Chapter 39: Vehicle Extrication and Special Rescue

Objectives

• Understand EMS rescue operations, including vehicle extrication and its 10 phases.
• Learn various specialized components of EMS operations: tactical EMS, trench rescue, high angle rescue, and EMT roles.
• Emphasize the safety aspects of these operations.

EMS Rescue Operations

• Role of EMTs: Primarily assist, not lead, in extrications; requires additional training beyond EMT level.
• Safety Priorities:
  • Mental and physical preparation.
  • Prioritize personal and team safety before patient care.
  • Equipment and gear based on expected hazards and scene evaluation.

Vehicle Safety Systems

• Hazards:
  • Shock-absorbing bumpers can release after collision.
  • Non-deployed airbags may inflate spontaneously during care.
  • Maintain clearance around non-deployed airbags.
• Substances: Corn starch or talc from airbags may cause irritation.

Fundamentals of Extrication

• Extrication: Removal from entrapment/dangerous situation.
• Entrapment: Person caught without escape or body part trapped.
• Roles and Responsibilities:
  • EMS Providers: Assess, provide care, triage, and transport.
  • Rescue Team: Secure, stabilize, and extricate.
  • Law Enforcement: Control traffic, maintain order, establish perimeter.
  • Firefighters: Extinguish fire, prevent ignition, ensure vehicle safety.

10 Phases of Extrication

1. Preparation: Pre-incident training and routine equipment checks.
2. Enroute to the Scene: Follow safety precautions similar to ambulance call phase.
3. Arrival and Scene Size-up:
   • Position ambulance to block traffic.
   • Evaluate hazards, number of patients, and perform 360 walk around.
   • Note vehicle damage for potential injuries.
4. Additional Resources: Assess need for extra support like fire, law enforcement, hazmat.
5. Hazard Control:
   • Manage downed electrical lines safely.
   • Handle alternative fuel vehicles cautiously.
   • Avoid high voltage cables and toxic fumes from damaged batteries.
6. Support Operations: Include scene lighting and equipment staging.
7. Gaining Access: Ensure vehicle stability and eliminate hazards.
   • Simple Access: Without tools, minimal effort.
   • Complex Access: Requires specialized tools, training.
8. Emergency Care: Similar to standard care; priority on safety and ABCs.
9. Patient Removal: Coordinate with rescue team for safe extrication path.
10. Termination: Return units to service, check and clean equipment.

Specialized Rescue Situations

• Technical Rescue Situations: Require special skills, equipment.
  • Examples: cave, confined space, water, mountain, and trench rescues.
• Tactical EMS: Involvement in law enforcement operations, ensure scene security before entry.
• Structure Fires: Coordinate with firefighters, ensure proper staging and readiness.

Key Quiz Points

• Protective Equipment: Blood and fluid impermeable gloves for all patient contacts.
• First Phase of Extrication: Preparation, including training and tool checks.
• Safety around Power Lines: Retreat and wait for power to be shut off.
• Simple vs. Complex Access: Complex requires tools, simple does not.
• Patient Assessment: Perform primary assessment once access is gained.

Conclusion

• Proper Technique: Slow, controlled movements for patient removal.
• Confined Space Rescue: Appropriate for grain silo incidents.
• Parking at Trench Collapse: Keep 500 feet distance.

Note: Practice and coordination with specialized teams are crucial for the safe execution of extrication and rescue operations.