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 cars 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 Extrication Safe and appropriate removal of a patient trapped in motor vehicle or in a dangerous situation EMRs 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

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

4. Emergency Medical Response Collisions and Extrications: Minimum Equipment Protective helmets and eyewear Turnout gear Protective gloves Boots with steel toes and insoles

5. Emergency Medical Response Unique Hazards Alternative-fueled (hybrid) vehicles Undeployed vehicle safety devices (airbags) Hazardous materials incident

6. 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

7. 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.

8. 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 Identify and avoid hazardous vehicle safety components Take any additional steps necessary

9. 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

10. 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

11. 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.