Extrication and Rescue
Temple College
EMS Professions
General Principles
 All operations include 7 basic steps
 Form a mental picture of how the
operation will be carried out
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 Begins at moment of dispatch; continues
throughout rescue
 In route:
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Think through the steps
Decide what you are going to do first
 When you arrive:
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Avoid being caught up in the situation
Step back, survey scene
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 Safety
Are there potential hazards to you?
 Are bystanders at risk?
 Is the patient in danger?
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Dead Rescuers Don’t Help
Anyone!
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 Outside Help
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Is additional assistance needed?
If you need something, call for it!
Stay ahead.
If you routinely work with other agencies,
have plan of operations worked out in
advance.
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 Significant Information
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What kinds of vehicles?
How many?
What kind of collision?
How many patients?
Any potential for hazardous materials?
Anyone ejected?
Hazard Control
 Traffic
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Park on same side of highway as collision
Park up highway, beyond scene if possible
Have someone spotting traffic at all times
Wear reflective clothing at night
Provide clear visual signals to drivers well in
advance of reaching scene
Hazard Control
 Power Lines
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Consciously look for lines on ground
Use particular caution when vehicle has
struck utility pole or tree
Tell patients to stay in vehicle
Call the power company!
Hazard Control
 Gasoline or Fuel Spillage
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Shut off vehicle ignition keys
Remove all ignition sources from area
Ask Fire Department to get a charged hose
line on the ground
Disconnect battery cable (+)—weigh risks
vs. benefits
Hazard Control
 Unstable Vehicles
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Any vehicle that does not have all 4 wheels
touching the pavement is unstable!
Never push back into position
Stabilize as found
Maximize number of contact points with
ground; spread over as wide an area as
possible
Hazard Control
 Hazardous Materials
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Assume presence at all incidents until
proven otherwise
Base decision to attempt rescue on best
available information about product(s) and
on expert advice
Hazard Control
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Appropriate Protective Clothing
 At
least helmet, gloves
 Eye protection
 Work boots
 Turnout coat
Gaining Access
 Objective is to get to patient.
 Try before you pry!
 Work from simple to complex.
Gaining Access: Residences
 Check for open windows, doors
 Ask if anyone else (neighbors, relatives)
has key
 If a window is open, cut through screen
 If no windows are open, break smallest
window through which access can be
obtained
Gaining Access:Vehicles
 Upright vehicle
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Enter through doors
When you open door, be sure patient is not
against it
If door is locked, ask patient if he can open it
If door will not open, break furthest window
away from patient to gain access
Gaining Access
 Vehicle on Side
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Stabilize vehicle
Enter through top door
If door will not open, break rear window
Gaining Access
 Vehicle Upside Down
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Gain access through windows
Doors may be supporting vehicle body
Careless opening, removal may cause
vehicle collapse
Gaining Access
Glass can be broken quickly and
effectively with a sharp blow to the
corner of a window about 2 inches
from the edge of the glass.
Life-Saving Care
 Rapidly evaluate patient’s condition
 Immediate threats are:
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Hypoxia
Shock
 At this point, why patient isn’t
oxygenating or perfusing is irrelevant
Life-Saving Care
 If ABCs compromised, correct problem!
 If you cannot correct problem:
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Support oxygenation, ventilation
Extricate patient to long board ASAP
Rapidly transport
Disentanglement
Remove vehicle from patient,
NOT patient from vehicle!
Disentanglement
 Patient-centered
 Keep someone with patient to:
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Monitor condition
Ensure that attack on vehicle does not
endanger patient
Disentanglement
 Do NOT do anything to vehicle unless
you know EXACTLY what result will be
 Protect patient at all times
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Cover blanket for protection
Talk to him
Explain what is happening
Preparation for Removal
 Packaging = Preparing patient for
removal as unit
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All injuries stabilized
Patient moves as single unit through route
of egress
Preparation for Removal
 Any lower extremity injury can be stabilized
temporarily by securing it to other extremity
 Any upper extremity injury can be stabilized
temporarily by securing it to the chest
 KEDs are used to keep head-neck-torso in line
during extrication; patient must be extricated
onto a long board.
Preparation for Removal
Do NOT attempt complete
packaging of patients with
compromised ABCs
There in NO value in a wellpackaged corpse!
Removal
 Through doors if vehicle is upright.
 Through roof if vehicle is on side.
 Through window if vehicle is overturned.
Conclusion
 Successful rescues are based on planning,
practice.
 Know what community’s target hazards are.
 Have plan for managing them.
 Know who you will be working with; train with
them.
 Know what kinds of help are available.
 Do NOT be afraid to call for help if you need it!
Conclusion
The challenge is NOT to be innovative in
a crisis.
The challenge is to be well-trained and
well-disciplined enough to
FOLLOW THE RULES!