some coveralls. something to protect you, firefighter gear with helmet eye protection.
As everything we talk about, if everybody else in the party is dressed in costume, you should be dressed in the same type of costume. If you are wearing a vest, a traffic vest, and everybody else is in bunker gears with helmets, you probably shouldn't be there. Make sure you're prepared.
in the same outfit that everybody else is or you're going to feel out of place and possibly be in danger. Almost always need to have some type of head protection, some type of helmet, whether it's a hard hat, whether it's a fire helmet, whether they make special EMS helmets, rescue helmets, something to protect your head. Eye protection should be ANSI certified eye protection. The best thing you can get. They make a eye protection that has foam rubber gaskets around the edges so that if anything flips up, it won't get down in your eye.
It won't go around the eye protection. If you wear glasses, you want to get the eye protection that goes over the top of the glasses to give you that extra protection level. Some type of hand protection, gloves, cut-resistant gloves.
If you're going to be anywhere that's going to have a potential for... lacerations on your own hands, and then your body protection, your jumpsuit, your bunker gear, whatever you think is necessary. So looking at these two gentlemen getting out of their rescue truck, they've got their ANSI vests on, they've got their helmets on, they got their eye protection on, looks like in gloves. They've got their visors protecting their shields on their hats, so they're safe too.
Now just think, if you've got all this protection on, what kind of protection does your patient have? Try to get a blanket, coat, something over that. Patient to give them the protection. Maybe use a backboard, long or short backboard, helmet, eye protection, maybe even hearing protection for your patient.
If you're going to be doing a lot of cutting around the patient, it's going to be loud and you may want to make sure that they have some type of hearing protection on. Maybe a hard hat, safety goggles, dust masks, thermal masks. And then just be aware. It's not the best day this patient's been having.
They may need your support emotionally as they're trying to cut them out of the car. It's not a good day. They're going to be upset. You're going to have to keep them calm while this stuff's going on around them. Managing the traffic is always a hard thing.
It's easy if we can shut down the highway completely, but not always possible. So do what you can to protect the area. use the fire trucks.
I've seen some recent articles about fire trucks being, after they're out of service, being converted to blocking vehicles with the scorpions on the back and the traffic management signs. So you'd have a second fire truck show up, they'd put the sign up with the arrow boards, and then they have the scorpion impact absorbers on the back of them. You can use flares as a warning device.
but just be like i said be aware of don't drop them down in the brush on the side of the road start a wildfire don't drop them in the gasoline and set your cars on fire and definitely do not throw out of moving vehicles that should be an easy one to not do but it's been done enough that we need to say it take the handfuls of flares and walk carefully towards oncoming traffic put the flares out every 10 feet channel the vehicles there are things that are more economical and safer than flares use those if you have an option they're they're lights that just set on the highway think of traffic going both ways try to protect yourself from all different directions and never use a flare as a traffic wand unless you really like third-degree burns on your hand. All right, supplemental restraint systems. They are great for protecting the patient. They disseminate the kinetic energy on impact. If the person is seated correctly, they're belted in, they will be a great protective measure for your patient.
If they're not belted in correctly, they can cause some damage. The trend right now that we're seeing a lot of is people putting their feet on the dash and when the air boil goes off, it shoves the femurs through the back of the pelvis. So be aware of that as a potential mechanism of injury.
The other problem people have is the smoke that comes out of vehicles. It is cornstarch and talcum powder. It is nothing dangerous.
In the 90s, when they first started having airbags, The standard was always have an air pack on when you went up to a vehicle that had an airbag deployed because that was a toxic gas. That has since been proven wrong. We were just overreacting at the time.
But the thing you want to be aware of is if they have airbags and they have not deployed, they are a loaded weapon underneath that steering wheel or in the side of the... The passenger side or in the door panels, they could go off any time because they have been triggered. They just haven't activated yet. So be aware of those.
Do not put yourself in the line of fire and try to get your patient out as soon as possible. The other thing that's a hazard are bumpers. Behind the bumper, if you look, they've got a shock absorber system. This shock absorber will absorb the energy and then hopefully re... re-extend and dissipate the energy that way.
Sometimes they will hold the energy and stay compressed. and then at a random time just release energy all at once shooting the bumper off down the roadway in front of the car imagine if you are standing directly in front of that bumper when it goes off you will not have any kneecaps left or worse so always stand to the side 45 degree angle keep yourself out of the line of fire front bumpers or rear bumpers The other hazard on the scene are the spectators. We want to make sure we're watching for them, keeping them out of our way, and using them to our best advantage if we can, if we need to, but making sure we're making sure they're safe at the same time.
Electrical hazards. High voltage lines above and below the surface. We have wires above which are 7200 volts or higher depending on what the transmission system is. If the wire hits the ground assume it is live.
Whether it's a cable wire or electrical wire we don't know. We don't need to know. We just treat them all as live. So once it hits the ground it sends waves of energy out kind of like the circles in a lake if you drop a pebble in. There'll be energy bands that are going out from the center of contact, so we do not want to step through those bands and create a circuit between one potential energy source and another because that would do some serious damage to our bodies.
Your ordinary clothing including bunker gear is no protection against this electricity. There's very specialized equipment that Your utility workers will be wearing to protect them from this, and it's not anything that EMS providers or firefighters will have. You may have seen on TV shows where they'll take a rope or a pike pole and pull the wire off the vehicle.
