Auto Extrication Flashcards
What is extrication?
Extrication—The process of removing vehicle form around the patient
What is the golden hour?
This concept is based on the statistics that show that a seriously traumatized patient has about 60 minutes from the time of the accident to be delivered to a surgical team at the hospital
What is the national average extrication time and what is our goal for extrication time?
a. National Average Time—73 minutes
b. Our Goal (TFD) is to keep the average extrication time at 10 to 15 minutes
How can we achieve our goal extrication time?
a. Training
b. Knowing our equipment
c. Understanding new vehicle construction and technology
d. A systematic approach to vehicle extrication
e. Always working as a team
Personal safety for auto extrication
a. Full turnouts
b. Eye protection (Shield & Safety glasses)
c. Hand protection (Leather work gloves, EMS)
d. Hearing protection
Safety equipment needed for auto extrication
a. Respiratory protection / SCBA if fire involved
b. Charged hoseline (Booster -1 ¾”)
c. Sufficient lighting
d. Be alert around traffic
Who brings what tools to an extrication response?
a. All TFD Engines and Ladder Tenders carry AMKUS units including power plant, spreaders, cutters, ram and extension kit.
b. LT’s also carry Sawzalls (Beware of glass dust)
d. Heavy Rescue 4 carries wide assortment of Paratech, Rams, Airbags, Sawzall, Porta Power, and other valuable equipment
What do you need to know about your extrication equipment?
a. Hooking it up right the first time
b. Does the power plant have fuel and oil?
c. The longer the line the slower the tool will run
d. Can you operate multiple tools at once?
e. Limitations of combination tools
Who do you call for TFD extrication response?
a. Consider dispatching Heavy Rescue 4 early
b. Additional Paramedic Units
c. Consider “Major Medical Response”
i. 1 Batt. Chief
ii. 3 Suppression Units ( Engines or Ladders)
iii. 3 Paramedic Units
iv. 1 EC
d. Emergency Medical Captain (EC 1, 2, 3, 4)
e. Consider air transport due to extrication time
f. TPD for traffic control!!
Units in a medical alarm (“Major medical response”)
i. 1 Batt. Chief
ii. 3 Suppression Units ( Engines or Ladders)
iii. 3 Paramedic Units
iv. 1 EC
What are loaded bumpers?
a. In 1973 it was put into law that front bumpers on light vehicles were to be able to withstand a 5 mph impact. A year later rear bumpers were also included under the law. These types of bumpers can store potential energy after a crash. When a bumper is compressed and becomes entangled in metal, the folded metal can be accidentally moved during extrication allowing the bumper to spring out and possibly injuring rescuers. So be aware of loaded bumpers.
What are posts on a car?
a. Are rolled sheet metal and are hollow. Since most posts are reinforced at each end and have a hollow center, it is clear that the center of the post is the weakest point. This fact is especially important to remember when cutting a post with hand tools. Exceptions to this rule are the “B” posts which have reinforcing plates for seatbelts and the rear posts of most sedans.
Should I look at the diagrams in the PP?
HECK YES!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
What’s a detent pin?
a. This is a hardened steel pin that goes through the hinge
b. Do not cut this pin with the cutters
c. To remove door place spreader tips in center of this hinge and open. Pin will fail
Extrication action plan (8 steps)
a. Parking and scene size-up
b. Hazards & Circle surveys
c. Vehicle stabilization
d. Initial and sustained patient access
e. Disentanglement
f. Patient packaging
g. Patient transport
h. Scene termination
Parking and size up
i. Park apparatus in a defensive upstream position. Position your apparatus to block the scene and guide traffic around the incident
ii. Assess and park appropriate for hazards
iii. Size-up and Command
1. Who takes command?
2. Can a paramedic unit, who is first on scene take command?
iv. Initiate Sectors
1. Rescue/Extrication
2. Hazards-HazMat
3. Medical-Triage, Treatment, Transport
Hazard and Circle surveys
i. Involves someone walking a large circle around the scene in order to:
1. Locate other patients
2. Locate other involved cars
3. Locate additional hazards
4. Ensure safety of inner circle team
Extrication hazards
- Control hazards immediately
a. Fluid spills (Gasoline, Battery Acid)
b. Airbags (Un-deployed)
c. Loaded Bumpers
d. Hatchbacks
e. Sharp metal
f. Electrical - Unstable Vehicles
- Establish action circles. Do you need to be there?
- Establish tool staging
Inner circle survey
- Close-up look at crash
- Initial patient contact
- Identify patient condition
- Identify degree of entrapment
- Do not touch car until safe
- Initial scan for live airbags!!!
- Check For Airbags
a. Scan vehicle for airbag ID’s
b. Note loaded airbags
c. Inform rescuers of loaded airbags
d. Make airbags safe!!
Airbag facts
a. Rescue workers have been injured from airbag deployments
b. Since the use of supplemental restraint systems, traffic deaths have been reduced drastically
i. There have been 2.6 million airbags deployed from the late 1980’s to Sept. 1, 1998
c. Airbag effectiveness (frontal crashes)
i. Car drivers: 31 percent fatality reduction
ii. Car passengers: 27 percent fatality reduction
iii. Light truck drivers: 27 percent fatality reduction
d. Confirmed Airbag Deaths (as of 9/1/98)
i. Children in rear-facing child safety: 15
ii. Children not in rear-facing: 51 (Three restrained, but not properly)
iii. Adult drivers : 42 ( 11 properly restrained)
iv. Adult passengers: 5 ( 2 restrained)
v. Total: 113
e. Note: Proximity to the air bag has been the leading factor in nearly every death. The greatest issue involving deaths related to airbag deployment was improper use of seatbelts and infants riding in the front passenger seat.
