Ch 38 Extrication

Question 1

During a 360-degree walk around, identify:

Answer 1

–Mechanism of injury
–Trapped or ejected patients
–The number of patients and vehicles involved
–Safety concerns

Question 2

Situational awareness

Answer 2

the ability to recognize possible issues and act proactively to avoid a negative impact.

Question 3

Size-up

Answer 3

is the ongoing process of scene assessment to determine strategies and tactics to manage an emergency

Question 4

While looking at the vehicle, note damage, including:

Answer 4

–Bent steering wheel 
–Imprints in the dashboard
–Unrestrained patient
–Check windshield for a spider-web pattern of shattered glass.
–Document your findings.
–Maintain a high index of suspicion

Question 5

potential hazards during a scene size up include:

Answer 5

–Look for spilled fuel and other flammables
–Electrical short or damaged battery
–Rain, sleet, snow
–Crashes that occur on hills
–Violence

Question 6

Coordination of efforts with rescue teams and law enforcement includes:

Answer 6

–Communicate with the rescue team.
–Communicate with the incident commander as soon as you arrive.
–You may enter the vehicle to provide patient care when approved by the incident commander

Question 7

Hazard control of downed electrical lines (a common hazard at vehicle crash scenes)

Answer 7

–Never attempt to move the patient.
–Instruct the patient to remain in the vehicle until power is shut off.
–Remain in the safe zone, outside of the hot zone.

Question 8

potential hazard and control of a vehicle

Answer 8

–Unstable vehicle (on its side or roof)

–Ensure that the car is in “park” with the parking brake set and the ignition turned off.

Question 9

Alternative fuel vehicles

Answer 9

Powered by electricity and electricity/gasoline hybrids, or fuels such as propane, natural gas, methanol, or hydrogen

Question 10

Support operations include:

Answer 10

–Lighting the scene
–Establishing tool and equipment staging areas
–Marking helicopter landing zones

Fire and rescue personnel will work together on these functions.

Question 11

Considerations when gaining access to a patient

Answer 11

Ensure vehicle is stable and hazards are eliminated or controlled.
Method to gain access depends on situation.
Is patient in a vehicle or other structure?
Is vehicle or structure damaged?
Hazards present?
Vehicle position?
On what type of surface?
Is it apt to roll or tip?

Question 12

Rapid extrication may be needed to remove a patient who

Answer 12

Needs resuscitation

Question 13

Keep the patient safe during extrication with/by

Answer 13

–A heavy, nonflammable blanket can protect from flying glass or other objects.
–Talk to the patient and explain what is happening.

Question 14

Simple access to a patient looks like

Answer 14

–Access the patient without using tools or breaking glass.

–Try all door handles or roll down the windows before using complex access.

Question 15

Complex access to a patient requires

Answer 15

requires special tools:

–Hand, pneumatic, and hydraulic rescue tools

Question 16

Perform a primary assessment and provide care BEFORE further extrication:

Answer 16

–Provide manual stabilization to the spine.
–Open the airway.
–Provide high-flow oxygen.
–Assist or provide for adequate ventilation.
–Control any significant external bleeding.
–Treat all critical injuries.
–Address life-threatening external hemorrhage before airway and breathing.

Question 17

Coordinate with rescue personnel to determine the best removal route by:

Answer 17

–Determining the urgency of extrication.
–Determining the position to best protect the patient
–Determining how you will move the patient.

Question 18

Because you will likely be placed in the vehicle with the patient, be sure to

Answer 18

Wear proper PPE

Question 19

Transfer of the Patient: once the patient is freed

Answer 19

Perform a primary assessment.
–Ensure that the spine is manually stabilized.
Move the patient in a series of controlled steps.

Question 20

Termination involves returning emergency units to service.

Answer 20

–All equipment used on the scene must be checked.
–Check and clean the ambulance, replacing used supplies.
–Complete all necessary reports.

Question 21

Sometimes a patient can only be reached by special teams, such as:

Answer 21

–Cave rescue
–Confined space rescue
–Cross-field and trail rescue
–Dive rescue
–Mine rescue
–Missing person search and rescue
–Mountain-, rock-, and ice-climbing
–Ski/ snow rescue–Structural collapse
–Special weapons and tactics (SWAT)
–Technical rope rescue 
–Trench rescue
–Water and small craft rescue
–White-water rescue

Question 22

When you arrive to a technical rescue situation, you will be directed or led to the staging area to:

Answer 22

–Set up your equipment at the staging area.
–Perform assessment and initiate care as soon as the rescue team brings the patient to you.
–Packaging and carrying the patient back to the ambulance requires a joint effort.

Question 23

Once the missing person is found

Answer 23

you will be guided by search personnel to the location where you can begin treatment.

Question 24

Many cave-ins and trench collapses have poor outcomes for victims because:

Answer 24

–Collapses usually involve large areas of falling dirt.

–Victims cannot fully expand their lungs and may become hypoxic.

Question 25

When there is a Risk of secondary collapse

Answer 25

–Park response vehicles at least 500′ from the scene.
–All vehicles should be turned off.–Road traffic should be diverted from the area.
–Construction equipment may be unstable and could fall into the cave-in or trench.

Question 26

10 Phases of extrication

Answer 26

Preparation
En route to the scene
Arrival and scene size up
Hazard control
Support operations
Gaining access
Emergency care
Removal of the patient
Transfer of the patient
Termination

Question 27

A hazardous material is

Answer 27

Any substance that is toxic, poisonous, radioactive, flammable or explosive that can cause injury or death with exposure

Question 28

Always park _____ and ____ from any hazardous material

Answer 28

Uphill and upwind

Question 29

Extended entrapment of a limb or other body part can lead to

Answer 29

Crush syndrome

Question 30

FAILURE

Answer 30

Reasons for failure best described as:

F - failure to understand the environment or underestimating it
A - additional medical problems not considered
I - inadequate rescue skills
L - lack of teamwork or experience
U - underestimating the logistics of the incident
R - rescue versus recovery mode not considered
E - equipment not mastered

Question 31

When arriving at the scene of a trench collapse or cave in, you should

Answer 31

Park at lease 500 feet from the scene because vibration is the primary cause of secondary collapse

Question 32

At no time should medical or rescue personnel enter a trench deeper than ____ without proper shoring

Answer 32

4ft (1m)

Question 33

In what situation would you not provide spinal immobilization?

Answer 33

In an unsecured area where gunfire is a risk