1. Emergency Medical Response You Are the Emergency Medical Responder You are an EMR and a member of a rural volunteer rescue squad. There has been a motor-vehicle crash on a main county road in which the driver apparently lost control of his car on a curve and struck a large tree. There is major damage to the car’s front end. The driver (and sole occupant) most likely impacted the steering wheel with his upper body. He appears to be pinned. Fire rescue personnel are on scene. As you size-up the scene you notice that fluids are leaking from the vehicle and there is a steady flow of traffic on the road; the car is tilted along the shoulder. Lesson 43: Access and Extrication

2. Emergency Medical Response Scenario 1 What potential safety issue should be considered? How might you ability to provide emergency medical care be affected by this situation? –Personal and patient safety at the scene –Traffic control –Vehicle stabilization – Removal of patient from the car & care of patient while being pinned and after removal

3. Emergency Medical Response Extrication  Safe and appropriate removal of a patient trapped in motor vehicle or in a dangerous situation  EMR’s role  Administer necessary care to the patient before extrication (but more commonly simultaneously with the extrication)  Ensure patient is removed in a way that minimizes further injury

4. Emergency Medical Response Basic Extrication Equipment  Crowbars  Screwdrivers  Chisels  Hammers  Pliers  Work gloves/goggles  Wrenches  Shovels  Car jacks  Tire irons  Knives  Ropes or chains

5. Emergency Medical Response Scene Safety: Personal Safety  Protective helmets with chin strap  Eyewear  Turnout gear  Protective gloves  Boots with steel toes and insoles

6. Emergency Medical Response Scene and Traffic Control Protect the scene from further collisions Prevent injury to rescue team Ensure minimal disruption Allow emergency vehicle to reach the scene –Blocking –Cones/flares 10-15 foot intervals safe zone 50 feet

7. Emergency Medical Response Unique Hazards  Alternative-fueled (hybrid) vehicles  Disconnect battery  “live” up to 10 minutes after disabled  Chocking – aware of high voltage cables  Undeployed vehicle safety devices (airbags)  Disconnect wires  Do not cut/drill or heat  Hazardous materials incident  Rule of thumb

8. Emergency Medical Response Unstable Vehicle  On a tilted surface  On top of another vehicle (even partly)  On a slippery surface  Overturned or on its side

9. Emergency Medical Response Activity You arrive at the scene of a motor-vehicle crash in which a car went through a guardrail head-on into a hillside. The car is positioned at a 45- degree angle. The driver is pinned inside the car but is alert and responsive.

10. Emergency Medical Response Vehicle Stabilization  Put the vehicle in “park” or in gear (if a manual transmission)  Set the parking brake  Turn off the vehicle ignition and remove the key  Disconnect the battery or power source  No patients in seats, move seats back, roll down windows  Identify and avoid hazardous vehicle safety components

11. Emergency Medical Response Access  Simple: no equipment  Trying to open each door  Trying to open windows  Having patient unlock doors or open and roll down windows  Complex: use of specialized tools or equipment  Power hydraulic tool (Hurst Jaws of Life®)— most commonly used extrication tool  20,000 – 40,000 psi to spread apart metal  Cutters – 30,000 – 60,000 psi  Ram – push away dash area from passenger

12. Emergency Medical Response Extrication and the Role of the EMR  Safety is the priority  Use clear communication and follow the chain of command  Prevent further patient harm  Provide care:  Stabilize the cervical spine  Complete a primary assessment  Provide critical interventions as necessary

13. Emergency Medical Response You Are the Emergency Medical Responder As you perform the primary assessment, the patient complains of numbness and tingling in his hands. “What type of injury do you suspect the patient may have?” “What other steps would you take to provide care to this patient? ”