Chapter 38- Vehicle Extrication and Special Rescue

List the questions you and your team should consider whenever you need to determine the exact location and position of a patient.

1) Is the patient in a vehicle or some other structure? 2) is the vehicle or structure severely damaged? 3) What hazards exist that pose risk to the patient and rescuers? 4) In what position is the vehicle? Om what type of surface? Is the vehicle stable or is it likely to rollover?

List the 10 phases of extrication.

1) Preparation 2) En route to the scene 3) Arrival and scene size-up 4) Hazard control 5) Support operations 6) gaining access 7) Emergency care 8) Removal of the patient 9) Transfer of the patient 10) Termination

List the steps for assessing and caring for a patient who is entrapped once access has been gained.

1) Provide manual stabilization to protect the C-spine as needed 2) Open the airway 3) Provide high-flow Oxygen 4) Assist or provide for adequate ventilation 5) Control any significant external bleeding 6) Treat all critical injuries

At no time should medical personnel enter a trench deeper than _____ _____ without proper shoring in place.

4 feet

When removing an injured patient from a vehicle due to an environmental threat or the need to perform CPR, it is best to use the _____ technique. A) rapid extrication B) KED board C) upright chest compression D) intermediate extrication

A) Rapid extrication

______ is the ability to recognize any possible issues once you arrive on the scene and to act proactively to avoid a negative impact. A) Situational Awareness B) Situational Consciousness C) Situational Alertness D) Situational Disregard

A) Situational Awareness

Simple Access

Access requiring no special tools or force

Complex Access

Access requiring special tools or training

Danger Zone

Area where individuals can be exposed to sharp objects and hazardous materials

Prior to attempting to gain access into a vehicle, the parking break should be on and the _____ should be disconnected. A) radio B) battery C) hydraulics D) brake lines

B) Battery

Controlling traffic at a scene is typically the responsibility of: A) a firefighter B) Law Enforcement C) the rescue group D) EMS Personnel

B) Law Enforcement

During all phases of rescue, your primary concern is: A) Extrication B) Safety C) Patient Care D) Rapid Transport

B) Safety

Which of the following statements regarding tactical emergency medical support is FALSE? A) some incidents pose a risk to EMS B) once you have checked in at the command post, you are free to roam the area looking for ways to help C) lights and sirens should be turned off when nearing the scene D) planning measures and working with the incident commander will reduce the potential for chaos

B) once you have checked in at the command post, you are free to roam the area looking for ways to help

_____ is responsible for properly securing and stabilizing the vehicle and providing a safe entrance and access to the patient. A) law enforcement B) the rescue team C) the EMS Agency D) the HazMat unit

B) the rescue team

When attempting to access a vehicle, you should: A) use complex tools B) try opening doors using the door handles first C) break the windows initially D) make sure that all windows are rolled up

B) try opening the doors using the door handles first

Which of the following is NOT considered a specialized rescue situation? A) Cave rescue B) Dive rescue C) Truck rescue D) Mine rescue

C) Truck rescue

Lighting at a scene, establishing a tool and equipment area, and marking for a helicopter landing all fall under: A) logistic operations B) EMS operations C) support operations D) law enforcement

C) support operations

You should communicate with the members of _____ throughout the extrication process. A) law enforcement B) the media C) the rescue team D) the insurance company

C) the rescue team

_____ among team members and clear leadership are essential to safe, efficient provision of proper emergency care.

Communication

When arriving at the scene of a cave-in or trench collapse, response vehicles should be parked at least _____ away from the scene. A) 50 ft (15 m) B) 150 ft (46 m) C) 250 ft (76 m) D) 500 ft (152 m)

D) 500 ft (152 m)

When you arrive at the scene where there is a potential for hazardous materials exposure: A) Turn off your warning light B) Do not waste time waiting for the scene to be marked and protected C) Park your unit downhill of the scene D) Park your unit uphill of the scene

D) Park your unit uphill of the scene

If there are downed power lines near a vehicle involved in a crash, you should: A) attempt to move the power lines yourself B) touch the power lines with an object to see if there is active electricity C) have the patient slowly exit the vehicle D) have the patient remain in the vehicle

D) have the patient remain in the vehicle

During a 360 degree walk around the scene, you should look for all of the following EXCEPT: A) the mechanism of injury B) leaking fluids or fuels C) trapped or ejected patients D) the amount of air left in the tires

D) the amount of air left in the tires

Explain the individual responsibilities of EMS, firefighters, law enforcement, and rescue teams at a rescue scene.

