You Are the Emergency Medical Responder

1
You Are the Emergency Medical Responder
Lesson 43 Access and Extrication

• 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.

2
Scenario 1

• What potential safety issue should be considered?
• How might you ability to provide emergency
  medical care be affected by this situation?
• Personal and patient safety at the scene
• Traffic control
• Vehicle stabilization
• Removal of patient from the car care of
  patient while being pinned and after removal

3
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

4
Basic Extrication Equipment

• Crowbars
• Screwdrivers
• Chisels
• Hammers
• Pliers
• Work gloves/goggles

• Wrenches
• Shovels
• Car jacks
• Tire irons
• Knives
• Ropes or chains

5
Scene SafetyPersonal Safety

• Protective helmets with chin strap
• Eyewear
• Turnout gear
• Protective gloves
• Boots with steel toes and insoles

6
Scene and Traffic Control

• Protect the scene from further collisions
• Prevent injury to rescue team
• Ensure minimal disruption
• Allow emergency vehicle to reach the scene
• Blocking
• Cones/flares 10-15 foot intervals safe zone 50
  feet

7
Unique Hazards

• Alternative-fueled (hybrid) vehicles
• Disconnect battery
• live up to 10 minutes after disabled
• Chocking aware of high voltage cables
• Undeployed vehicle safety devices (airbags)
• Disconnect wires
• Do not cut/drill or heat
• Hazardous materials incident
• Rule of thumb

8
Unstable Vehicle

• On a tilted surface
• On top of another vehicle (even partly)
• On a slippery surface
• Overturned or on its side

9
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.

10
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
• No patients in seats, move seats back, roll down
  windows
• Identify and avoid hazardous vehicle safety
  components

11
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
• 20,000 40,000 psi to spread apart metal
• Cutters 30,000 60,000 psi
• Ram push away dash area from passenger

12
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

13
You Are the Emergency Medical Responder

• As you perform the primary assessment, the
  patient complains of numbness and tingling in his
  hands.
• What type of injury do you suspect the patient
  may have?
• What other steps would you take to provide care
  to this patient?