That is not realistic. The energy will travel up through those poles and the ropes with no problem. If you see a broken utility pole, You do not know what kind of utility is attached to it. Treat it as electricity.
Form a danger zone around it 50 to 100 feet away and then make sure nobody goes in there. If there are patients in there, tell them to stay put in their vehicles. Their wheels will provide them some protection and keep them off the ground.
So get the poll number, call dispatch, have them get a hold of the utility company. and somebody will be out there as quick as possible to disconnect power or they can do it remotely sometimes so get as much information you can and the utility company will help you out there do not attempt to move the wires and stay away wait for the professionals to get there we don't want a utility lineman doing cpr and we don't they don't want us messing with their electricity So keep out of the danger zones. If the wires are intact and not on the ground, still don't come any closer because there could be a grounding wire that is energized going into the ground close to that pole and we just don't want any EMS responders injured in that situation. The other thing we can run into are the pound mounted transformers. We see these little green boxes sitting on the side of the road every 100 200 feet in the neighborhood these are transformers they have 7200 volts coming up into them it's transformed down to 220 or 110 and then sent into the houses for use inside those compartments are bare copper wires going into the transformer if a vehicle hits it and just moves it off the cat the foundation the case can actually come in contact with the copper and energize the case of itself so stay away don't eat your lunch on them don't play on them and keep the spectators out of the way vehicle fires just remember you are emts you're not firefighters if it's a very very very small fire You can use your dry chemical extinguisher on the ambulance to try to put it out.
Do not open hoods. Do not do anything other than shoot the fire extinguishing agent through the sides of the hood if there's an opening or through the front. And hopefully that puts it out.
If not, wait for the fire department. Make sure it's safe for you to be there, and if you're comfortable doing it, do it. They're showing the fire extinguisher being put in. You notice he's wearing full, almost full PPE. He's not wearing his air pack, which he should be wearing, but he's at least in fire gear.
If it's in the passenger compartment, be cautious. When you put the... chemical agent in there to extinguish the fire it actually pushes the oxygen out that your patient needs to breathe so you gotta gotta make a risk a risk benefit decision here if the v uh fire is under the vehicle spray it on the vehicle sweeping back and forth hopefully catching the liquid that's on fire if it's an electrical vehicle on fire get your patient out and just watch it. It'll be a pretty fire for you. Truck fires, biggest thing you're going to run into are tire fires.
The truck tires do have a habit of catching on fire and exploding. So stay away. Stay away from these fires.
If you've got a small fire, use your ABC extinguisher, but get the people away and let the pros come in with the... the fire trucks and with the big water guns. Be cautious and watch your firefighters about disconnecting all the batteries. Sometimes getting your patient out can be really simple if you can move the seat back.
A lot of newer cars, the seats are tied into electrical systems, so if you don't have a good battery, you can't move your seat to get your patient out easier. So think about what you're doing and why you're doing it. Don't just let them run in there and clip the battery cable right away. It's very beneficial to have the battery cable clipped so that you can reduce the hazards of fire, but it may take away a benefit you'd have.
So have a discussion with your instant command. Make sure everybody knows what's going on. Stabilizing the vehicle, we want to make sure the engine's turned off. and step chalk three sides. I'm going to show you a picture of a step chalk so you understand what we're talking about but somehow we're trying to keep that vehicle from moving.
You can also cut off the valve stems on the tires and that will flatten the tires which creates the same effect so it won't roll away. Here's the step uh step chalks they're just little little uh probably Two by sixes affixed together so you can just slide them in, lift it up, and it slides in until you have good contacts. Give you good support for the car so you can keep it from rocking while you're getting in and out with your patient and keep it from rolling away.
You can also use ropes, cribbing, stabilizer bars. If you ever play Jenga, that's the favorite game of truckies for the fire department. They have all these cribbing blocks and they like to build little boxes underneath them.
of four by fours crib it up until it's nice and secure they also have rams or struts they can use these to kind of stabilize vehicles if they're on their side do not get into the vehicle until they have it stabilized because it can roll with you in there so make sure that everything's safe before you enter a vehicle gaining access very important to make sure we understand how to gain access. The simplest is open the door. It's always good to try all four doors before you start using tools to open the car up. Maybe it's as simple as unlocking the door. Maybe we can pop a window and then unlock the door.
If you do have to break glass, break it as far away from your patient as possible. We don't want to make We don't want to cause any more damage to your patient that's already been done. So just remember, simple access is open the door, try before you pry.
Complex is using the tools, from breaking the window to using your hydraulic extrication tools or saws to try to get in. Disentanglement, three-part process. We're going to gain access.
Get rid of the roof. Get rid of the doors. Make sure we can get in.
Create a large exit so we can get the patient out safely and securely. We're also going to try to get fresh air into the patient. That's going to help them breathe, help them be more comfortable.
Step three is disentangle the patient. Pull everything away from them. Get the steering wheel off their lap. Pull the seat back. Get the roof away.
One thing we've learned is we don't want to cut steering columns because of all the wiring and the airbags. But that's something we have to have our extrication crew. Thank you for taking the time to watch this video.
Hopefully it helps you on your journey to become an EMT. Please like and subscribe. And let me know in the comments how you're doing on your class and if you have any questions. Thanks and have a great day.