EMS personnel: responsible for assessing and providing immediate medical care, performing triage and assigning priority to patients, packaging the patient, providing additional assessment and care as needed once the patient has been removed, and providing transport to the emergency department. Firefighters: responsible for extinguishing any fire, preventing additional ignition, ensuring that the scene is safe, and washing down spilled fuel. Law enforcement: responsible for traffic control and direction, maintaining order at the scene investigating the crash or crime scene, and establishing and maintaining a perimeter so that bystanders are kept at a safe distance and out of the way of rescuers. Rescue team: responsible for properly securing and stabilizing the vehicle, providing safe entrance and access to patients, safely extricating any patients, ensuring that patients are properly protected during extrication or other rescue activities, and providing adequate room so that patients can be removed properly.

_____ _____ are responsible for providing immediate assessment and treatment of injured people at rescue scenes.

EMS providers

It is spring, and the water runoff from the melting snow has caused the local viaduct to swell with cold, fast-moving waters. You are off duty when you hear a tone out for "small boy swept away by flood waters." You arrive on scene before your department's on-duty responders. You see a boy approximately 13 years who is clinging to life in the middle of the channel, holding onto a trapped log. His mother is hysterical and screaming for you to "jump in and get him." You have no safety equipment available. How would you best manage this patient?

Entering the water could be a death sentence for you both. If you have a cell phone and/or department radio with you, your best course of action would be to inform incoming units of the boy's location and situation. It would be advisable to direct some responding units downstream so that if the boy should lose his grasp on the log, other responders will be available to retrieve him. If your department has areas that contain the possibility of swift water rescue, training should be conducted and appropriate helmets, throw bags, and life jackets should be made available for safe response. You must assess the scene before trying to effect immediate rescue operations. many responders have been killed by "jumping into" all types of rescues without performing a scene size-up or using the proper gear. Don't become a victim. Doing so will only make you part of the problem.

_____ is the term used when a person is caught within a closed area with no way out or who has a limb or other body part trapped.

Entrapment

The reasons for rescue failure can be summarized by the mnemonic FAILURE. What does FAILURE stand for?

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

A vehicle on its side is typically not a danger to you as long as the vehicle is not swaying.

False

Ambulances are not typically summoned to search and rescue scenes.

False

It is generally uncommon for EMTs to be in the vehicle with a patient during the disentanglement process.

False

Simple access typically involves breaking glass.

False

There are 5 phases of the extrication process.

False

Structure Fire

Fire in a house, apartment building, or other building

Incident Commander

Individual who has overall command of the scene in the field

Technical Rescue Group

Individuals trained to respond to special rescue situations

Command Post

Location of the incident commander

Extrication

Removal from entrapment or a dangerous situation or position

Respirator with independent air supply used by firefighters to enter toxic and otherwise dangerous atmospheres.

SCBA

A specialized law enforcement tactical unit.

SWAT

SCBA

Self -Contained Breathing Apparatus

_____ is the ongoing process of information gathering and scene evaluation to determine measures for managing an emergency.

Size-up

SWAT

Special Weapons and Tactics Team

Access

The ability to reach patients

Hazardous Material

Toxic, poisonous, radioactive, flammable, or explosive

A short in a vehicle's electric system or damaged battery may also cause a post-crash fire.

True

Airbags can be located in the steering wheel, doors, or seats.

True

At a fire scene, you must ensure that your ambulance will not block or hinder other arriving equipment.

True

Following the termination of a rescue incident, all equipment used at the scene must be checked before being reloaded onto the apparatus.

True

Hybrid batteries have a higher voltage than traditional automotive batteries, and it may take up to 10 minutes for a high-voltage system to de-energize after the main battery is turned off.

True

Providing medical care to a patient who is trapped in a vehicle is principally the same as for any other patient.

True

Securing an injured arm to the body is generally considered to be acceptable until the patient is fully extricated.

True

When determining a rescue plan, your input will be essential so that the patient's injuries will be considered during the rescue process.

True

When there are multiple patients, you should locate and rapidly triage each patient to determine who needs urgent care.

True

When you arrive at the site of a technical rescue, you should identify the staging area where the technical rescue team will bring the patient.

True

White-water rescue, structural collapse, and mountain-climbing rescue require specialized rescue teams.

True

You should put on proper protective gear before exiting your vehicle at an emergency scene.

