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44 Cards in this Set

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Extrication -
The process of removing vehicle from around the patient

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.

National Extrication Time

5 min. Call time
8 min. Response time
35 min. Extrication time
15 min. Treatment time
10 min. Transport time
73 min. Total


Average Extrication Time

Our goal TFD is to keep the average extrication time at 10 to 15 minutes

How can we do this?

Training
Knowing our equipment
Understanding new vehicle construction and technology.
A systematic approach to vehicle extrication
Always working as a team

Personal Safety

Full turnouts
Eye protection (Shield & Safety glasses)
Hand protection (Leather work gloves, EMS)
Hearing protection

Safety Equipment

Respiratory protection/ SCBA if fire involved
Charged hoseline (Booster – 1 Sufficient lighting
¾”)
Sufficient lighting
Be alert around traffic

TFD Extrication Response

All TFD Engines and Ladder Tenders carry Amkus units including power plant spreaders, cutters, ram and extension kit.
LT’s also carry Sawzalls (Beware of glass dust)
Squad 19 and Squad 20 also are equipped with Paratech, Rams and Airbags
Heavy Rescue 4 carries wide assortment of Paratech, Rams, Airbags, Sawzall, Porta power, and other valuable equipment.

Know your Equipment!!!

Hooking it up right the first time
Does the power plant have fuel and oil?
The longer the line the slower the tool will run.
Can you operate multiple tools at once?
Limitations of combination tools


TFD Extrication Response

Consider dispatching Heavy Rescue 4 early
Additional paramedic Units
Consider Major Medical Response
1 Battalion Chief
3 Suppression units (Engine or Ladders)
3 Paramedic units
1 EC
Emergency Medical Captain (EC 1,2,3,4)
Consider air transport due to extrication time.
TPD for traffic control!!!

Loaded Bumpers

In 1973 it was put into law that front bumpers on light vehicles were to be able to withstand a 5mph impact. A year later rear bumpers were also included under the law. These type of bumpers can store potential energy after a crash. When a bumper is compressed and becomes tangled 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.

Posts:
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. The 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.

Detent Pin (Hinge)

This is a hardened steel pin that goes through the hinge.
Do not cut this pin with the cutters
To remove door place spreader tips in center of this hinge and open. Pin will fail.

Extrication Action Plan

Parking and scene size-up
Hazards & Circle Surveys
Vehicle stabilization
Initial and sustained patient access
Disentanglement
Patient packaging
Patient transport
Scene termination

Parking and Scene Size-up

Park apparatus in a defensive upstream position. Position your apparatus to block the scene and guide traffic around the incident.
Assess and park appropriate for hazards


Initiate sectors

Rescue/Extrication
Hazards – Haz Mat
Medical – Triage, Treatment, Transport

Hazards & Circle Surveys

Involves someone walking a large circle around the scene in order to:
Locate other patients
Locate other involved cars
Locate additional hazards
Ensure safety of inner circle team

Extrication Hazards (EFLASH)

Fluid Spills (gasoline, battery acid)
Air bags (undeployed)
Loaded bumpers
Hatchbacks
Sharp metal
Electrical
Control hazards immediately
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

Scan vehicle for airbag ID’s
Note loaded airbags
Inform rescuers of loaded airbags
Make airbags safe!!

Air Bag Facts

Rescue workers have been injured from airbag deployments
Since the use of supplemental restraint systems, traffic deaths have been reduced drastically
There have been 2.6 million airbags deployed from late 1980s to Sept 1, 1998
Airbag Effectiveness (frontal crashes)
Car drivers: 31 percent fatality refuction
Car passengers: 27 percent fatality reduction
Light truck drivers: 27 percent fatality reduction.

Airbag Activation

Car is involved in a crash severe enough to activate all sensing units.
Electrical chargeis routed to the gas generator which ignites the fuel.
The fuel creates a tremendous amount of inert gas filling the airbag.
Total elapsed time from contact to deployment of airbag will vary, but should deploy within 0.03 seconds. Side airbags are faster.

Air Bag Facts death counts

Confirmed Airbag Deaths as of 9/1/98
Children in rear-facing child safety is 15
Children not in rear-facing child safety seats:51 (three restrained, but not properly)
Adult drivers: 42 (11 properly restrained)
Adult passengers: 5 (two restrained)
Total 113
Note: Proximity to the airbag 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.

New Airbag Technology

Smart Airbags: Analyze the weight/pressure applied on the passenger seat. Firefighter kneelling on passenger seat for treatment can make smart airbag live.
Knee Airbags.

Airbag Injuries
OOPS
( out of Position Seating) Airbags designed to work in conjunction with the seatbelt and the occupant sitting upright.
Fractures – people who try to brace for a collision can have fracture of arms. California style drivers..

Airbag Injuries
Burns-
the average temperature inside drivers 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.)

Leftover sodium azide residue can
get on skin and cause burning. If patient complains of burning skin, or expecially eyes., flush them with copious amounts of water. (Can wrap steering wheel of a deployed airbag in a garbage bag to contain dust)


Vehicle Stabilization
Why is this important?
Patient safely less cervical damage from rescuers moving behicle during extrication. Safety for rescuers
Stabilize vehicle – remove air from tires. – cribbing

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.

Additional Cribbing –
TRT has a building collapse trailer which carries large amounts of wood that can be used for cribbing.

When should I use cribbing?
To stabilize behicles during extrication.
To stabilize behicles during extrication.

Initial Patient Access

First physical contact with patient
Usually accomplished through open window or door.
Bring necessary EMS equipment
.
Sustained Patient Access

Accomplished by entering the car after it is stabilized.
May involve breaking glass.
Allows for more definitive care.

Interior Responsibilities

Roll Down Windows
Turn off ignition
Pass keys outside
Communicate with patient
Cover patient with hard and soft protection as needed.


Ready to Extricate
5 Disentanglement/Extrication

Patient Access
Glass Management
Purchase Points
Flap roof
Force & remove doors
Relief Cut in Fender
Lower “A” Post cut
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
Unibody structure is weakened.
Roof-Flap – Tie off pic

Total roof or Roof flap

When cutting posts be mindful of live airbag systems
Option: use a pie-cut high on “B” post to sty away from pretensioner cylinders
Remove moldings to visualize (Peel and Peek) (Strip and Rip)

Door Removal

Create purchase point
Locate nader 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 to nader pin, then you can successfully force door.
Proper angle and body position.

Clearing Fender for Hinge Access

If you have a live side airbag you may consider removing door from hinge side first.
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.

Lower “A” Post Cuts

Once door is removed make two cuts at bottom of “A” post.
First cut should below the bottom door hinge at rocker panel level.
Make second cut above the bottom door hinge.

Create a “U” shaped channel

Pinch between two cuts with spreaders.
Roll metal out to create an open space.

SAFETY tool

Do not over reach or over extend yourself while holding the tool.
Use proper lifting techniques when lifting up the tool and power units.
Do not use tool as a battering ram.
When lifting with the tool always stabilize the load with cribbing. Keep all body parts out from under object being lifted.

SAFETY shearing

When cutting, be careful for flying shrapnel
Never cut rear hatch back assemblies.
If removing a roof with a rear hatch assembly, lift hatch first then cut posts leaving the hatch with the roof.