EMT Chapter 38 Vehicle Extrication and Special Rescue
Define hazardous material.
A hazardous material is any substance that is toxic, poisonous, radioactive, flammable, or explosive and can cause injury or death with exposure.
_____ is defined as the ability to reach the patient.
Access
Your unit has been dispatched to stand by at the scene of a structure fire. There are no injuries of which you are aware. Upon arriving at the scene, you should:
Ask the incident commander where the ambulance should be staged
While the EMT is in a vehicle assessing the patient, the rescue team should be: assessing exactly how the patient is trapped and determining the safest way to extricate. awaiting further instructions from the EMT regarding how to proceed with the extrication. actively extricating the patient using whichever rescue method is deemed necessary by the rescue leader. preparing for a simple extrication process, as the EMT has obviously gained access to the patient.
Assessing exactly how the patient is trapped and determining the safest way to extricate
You respond to a wooded area to help search for a child who has been missing for approximately 24 hours. Which of the following equipment should you leave in the ambulance? Radio Flashlight Jump kit Backboard
Backboard When participating in a search and rescue effort, large equipment that is not easily carried (i.e. backboard, wheeled stretcher) should be left in the ambulance
Rescuers have brought you a patient rescued from a structural collapse. You should immediately _________.
Begin a rapid assessment
Proper protective equipment will vary depending on the hazards encountered. Which piece of equipment should be utilized during all patient contacts?
Blood and fluid-impermeable gloves
A two-door passenger car struck a tree while driving approximately 50 mph. The doors are badly damaged and jammed, and the driver appears to be unconscious inside the vehicle. Entering the vehicle by breaking the back window is an example of:
Complex access Complex access requires the use of special tools and special training and includes breaking windows or other forcible entry. Simple access does not involve the use of any tools.
A man has been sucked inside the bin of a grain silo and is trapped. Which of the following rescue teams is the MOST appropriate to request? Trench rescue High-angle rescue Local fire department Confined space rescue
Confined space rescue
Tactical EMS providers are specially trained to function during _________.
Dangerous law enforcement operations
What should be done for any type of alternative-fuel vehicle that is involved in an accident?
Disconnect the battery
To evaluate the scene for hazards and identify the number of patients, the EMT should first _________.
Do a 360-degree walk-around
How should you initially attempt to gain access to a crash victim?
Do not attempt to enter the scene until you are sure that it is stable and that any hazards have been identified and properly controlled or eliminated. The incident commander will inform you when it is safe to enter. Whenever possible, you should use simple access techniques to get to the patient If the patient's condition requires immediate care and you cannot access the passenger compartment, attempt to provide basic care as the extrication is being performed. If you must break a window to gain access, try to break one that is farthest away from the patient. If the patient's condition warrants immediate entry (i.e. airway compromise, bleeding), however, do not hesitate to break the closest window. If you cannot gain access to the patient by opening a door or breaking a window, pneumatic and/or hydraulic rescue tools will be necessary to gain access to the patient.
Which of the following is the BEST example of gaining simple access to a patient? Using a pry bar to open a damaged door Entering the vehicle through an open window Breaking glass to gain access to the patient Removing the roof to access a critical patient
Entering a vehicle through an open window
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
What information is obtained from a 360-degree assessment of a plane crash?
Focuses on hazards unique to this type of incident Common safety hazards include downed power lines, leaking fuels or other fluids, smoke or fire, broken glass, and aircraft instability Other information includes mechanism of injury, the position of the patient(s) in the aircraft, and whether the patient(s) are entrapped or have been ejected
While providing care for an entrapped occupant in the van, you note the unstable power pole start to sway. What should you do?
Immediately cease care and leave the scene
A hiker was injured when he fell approximately 20 feet from a cliff. When you arrive at the scene, a member of the technical rescue group escorts you to the patient, who is positioned on a steep incline. The MOST appropriate method of immobilizing and moving the patient to the ambulance is to:
Immobilize his spine with a long backboard and place him in a basket stretcher
Who has overall command of an emergency incident?
Incident commander
In contrast to simple access, complex access:
Involves forcible entry into a vehicle
How does the rapid extrication technique differ from other methods of patient removal? When is it indicated?
It is fast and requires minimal preparation of the patient in the vehicle before he or she is being removed. Can be performed in one minute or less. Use when patient is critically injured and needs immediate treatment and transport.