Airbag activation
a. Car is involved in a crash severe enough to activate the sensing units
b. Electrical charge is routed to the gas generator which ignites the fuel
c. The fuel creates a tremendous amount of inert gas filling the airbag
d. Total elapsed time from contact to deployment of airbag will vary, but should deploy within 0.03 seconds. Side airbags are faster
What are some new airbag technologies?
a. SMART Airbags:
i. Analyze the weight/pressure applied on the passenger seat. Firefighter kneeling on passenger seat for treatment can make smart airbag live
b. Knee Airbags
Whadiyaknow ‘bout side airbags?
a. Located in seats or doors at arm rest level
b. Side impact curtain
i. Will inflate the entire length of the roof rail and extend downward to protect occupants
c. Head protection system (HPS)
i. Sausage type airbags are deployed in a similar fashion as impact curtains
d. Strike Zone
i. 5 “ from head side
ii. 10” from steering wheel
iii. 20” from dashboard
What are some typical airbag injuries?
a. OOPS! (Out of Position Seating) Airbags designed to work in conjunction with the seatbelt and the occupant sitting upright
b. Fractures— People who try to brace for a collision can have fracture of arms. California style drivers
c. Burns—The average temperature inside driver’s side airbags is 1200 degrees. Larger passenger bags can get up to 2400 degrees. (If the vents are not in the 12 o’clock position when the air bag deploys, the patient can get burned)
d. Leftover sodium azide residue can get on skin and cause burning skin, or especially eyes, flush them with copious amounts of water. (Can wrap steering wheel of a deployed airbag in a garbage bag to contain dust)
Why is vehicle stabilization during auto extrication important?
- Patient safety, less cervical damage from rescuers moving vehicle during extrication
- Safety for rescuers
Stabilizing vehicles
- Remove air from tires
- Cribbing
a. Cribbing generally refers to the specially cut and/or assembled pieces of wood used to support raised objects, as ground pads or bases to place tools that are working, and as blocks over which chains and cables pass while moving objects
b. What TFD units carry cribbing?
i. All Engines and LT’s have cribbing kits
c. What does the new kit contain?
i. 4—2”x4”x24”
ii. 2—Step Chocks
iii. 8—4”x4”x24”
d. TRT has a building collapse trailer which carries large amounts of wood that can be used for cribbing
Initial patient access
i. First physical contact with patient
ii. Usually accomplished through an open door or window
iii. Bring necessary EMS equipment
Sustained patient access
i. Accomplished by entering the car after it is stabilized
ii. May involve breaking glass
iii. Allows for more definitive care
What are your responsibilities if you are interior with the patient during auto extrication?
- Roll down windows
- Turn off ignition
- Pass keys outside
- Communicate with patient
- Cover patient with hard and soft protection as needed
What are some of the steps in disentanglement/extrication?
i. Patient Access
ii. Glass Management
iii. Purchase Points
iv. Flap Roof
v. Force & Remove doors
vi. Relief Cut in Fender
vii. Lower “A” Post Cut
viii. Dash Lift/Push
Glass management
- Laminated & Tempered
- All glass must be removed in a controlled manner
- Center punch
- Irons (Two FF)
- Roll down & Break
- Windshield Removal
Roof flap
- Why should roof flap be done early?
- Quick and easy
- Allows for easier medical treatment
- Conscious patient feels less trapped and as though progress is being made
- Uni-body structure is weakened
- Total Roof or Roof Flap?
a. When cutting posts be mindful of live airbag systems
b. Option: Use as pie-cut high on “B” post to stay away from pre-tensioner cylinders
c. Remove moldings to visualize (Peel and Peek) (Strip and Roll)
Door removal
- Create purchase point
- Locate nadder pin
- To force door without tearing a lot of metal start at top of door seam near the window and work down until spreader tips rest on top of nadder pin, then you can successfully force door
- Proper angle and body position
Front fender crush
- This gives a place for the dash to go, for a dash roll
- Creates a gap between the front fender and door so the fender can be rolled ahead to expose the hinge post
- Acts as a hinge during dash push
Lower A posts cuts
- Once door is removed make two cuts at bottom of “A” post
- First cut should be below the bottom door hinge at rocker panel level
- Make second cut above the bottom door hinge
- Create a “U” shaped channel
a. Punch between two cuts with spreaders
b. Roll metal out to create an open space
Dash lift/push
- With spreaders at a 90 + degree angle to the car place closed tips in space created and push dash upward off of patient
- Spreaders can remain in place during patient removal
- Dash Push/Roll with a RAM
a. When using RAM make one cut in center of “A” post
b. Place square end of ram at bottom of “B” post for leverage. Depending on size of ram you may not have enough reach
c. Spreaders as improvised leverage point
d. Push from leverage point to upper “A” post
e. Relief cut should tear when pushing
f. Ram Procedure may make patient removal more difficult - Do Not!
a. Never cut ROCKER CHANNEL!!
b. This causes the car to lose strength
Safety during auto extrication
a. Do not over reach or over extend yourself while holding the tool
b. Use proper lifting techniques when lifting up the tool and power units
c. Do not use tool as a battering ram
d. When lifting with tool always stabilize the load with cribbing. Keep all body parts out from under object being lifted
e. When cutting, be careful for flying shrapnel
f. Never cut rear hatch back assemblies
g. If removing a roof with a rear hatch assembly, lift hatch first then cut posts leaving the hatch with the roof
Summary of auto extrication
a. Remember 8 steps to the Incident Action Plan—Following plan is key to success
b. Know your tool storage, set up, capabilities, and options (Drill Frequently)
c. Always have a plan A,B and C if needed
d. Start TRT/RRT early
e. Beware of new vehicle technology
f. BE SAFE!!
