1. Introduction to Emergency Medical Care 1
Advance Preparation
Research related multimedia links for illustration purposes.
Reach out to local rescue teams for assistance in teaching this lesson.
Prepare a vehicle for simulation and scenarios.
Prepare rescue and extrication equipment for scenario purposes.
Prepare personal protective equipment for demonstration.

2. OBJECTIVES
40.1 Describe the risks to EMS providers during highway emergency operations. Slides 12, Given a variety of highway response scenarios, describe how to create as safe a work area as possible. Slides 12–14
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3. OBJECTIVES
40.3 Discuss particular considerations in ensuring safety during night operations. Slide List the ten phases of vehicle extrication and rescue operations. Slides 19–20
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4. OBJECTIVES
40.5 In a rescue situation, recognize and manage hazards by wearing appropriate protective gear, safeguarding your patient, managing traffic, safely dealing with deployed air bags and energy- absorbing bumpers, and managing spectators, and exercising safe practices around electrical hazards. Slides 21, 23–26
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5. OBJECTIVES
40.6 Describe actions taken at a rescue scene by those trained to do so regarding control of vehicle fires, stabilizing a vehicle, and gaining access to patients. Slides 27–33

6. MULTIMEDIA
Slide 34 Information About Rapidly Extricating Patients Video
This video appears later in the presentation; you may want to preview it prior to class to ensure it loads and plays properly. Click on the link above in slideshow view to go directly to the slide.

7. How to recognize and manage hazards at the highway rescue scene
How to position emergency apparatus to create a safe work zone at a highway incident
How to recognize and manage hazards at the highway rescue scene
How to stabilize a vehicle
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8. How to gain access to the patient in a crashed vehicle
How to disentangle a patient from a crashed vehicle

9. Topics Highway Emergency Operations Vehicle Extrication
Planning Your Time: Plan 65 minutes for this chapter.
Highway Emergency Operations (20 minutes)
Vehicle Extrication (45 minutes)
Note: The total teaching time recommended is only a guideline.

10. Highway Emergency Operations
Teaching Time: 20 minutes
Teaching Tips: Use multimedia graphics to illustrate highway scenes. Show providers potential hazards. Use models/toys to present highway scene vehicle placement. Demonstrate personal protective equipment and warning devices. Discuss procedures for using them properly. Use a vehicle to practice exiting and positioning. Discuss best practices.

12. Initial Response
Limited access highways: only primary or first-due units should proceed directly to scene
On-scene units: park single file in same direction to minimize on-scene congestion
Points to Emphasize: Highway response is a significant safety hazard for EMTs. EMS response at a highway scene should be limited to only the manpower and vehicles needed to accomplish the mission.
Talking Points: First-due units should establish command, utilize apparatus for “upstream blocking,” and leave room for rescue trucks as they arrive.
Discussion Topic: Describe the potential scene safety hazards of a highway scene. What threats are present?
Class Activity: Create a mock highway response. Have students use cars to replicate emergency vehicles and demonstrate proper positioning and exit procedures.

13. Position Blocking Apparatus
Create one-and-a-half to two lanes of blockage
Position apparatus at angle; front wheels rotated away from incident
Point to Emphasize: The first-arriving unit at a highway scene should institute “blocking” to protect the work area. Because of its size and weight, fire apparatus is preferred for this purpose.
Talking Points: Apparatus operators should consider scene preservation when parking apparatus and avoid running over debris or crash evidence. Parking at an angle with the front wheels turned allows the blocking vehicle to steer away from the responders should it be struck by another motorist.
Discussion Topics: Describe the safety responsibilities of the first units on scene at a highway response. Describe the process of positioning a “blocking” vehicle. What types of units are best suited for this role?
Knowledge Application: Use multimedia graphics to demonstrate a highway scene. Ask students to discuss initial safety procedures.
Critical Thinking: You are confronted on scene by an angry law enforcement officer, who tells you that your blocking vehicle has created a major traffic issue. He demands that you open the lane to traffic. You are concerned that doing this will create a safety issue for responders. What do you do?

14. Position Other Apparatus
Leave space immediately next to crash for vehicle extrication units
Position ambulances, command vehicles, and other units downstream from crash
Allows safer patient loading and rapid departure from scene

15. Emergency Highway Safety
Exit vehicle into safe zone
Be alert for oncoming traffic
Place flares or cones to slow traffic and channel away from incident lane
Night operation: shut off vehicle’s white response lights and headlights
Points to Emphasize: Responders exiting apparatus always should exit into the safe zone and should check for oncoming traffic before leaving the vehicle. For further support, EMTs should use protective clothing and warning devices at highway scenes.
Talking Points: During night operations, shut off white response lights and headlights so oncoming traffic is not temporarily blinded.
Discussion Topic: Describe the specific safety practices associated with nighttime highway operations. How might these operations be different from the ones used in daytime situations?
Knowledge Applications: Have groups of students use a tabletop and models/toys to demonstrate proper highway procedures. Focus on vehicle placement. Using actual warning devices, demonstrate deployment and best practice safety procedures.

