Ch 38 Extrication Flashcards
During a 360-degree walk around, identify:
–Mechanism of injury
–Trapped or ejected patients
–The number of patients and vehicles involved
–Safety concerns
Situational awareness
the ability to recognize possible issues and act proactively to avoid a negative impact.
Size-up
is the ongoing process of scene assessment to determine strategies and tactics to manage an emergency
While looking at the vehicle, note damage, including:
–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
potential hazards during a scene size up include:
–Look for spilled fuel and other flammables –Electrical short or damaged battery –Rain, sleet, snow –Crashes that occur on hills –Violence
Coordination of efforts with rescue teams and law enforcement includes:
–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
Hazard control of downed electrical lines (a common hazard at vehicle crash scenes)
–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.
potential hazard and control of a vehicle
–Unstable vehicle (on its side or roof)
–Ensure that the car is in “park” with the parking brake set and the ignition turned off.
Alternative fuel vehicles
Powered by electricity and electricity/gasoline hybrids, or fuels such as propane, natural gas, methanol, or hydrogen
Support operations include:
–Lighting the scene
–Establishing tool and equipment staging areas
–Marking helicopter landing zones
Fire and rescue personnel will work together on these functions.
Considerations when gaining access to a patient
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?
Rapid extrication may be needed to remove a patient who
Needs resuscitation
Keep the patient safe during extrication with/by
–A heavy, nonflammable blanket can protect from flying glass or other objects.
–Talk to the patient and explain what is happening.
Simple access to a patient looks like
–Access the patient without using tools or breaking glass.
–Try all door handles or roll down the windows before using complex access.
Complex access to a patient requires
requires special tools:
–Hand, pneumatic, and hydraulic rescue tools
Perform a primary assessment and provide care BEFORE further extrication:
–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.
Coordinate with rescue personnel to determine the best removal route by:
–Determining the urgency of extrication.
–Determining the position to best protect the patient
–Determining how you will move the patient.
Because you will likely be placed in the vehicle with the patient, be sure to
Wear proper PPE
Transfer of the Patient: once the patient is freed
Perform a primary assessment.
–Ensure that the spine is manually stabilized.
Move the patient in a series of controlled steps.
Termination involves returning emergency units to service.
–All equipment used on the scene must be checked.
–Check and clean the ambulance, replacing used supplies.
–Complete all necessary reports.
Sometimes a patient can only be reached by special teams, such as:
–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
When you arrive to a technical rescue situation, you will be directed or led to the staging area to:
–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.
Once the missing person is found
you will be guided by search personnel to the location where you can begin treatment.
Many cave-ins and trench collapses have poor outcomes for victims because:
–Collapses usually involve large areas of falling dirt.
–Victims cannot fully expand their lungs and may become hypoxic.
When there is a Risk of secondary collapse
–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.
10 Phases of extrication
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
A hazardous material is
Any substance that is toxic, poisonous, radioactive, flammable or explosive that can cause injury or death with exposure
Always park _____ and ____ from any hazardous material
Uphill and upwind
Extended entrapment of a limb or other body part can lead to
Crush syndrome
FAILURE
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
When arriving at the scene of a trench collapse or cave in, you should
Park at lease 500 feet from the scene because vibration is the primary cause of secondary collapse
At no time should medical or rescue personnel enter a trench deeper than ____ without proper shoring
4ft (1m)
In what situation would you not provide spinal immobilization?
In an unsecured area where gunfire is a risk
