Chapter 39: Vehicle Extrication and Special Rescue

Objectives

• Understand EMS rescue operations including vehicle extrication phases.
• Describe specialized EMS operations (e.g., tactical EMS, trench rescue, high angle rescue).
• Discuss safety in rescue operations.

Responsibilities and Safety

• Responsibilities: EMS usually assists, not leads, in rescue; specialized training required.
• Safety: Prioritize personal/team safety before patient care.
• Equipment: Wear appropriate gear based on observed hazards.

Vehicle Safety Systems

• Shock Absorbing Bumpers: Can be hazards if compressed; approach from the side.
• Airbags: Maintain clearance around non-deployed airbags (5-20 inches); contain non-harmful gas.
• Hazards: Cornstarch/talc haze in deployed airbags can irritate eyes/lungs.

Extrication Fundamentals

• Extrication: Removal from entrapment or danger.
• Entrapment: Caught in closed area with no exit.
• EMS Roles: Medical care, patient triage and packaging, transportation.
• Rescue Team Roles: Vehicle stabilization, patient access, extrication.

Phases of Extrication

1. Preparation: Pre-incident training and tool checks.
2. Enroute: Safety precautions during response.
3. Arrival and Scene Size-Up: Block traffic, use PPE, evaluate hazards, patient number.
4. Hazard Control: Avoid moving downed lines; stabilize vehicles; disconnect batteries.
5. Alternative Fuel Vehicles: Handle high-voltage systems carefully.
6. Support Operations: Scene lighting, tool staging, helicopter zones.
7. Gaining Access: Determine access based on terrain/vehicle stability.
8. Rapid Vehicle Extrication: For threatening environments or CPR necessity.
9. Emergency Care: Perform primary assessment; stabilize spine; manage hemorrhage.
10. Patient Removal: Coordinate with rescue team; ensure smooth patient transition.

Specialized Rescue Situations

• Teams' Skills: Cave, confined space, water, mountain, SWAT, etc.
• Technical Rescue: Requires special skills; EMS aids when safe.
• Staging Area: Coordinate with incident commander; set up equipment for treatment.

Trench Rescue

• Hazards: Secondary collapse risks; park vehicles 500 feet away.
• Response: Wait for shoring; prepare to receive patients post-extrication.

Tactical EMS Support

• Safety in Violence: Wait for law enforcement; approach command post discreetly.

Structure Fires

• Coordination: Work with fire departments; use PPE.
• Complications: Be aware of hazardous materials.

Review Questions

1. Protective Equipment: Use fluid impermeable gloves.
2. Phases of Extrication: Start with preparation.
3. Power Line Hazards: Stay back until power is cut.
4. Simple vs. Complex Access: Breaking windows is complex access.
5. Primary Assessment: Perform immediately after gaining patient access.
6. Rescue Team Role: Assess entrapment during patient access.
7. Patient Removal: Execute slow, controlled movements.
8. Rescue Teams: Confined space rescue for grain silo incidents.
9. Search and Rescue: Leave heavy equipment like backboards in the ambulance.
10. Trench Collapse Safety Distance: Park 500 feet away.

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