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44 Cards in this Set
- Front
- Back
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Extrication -
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The process of removing vehicle from around the patient
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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. |
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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 |
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Average Extrication Time |
Our goal TFD is to keep the average extrication time at 10 to 15 minutes |
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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 |
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Personal Safety |
Full turnouts Eye protection (Shield & Safety glasses) Hand protection (Leather work gloves, EMS) Hearing protection |
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Safety Equipment |
Respiratory protection/ SCBA if fire involved Charged hoseline (Booster – 1 Sufficient lighting ¾”) Sufficient lighting Be alert around traffic |
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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. |
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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 |
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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!!! |
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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. |
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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.
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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. |
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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 |
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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 |
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Initiate sectors |
Rescue/Extrication Hazards – Haz Mat Medical – Triage, Treatment, Transport |
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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 |
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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 |
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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!! |
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Check for Airbags |
Scan vehicle for airbag ID’s Note loaded airbags Inform rescuers of loaded airbags Make airbags safe!! |
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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. |
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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. |
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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. |
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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. |
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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.. |
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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.)
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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)
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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 |
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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.
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Additional Cribbing – |
TRT has a building collapse trailer which carries large amounts of wood that can be used for cribbing.
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When should I use cribbing? |
To stabilize behicles during extrication.
To stabilize behicles during extrication. |
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Initial Patient Access |
First physical contact with patient Usually accomplished through open window or door. Bring necessary EMS equipment |
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Sustained Patient Access |
Accomplished by entering the car after it is stabilized. May involve breaking glass. Allows for more definitive care. |
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Interior Responsibilities |
Roll Down Windows Turn off ignition Pass keys outside Communicate with patient Cover patient with hard and soft protection as needed. |
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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 |
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Glass Management |
Laminated & Tempered All glass must be removed in a controlled manner Center Punch Irons (two FF) Roll down & break Windshield Removal |
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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 |
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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) |
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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. |
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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. |
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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. |
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Create a “U” shaped channel |
Pinch between two cuts with spreaders. Roll metal out to create an open space. |
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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. |
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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. |