16. Think About It Is it safe to enter the highway scene?
Which units are necessary?
Talking Points: EMTs must determine whether hazards are sufficiently accounted for so as to allow emergency response. EMTs should limit responders on a highway scene but also must recognize the need for specialized services such as rescue.

17. Vehicle Extrication Teaching Time: 45 minutes
Teaching Tips: Use multimedia graphics to help demonstrate scene size-up. Have on hand and demonstrate examples of safety and appropriate personal protective equipment for extrication. Invite an extrication technician to class. Have him discuss the process and tools of extrication. Consider arranging an extrication demonstration. Contact a local fire department and arrange a dual training. Always assure a safe environment and appropriate personal protective equipment.

19. Phases of Extrication Preparing for rescue Sizing up situation
Recognizing and managing hazards
Stabilizing vehicle prior to entering
Gaining access to patient
Point to Emphasize: Vehicle extrication often requires specialized training and resources. EMTs should know their local resources and the procedure for activating those resources.
Talking Points: Preparing for rescue is a combination of training, practice, and the right protective gear. Your size-up upon arrival should evaluate the scene for hazards and assess the need for additional resources. Hazards should be managed, if not eliminated, before any attempt to reach injured persons is started.
Discussion Topic: Discuss the critical elements of a scene size-up as they apply to vehicle extrication.
Class Activity: Use multimedia graphics to present a motor-vehicle collision. Ask the class to perform a scene size-up; discuss priorities of extrication.
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20. Phases of Extrication
Providing primary patient assessment and rapid trauma exam
Disentangling patient
Immobilizing and extricating patient from vehicle
Providing assessment, care, and transport
Terminating rescue
Discussion Topic: Describe the ten phases of the extrication process. Discuss the role of the EMT in each phase.
Knowledge Application: Review images of motor-vehicle collisions. Discuss the need for extrication in each and the method that might be most effective.

21. Protective Gear for EMS Responders
ANSI reflective safety vest
Point to Emphasize: Proper personal protective equipment is essential at a vehicle extrication scene. EMTs also should consider patient protection.
Talking Points: Federal standards require all emergency responders wear ANSI safety vests during highway operations.

22. Think About It
What does scene size-up tell me about the need for extrication?
Talking Points: EMTs must decide what specialized resources they need and what priority they should establish.

23. Protective Gear for EMS Responders
Helmets
Eye protection
Hand protection
Body protection
Discussion Topic: Describe the personal protective gear necessary during vehicle extrication.
Class Activity: Select and don appropriate personal protective equipment for vehicle extrication.

24. Managing Traffic Use flares for traffic control
Talking Points: When utilizing flares, remember to avoid spilled fuel, don’t throw flares at moving vehicles, and position flares at 10-foot intervals. Never use a flare as a traffic wand, as it can spew molten phosphorus, which can cause instant third-degree burns.

25. Supplemental Restraint System: Air Bags
Air bags designed to inflate on impact, dissipate kinetic energy, minimize trauma to body
Creates “smoke” in vehicle—cornstarch and talcum powder (and sometimes sodium hydroxide)
Point to Emphasize: Airbags and energy-absorbing bumpers can pose a safety risk to responders and should be approached carefully.
Talking Points: Disconnecting the vehicle’s power will cause the airbag system to power off in 2–3 minutes, and an undeployed airbag may still fire during this period. Never stand in front of a “loaded” bumper that has been impacted, as it may spring out and strike you.

26. Electrical Hazards High voltage lines common
Assume entire area around exposed wire dangerous—conductors may have touched and energized
Ordinary protective clothing gives no protection against electrocution
Talking Points: A broken utility pole is a dangerous obstruction on an emergency scene. Attempting to access a scene that has wires or a broken pole obstructing it should only be done after a utility representative is on scene and has declared the current dead.

27. Vehicle Fires
Small fires: 15- or 20-pound class A:B:C dry chemical fire extinguisher extinguishes almost anything burning
Fire under hood: do not attempt extinguishment unless hood fully open
Talking Points: A fire under the fully opened hood should be attacked from the “A” post of the vehicle with short bursts of an extinguisher at the base of the fire.
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28. Vehicle Fires
Fire in passenger compartment: apply extinguisher sparingly until occupants can be freed
Fire in trunk: apply same principles as engine compartment fire
Critical Thinking: You and your partner witness a motor-vehicle collision. As you approach, you note that the vehicle is on fire. The patient is awake and yells that the door is jammed. Your partner notes that you probably could just break the window and extricate the patient. You do not have PPE. Discuss your immediate actions.

