[Music] chapter 40 Highway Safety and vehicle extra 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 that 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 be aware of all these hazards out there uh 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 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 the vehicle the danger from uh anything to do with the extrication process but being a two-lane road with no sides your traffic is completely blocked which creates a a 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 uh try to make make sure you're safe there when we have limited access highways such as a 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's no traffic coming at you uh 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 uh 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 ident ified by a green flashing light that's a common common uh tool used in EMS we will try to uh block off as much traffic as we can but just remember we need to have an exit path for our transport units and we have 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 blocked to give us room to move around and to load our patients and properly assess and treat and uh 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 it 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 uh the responders you also want to provide any type of chalking under the wheels so that they don't move when they're hit also when you're uh parked in the area make sure sure you have plenty of space for entrance and exit at one time I I was on a scene where a high 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 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 on 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 an approved safety vest safety vest come in class two and class three class two is for your regular roadways in the city class three is for anything 55 mil and over my recommendation is always go class three you can always be better do anything you can to make yourself visible road flares traffic cones lights anything you can to alert the the oncoming traffic 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 green or red and blue lights work really good at light uh nighttime they can see those the white lights tend to Blind them so uh red Amber headlights off fog lights off some services are even using traffic directional boards you can also reach out to 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 uh Highway Department dep uh 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 be 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 just remember for testing purposes you are a EMT responsible for patient care the initial phase of your exucation is always preparing taking classes making sure your equipment's up to dat 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 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 card when there's newer cars coming out practice on those learn how 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 uh 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 absorb punishment so they will stay in one piece a lot longer but that gives us the added uh difficulty of trying to cut them apart hard 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 uh helicopters or do we need maybe even a bus that we can transport non-injured mobile patients on how bad are our patients ENT trapped 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 exucation 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 resistance 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 need 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 ansy vest on that gives you that extra uh visibility it's good it's safe and it's the law it's covered under the oosha you have to have it on where the appropriate helmet something that's going to give you good face protection back of your head protection head top of your head protection something that's going to uh 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 f uh coveralls something to protect you firefighter gear with helmet eye protection as everything we talk about if the 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 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 a fire helmet whether they they make special EMS helmets rescue helmets something to protect your head eye protection should be ANC certified eye protection the best thing you can get that they make a eye protection that has foam rubber gaskets around the edges so that anything flips up if 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 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 ansy vests on they've got their helmets on they got their eye protection on looks like and gloves they've got their uh visors protecting their shields on their hats so they're they're safe too now just think if you got all this protection on what kind of protection does your patient have try to get a blanket coat something over that uh patient to give them the protection maybe use a backboard long sport 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 mask and then just be aware it's not the best day this patients'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 all 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 air use the fire trucks I've seen some recent articles about fire trucks uh being after they're out of service being converted to blocking vehicles with the Scorpions on the back and the uh traffic management signs so you'd have a second firet truck show up they put the sign up with the arrow boards and then they have the Scorpion uh 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 uh don't drop them in the gasoline and set your cars on fire and definitely do not throw out a 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 ft feet channnel the vehicles there are things that are more economical and safer than uh 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 a flare as a light a traffic wand um 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 their uh 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 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 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 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 uh 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 uh uh the passenger side or in the door panels they they could go off any time because they have been triggered they just haven't you 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° angle keep yourself out of the line of fire front bumpers or rear bumpers another Hazard on the scene are the spectators we want to make sure we're watching for them keeping them out of our way and uh using them to our best Advantage if we can if we need to but making sure we're we're make 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 or higher depending on what the transmission system is if the wire hits the ground assuming is Al whether we don't 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 uh the circles in a lake if you drop a pebble in there'll be energy bands that going out from the center of contact so we do not want to step through those bands and create a circuit between one uh potential energy source and another because that would uh 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 they will the energy will travel up through those poles and the 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 ft 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 pole uh 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 as 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 the wire 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 in injured in that situation the other thing we can run into are the P mounted Transformers we see these y little uh green boxes sitting on the side of the road every 100 200 ft in the neighborhood these are Transformers uh they have 7200 volts coming up into them it's transformed down to 2 220 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 C uh the foundation the case can actually come in contact with the copper and energize the case of it 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 side of the uh 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 so there's 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 uh 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 got to got to make a a risk a risk benefit decision here if the ve uh fire is under the vehicle spray it under the vehicle so we mov 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 uh 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 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 uh 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 Al it's very beneficial to have the battery cable clipped so that you can relu the 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 sure um 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 chocks they're just just little little uh probably 2x sixes a fix together so you can just slide them in lift it up and it slides in until you will 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 trucky for the fire department they have all these cribbing blocks and they like to build little boxes underneath them of 4x4s 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 uh if you do have to break glass break it as far away from your patient is possible we don't want to make we don't want to cause any more damage to your patient than 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 uh hydraulic extrication tools or saws to try to get in disentanglement three parts process we're going to gain access get rid of the roof get rid of the doors make 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 uh be more comfortable step three is disentangle the payment patient pull everything away from them get the whe 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 uh airbags but that's something we we have to be uh 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 [Music]