True

You are dispatched to a chemical spill where a train car derailed. The patient is the engineer; he was injured when he went to the back of the train to survey the damage. He is lying beside the tracks. From your vantage point at the staging area, he appears to be breathing. HazMat team members are suiting up to go in and retrieve the patient. They will decontaminate him before bringing him to the staging area. How would you best manage this patient?

Try to learn as much about the chemical as possible by having the dispatcher contact CHEMTREC or another agency to find out about possible effects to the patient. Prepare necessary equipment to manage the airway and ventilation. Be prepared to do CPR, if necessary. Have all equipment within reach. Once the patient is brought to you, rapidly begin to manage the ABC's and prepare for rapid transport.

You and your partner arrive on scene to find an extrication in progress. Your patient is a middle-aged female driver entrapped in a vehicle. One of the rescue team is yelling something about "bleeding" and waving you forward. The driver's side window is down and the woman is screaming in pain. You note bright red blood spurting from her left upper arm. There are no immediate scene hazards to prevent you from approaching. How would you best manage this situation?

Unless there is an immediate threat of fire, explosion, or other danger, once entrance and access to the patient have been provided and the scene is safe, you should perform a primary assessment and provide care before further extrication begins. She is obviously alert and her airway is open. The first concern is to address the arterial bleeding, which is vest managed with a tourniquet in this situation. You should direct your partner to take C-spine control, and you should attempt to calm the patient and assess her mental status as you control the bleeding. Explain to her what you are doing and offer encouragement. Provide oxygen as needed and look for other life threats. Once these have been addressed, the extrication can continue and you should participate in the preparation for patient removal.

_____ is a primary cause of secondary collapse in a trench collapse.

Vibration

Gaining entry to an enclosed area and reaching a patient.

access

You should consider using _____ _____ if the patient will need to be transported an extensive distance.

air transport

No matter what the fuel source of a crashed vehicle is, one common practice remains the same- the need to disconnect the _____.

battery

The incident _____ has the overall command of the incident in the field.

commander

Complicated entry that requires special tools and training and includes breaking windows or using other force.

complex access

An area where individuals can be exposed to hazards, such as sharp metal edges, broken glass, toxic substances, lethal rays, or ignition or explosion of hazardous materials.

danger zone

The rescue team will set up a _____ _____ that is off-limits to bystanders to protect their safety.

danger zone

To be caught (trapped) within a vehicle, room, or container with no way out or to have a limb or other body part trapped.

entrapment

Removal of a patient from entrapment or a dangerous situation or position.

extrication

Extinguishing fires, preventing additional ignition, and removing any spilled fluid us primarily the responsibility of _____.

fire-fighters

During disentanglement, cover the patient with a heavy _____ _____ or place a _____ between the windshield and the patient to protect him or her from breaking glass or other hazards.

fire-resistant blanket, backboard

A team of individuals from one or more departments in a region who are trained and on call for certain types of technical rescue known as a technical rescue _____.

group

Any substances that are toxic, poisonous, radioactive, flammable, or explosive and cause injury or death with exposure are _____ materials.

hazardous

In addition to posing a threat to you and others at the scene, _____ _____ may pose a threat to a much larger area and population.

hazardous Materials

Extrication is often extremely noisy, and appropriate _____ _____ should be worn by you and the patient.

hearing protection

Unless otherwise instructed, only the _____ _____ should communicate any news or progress of a search and rescue to a victim's family.

incident commander

A lack of identifiable _____ at the scene hinders the rescue effort and patient care.

leadership

Once entrance and access to the patient have been provided and the scene is safe, you should perform a _____ _____ and provide care before further extrication begins.

primary assessment

All EMS personnel should wear proper _____ _____ while in the working area.

protective gear

A team of experienced EMTs should be able to perform _____ _____ in 1 minute or less.

rapid extrication

The _____ _____ should provide you with the entrance you need to gain access to the patient.

rescue team

An area of protection providing safety from the danger zone (hot zone).

safe zone

Access that is easily achieved without the use of tools or force.

simple access

A technical rescue _____ requires special technical skills and equipment in one of many specialized rescue areas.

situation

The ongoing process of information gathering and scene evaluation to determine appropriate strategies and tactics to manage an emergency.

size-up

Cave rescue, confined space rescue, and search and rescue are all considered to be _____ _____ situations.

specialized rescue

You should not attempt to gain access into a vehicle until you are sure it has been _____.

stabilized

In most areas, an ambulance is dispatched with the fire department to any _____ _____.

structure fire