29. Stabilizing a Vehicle Vehicle on wheels
Turn off engine; step-chock three sides
Talking Points: This information is to help you understand the process and should not be considered formal training in stabilizing a vehicle. If the vehicle is lying on its side or on its roof, attempting to right the vehicle can cause increased and severe injury to trapped occupants. Entering the vehicle puts the responder at risk if the vehicle is not adequately stabilized.
Discussion Topic: Describe the important safety considerations when dealing with the following situations: broken utility pole with wires down, broken utility pole with wires intact, vehicle fires, unstable vehicles.
Knowledge Application: Use a programmed patient and a vehicle to simulate motor-vehicle collision scenarios. Discuss stabilization and simple extrication.

30. Stabilizing a Vehicle Vehicle on side Vehicle on roof
Stabilize with ropes, cribbing, or stabilizer bars
Vehicle on roof
Utilize 4x4 wood blocks to build crib box

31. Gaining Access Simple access Complex access
Check if door or window can be opened
Try before you pry
Complex access
Utilize tools and equipment
Break glass in side or rear window as far from passengers as possible
Point to Emphasize: Gaining access to patients should begin simply and should become more complicated only when simple measures fail.
Talking Points: Nader pins are steel-reinforced pins designed to hold a door shut in the event of a collision, thereby keeping the occupants’ door from flying open. Their incorporation into all car doors has made rescue operations more difficult. Complex access generally requires advanced training in vehicle extrication. Once an entry point is gained, a properly dressed EMT should crawl inside and immediately begin the primary assessment.

32. Disentanglement Gain access by disposing of doors and roof
Makes vehicle interior accessible
Creates large exit-way
Provides fresh air and helps cool heated patient
Talking Points: In most instances, EMTs will not be directly involved in disentanglement other than acting as the patient’s advocate and being the EMT inside the vehicle. However, it is helpful to understand the plan for complex access that may be used by rescue personnel to free the trapped patient.
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33. Disentanglement Disentangle occupants by displacing front end
Easily accomplished with heavy duty jacks and hacksaws
Do not cut steering column or airbag wiring; may cause unexpected firing
Class Activity: Attend an extrication demonstration. Use appropriate PPE and train with a local fire department or extrication squad.
Knowledge Application: Have students work in small groups. Assign each group a particular vehicle extrication hazard (wires down, for example). Ask each group to plan an appropriate approach and extrication strategy.

34. Information About Rapidly Extricating Patients Video
Video Clip
Information About Rapidly Extricating Patients
What equipment is necessary to rapidly extricate a patient from a vehicle?
Discuss the types of tools that may be required in order to extricate a patient from a vehicle.
What types of patients require rapid extrication?
Describe the steps in rapidly extricating a patient from a vehicle.
Discuss scenarios that may pose problems during extrication.
Click here to view a video on the subject of rapidly extricating patients from a vehicle.
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35. Chapter Review

36. Chapter Review Highway operations are a high-risk scene.
Scene size-up is key to determine how many patients.
Protect yourself from traffic, un-deployed airbags, loaded bumpers and sharp metal.
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37. Chapter Review Ensure scene safety.
Try simple means to gain access first.
Protect your patient during the extrication process.

38. Remember
Highway response is a significant safety hazard for EMTs. Specific safety planning and procedures must be utilized to keep responders safe.
Responding units should evaluate need for further units, institute “blocking” to protect work area, and always exit apparatus into safe zone.
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39. Remember Use protective equipment and warning devices.
Vehicle extrication often requires specialized training and resources. Know local resources and procedure for activating those resources.
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40. Remember
Determine extrication resources needed and patient extrication priority through thorough scene size-up.
Extrication can pose a variety of threats. Evaluate the scene carefully and employ safety procedures.
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41. Remember
Gaining access to patients frequently requires mechanical and technological assistance. Always start simply and escalate only when simple measures fail.

42. Questions to Consider What is the best access for my unit?
Where should I park the apparatus?
Does the vehicle need to be stabilized?
Talking Points: The best access may not be with the normal flow of traffic, always consult command. Apparatus should be parked in a way to block and secure the scene. Stabilizing a vehicle should be done if rescuers will be in the vehicle.

43. Critical Thinking
The highway crash you are dispatched to is a seven-car pile-up. Your unit is first on the scene. What steps are required that are different from those for a crash involving one car striking a tree?
Talking Points: When dealing with a multiple-casualty incident, principles of incident command should be initiated as well as the primary role of triage.

44. Please visit Resource Central on www. bradybooks
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