Is it appropriate to obtain vital signs of a patient who is entrapped?
It is not always appropriate or practical to obtain a complete set of vital signs while a patient is entrapped. Your primary focus should be providing lifesaving care and then have the patient extricated as quickly and safely as possible. In some cases, there may be a delay in extricating the patient. If this is the case, obtain a baseline set of vital signs; doing so will provide you with information about the patient's condition. However, make sure that you have identified and corrected all immediate life threats FIRST. Do not delay extrication to assess the patient's vital signs. The longer the patient remains in the vehicle, the longer the delay to definitive care.
Common duties and responsibilities of EMS personnel at the scene of a motor vehicle crash include all of the following, EXCEPT: Keeping bystanders at a safe distance Assigning all patients a triage category Preparing all patient for transportation Continual assessment of critical patients
Keeping bystanders at a safe distance
A 50-year-old female is entrapped in her passenger car after it struck a tree. As the rescue team is preparing to extricate her, you quickly assess her and determine that she is breathing shallowly and that her radial pulse is absent. You should:
Maintain spinal stabilization as she is extricated
Proper removal of a critically injured patient from an automobile involves:
Moving the patient in smooth, slow, controlled steps
Upon arrival at an active law enforcement incident, the EMT should _________.
Notify the incident commander
You note three occupants. There are two adults in the front and a small child in a child safety seat in the rear. Patient care should be initiated:
Only after all patients have been triaged
Once the scen is declared safe to approach, you attempt to gain access to patients stuck inside a van. Which of the following is an example of simple access? Opening a rear door Removing the windshield Breaking a side window Prying open a door
Opening a rear door
The EMT's primary responsibility during a rescue or extrication situation is:
Patient care
A 30-year-old semiconscious man is pinned by the steering wheel of his badly wrecked vehicle. Once access has been gained to the patient, the EMT should:
Perform a primary assessment and provide any needed emergency care prior to extrication
What is the first phase of extrication?
Preparation
You and your partner are standing by at the scene of a residential fire when you hear the incident commander state, "We have located a victim" over the radio. You should:
Remain with the ambulance and wait for fire personnel to bring the victim to you
Disentsanglement involves:
Removing a patient from a dangerous position
As you approach an unconscious patient who is still in her wrecked vehicle, you note that there is a power line entangled in the wreckage of the vehicle. You should:
Retreat until the power line has been removed or the power is shut off.
How would your approach change if leaking fuel were present?
Scene cannot be made 100% safe unless the plane's fuel tank is emptied. Plan an exit route in case the scene becomes more unstable. If fuel spills on the patient, he or she will have to be decontaminated prior to transport. Fuel spills require specially trained personnel.
As you and your team are removing an unresponsive patient from her wrecked car, you note that she has closed deformities to both of her legs and a deformity to her left humerus. You should:
Support the injured extremities and continue removal
A unique consideration when dealing with a hybrid vehicle is that:
The battery has higher voltage than a traditional vehicle battery
Which of the following is most important in protecting EMS providers during an extrication operation?
The scene size-up
The reasons for a rescue failure can be referred to by the mnemonic FAILURE. In this mnemonic the "U" stands for:
Underestimating the logistics of the incident
What treatment should you provide to a patient who is entrapped in wreckage?
Unless there is an immediate threat of fire, explosion, or other danger, once entry and access to the patient have been provided, perform a primary assessment and begin immediate emergency care before the process of extrication begins.
There are downed power lines at the scene. How should you handle this situation?
Wait for the power company to tell you the scene is safe before approaching either vehicle
What are your considerations when calling for an air transport?
When a patient is critical and time is a factor. You must locate an area that is large enough for a landing zone. To save valuable time in critical situations, designate primary and secondary landing zones, identify the closest hospital, burn center, and trauma center, and the most efficient route of travel to these facilities.
What should you do as the patient is being extricated from the wreckage?
When possible, position yourself alongside the patient to monitor his or her condition as the wreckage is being cut. Be sure that you are wearing the appropriate protective clothing (i.e. a bunker coat, heavy-duty gloves over your exam gloves, a rescue helmet, and hearing protection)
Once the scene is safe to approach, what steps should you take to perform a primary assessment and provide care prior to the initiation of extrication?
1. Provide manual stabilization to protect the cervical 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.
You are dispatched to the scene of a trench collapse. Upon arrival at the scene, your ambulance should be parked at least _____ feet from the incident.
500
