Vehicle Extrication and Rescue Operations Unit 52 Vehicle Extrication and Rescue Operations

Overview Phases of the rescue Vehicle extrication Water rescue Search and rescue

Introduction Many common hazards and rescue situations are seen in every day Every community should have a for how to respond to these types of emergencies Training and preparation required before EMT attempts rescue

Phases of the Rescue Rescue typically takes place in environment or situation Requires special knowledge and/or equipment to access, , and rescue patient Establishing command: first-arriving emergency services unit should establish scene

Scene Size-Up Perform assessment Request additional resources Ensure everyone is personal protective equipment Perform triage

Confined Space Rescue Confined spaces are hazardous to workers Rescue is dangerous EMT must never enter space without training and equipment Figure 52.2 Entry into a confined space is limited to specially trained rescue personnel

Management Technical rescues: complex operations requiring highly trained rescue technicians using specialized equipment Access: must patient; may require specialized rescuer Residence: elderly “trapped” within home Rescue: immediately perform lifesaving procedures once patient accessed

Treatment Severity of injury dependent The longer patient goes untreated, the greater the degree of injury Assume patient’s injuries more than usual based on amount of time required to access patient Transport: to definitive medical care as soon as possible

Vehicle Extrication Some patients entrapped in vehicle require use of rescue equipment Preparation Preplanning between rescuers can eliminate wasted time and confusion at emergency scene Combined training and preplanning are keys to successful rescue operation and improved patient outcome

Command As first EMT approaches scene, medical command Immediate concern is safety Perimeters Inner circle: area of danger for EMT Outer circle: equipment and personnel

Scene Size-Up Motor vehicle can create hazards EMT should perform “walk around” and check for spilled fluids Keep safe from undeployed airbags Look above and below motor vehicle for contacts with electric power lines or transformers

Hybrid Vehicles Following crash, hybrid car can remain charged with 300 to 500 volts of electricity, posing a to EMTs Battery must be before continuing with rescue operation and extrication of patient

Stabilization Movement of damaged vehicle can cause patient to also be moved, creating injury Car must be stabilized before patient care can Blocks of wood (cribbing) can be used to lift vehicle’s frame off wheels and stabilize vehicle

Access First, try doors Windshield has safety glass Not ideal for access Other windows have glass Shatters to allow access Window punch Glass-breaking tool After access, make sure engine is off

Prioritization Patients in condition needs rapid extrication May require Jaws of Life Heavy rescue: tools used to open door, remove roof, remove , or peel away dash board Patient safety: EMT should stay in vehicle with patient and provide shielding (e.g., wool blanket) from glass and debris

Figure 52.12 The glass from the windshield can be cut away and peeled back to gain access to the patient Figure 52.13 The patient should be protected from flying shards of glass by using a heavy oil tarp or the like

Assessment Following extrication, EMT should complete assessment and rapid secondary assessment Look for signs of internal injury (bruising, point tenderness) and external injuries (burns, lacerations) Transportation: typically to a center as soon as practical

Water Rescue Quick rescue can prevent Establishing command: EMT must work together with other emergency services Scene size-up: determine “flat water” (no current) or “swift water” (current) Management: locate and attempt shore-based rescue, if possible Access: determine where person last seen

Shore-Based Rescue— Flat Water “Reach, throw, row, and go” Offer and pull victim to shore Throw bag (rope coiled inside cloth sack) can be thrown to victim Personal device (PFD) may also be thrown out to victim As last resort, specially trained EMTs can enter water

Shore-Based Rescue— Swift Water Swift water rescue is , resulting in drowning of many rescuers Upstream team: at river crossing Downstream team: strings two or more ropes diagonally across water Two shore-based teams: search shoreline for Rescue attempted with throw bag/pole

Treatment and Transport Even if victim appears drowned, they may recover if aggressive treatment started Hypothermia from submersion in cold water may prolong window for recovery Every effort should be made to near-drowning victim Ambulance may be waiting in staging

Search and Rescue Areas for search and rescue (SAR): woods, mall, building, cities Person must be found (search) and carried out (rescue) The longer person is , the greater the likelihood of injury Search and rescue teams: identify high life hazards and plan rescue operations

Search and Rescue (cont’d.) Establishing command: prepare for long-term post Scene size-up: question witnesses, obtain detailed info about victim Access: direct rescue personnel to staging area and assign teams Hasty search: quick search along trails, roadways, and shorelines to look for clues

Figure 52.16 An EMT in a hasty search should look for clues

Search and Rescue (cont’d.) Rescue: in , patient normally carried out by rescuers Management: medical evaluation usually required Transportation: consider patient’s condition and advantage of airlift versus ground transportation

Conclusion Unique conditions of rescue require EMT to be creative and adjust plan of action to situation Reckless disregard of obvious dangers can change role of EMT from that of rescuer to that of patient EMT should participate only when there is adequate training to proceed safely