Roadway Extrication
Introduction
• 40 hour course
– minimum attendance is 90%
– end of course exam 80% or better
– practical examination-must pass all evolutions
• State Certification
– Practical passed at 100%
– State written exam at 70%
– Firefighter 2 certified
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General Safety Principles
• Must protect the patient and rescuers during
the extrication process
• Three factors that contribute to overall
safety of an accident scene
– The environment
– The incident itself
– The vehicle itself
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Personal Safety
• Protection of the Rescuers
– This is our number one priority
– Full protective clothing with eye and ear
protection
– Proper lifting and working techniques
– Proper evaluation of scene hazards
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Patient Safety (victim)
• Protect patients physical and mentally
– Physical protection
• Cover patient with blanket
• Protect with backboard or barrier
• Utilize eye and ear protection equipment?
– Mental protection
• Early communication between rescuer and victim
• Protect from unpleasant visual sights
• Protection of personal property
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Scene Safety
• Eliminate, Control, or Neutralize Hazards
– DO NOT TRADE LIVES FOR LIVES
• Scene Safety Priorities
– 1st Priority -- Rescuers
– 2nd Priority -- bystanders, Good Samaritans
– 3rd Priority -- victims
• Use apparatus as scene barrier-100ft away
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Scene Safety
• Hazardous Materials incidents-minimum of
2000’ uphill and upwind of incident
• Night operations require special
considerations
– Do not use headlights
– More scene lighting makes operations more
effective
• Vehicle stabilization is paramount
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Scene Safety
• Plastic fuel tanks in use
– failure within 30 seconds of fire
• Handlines and extinguishers are a must
• 2 pole rule for downed power lines
• Use action circle and safety zones
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Anatomy of a Vehicle
• 1973 was start of vehicle construction
changes
– Iron and steel to plastic and aluminum frames
– Bolted to spot welded and glued
• Three types of frames
– Full frame
– Uni-Body-integrity depends upon roof, posts
– Space Frame-cage like construction
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Anatomy of a Vehicle
• Posts
– A Post; divides engine compartment from
passenger compartment, extends to roof
– B Post; divides passenger compartment in half
or is rear post in 2-door vehicles
– C Post; divides passenger compartment from
trunk in 4-door vehicles
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Anatomy of a Vehicle
• Wheels
– Steel, aluminum, plastic, composite, alloy
• Catalytic Converters
– 1300 to 2000 degrees
• airbags damage at 200 and will melt at 330
– Potential ignition source
• Drive Shafts
– hollow and will explode as projectile
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Hazards of Vehicles
• Catalytic Converters
• Alternative Fuels
– CNG
– LPG
• Fuel Emission Control system
– Vapor holding canister
• Fuel Tank
– 10-25 gallons, located between frame rails
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Hazards of Vehicles
• Bumpers
– Spring loaded bumper (5 mph impact in 1970s)
– Piston fluid filled (2 1/2 mph impact) most
popular in use today
– Egg crate
• newest concept, 2 1/2 mph impact
• Assume all are loaded and ready to rebound
– Chain or drill 1/4” hole in narrow piston
– Bumper strike zone up to 300’
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Hazards of Vehicles
• Batteries
– Most common hazard at scene
– Key component in electrical system
– Cut NEGATIVE cable in 2 places first
• make sure power is not needed first; seats or
windows
• assure key off or fuel pump in EFI may keep
running
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Hazards of Vehicles
• Steering Columns
– Old ones were solid one piece rods
– New ones have hollow joints with up to 4
knuckles for various adjustments
• Wrap wheel low if you must pull
– Cut spokes of wheel to allow more room
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Supplemental Restraint Systems
• Minimum of 3 sensors in place on vehicle
– 2 must activate before system can deploy
– Needs about 12 mph impact
• Identification of unactivated system is key
to rescuer safety
– Look at steering wheel and dashboard
– Assume at least 1 in place after 1990
– Maybe in headliner, seat and doors in new cars
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Supplemental Restraint Systems
• Uses 12 volt charge to ignite SODIUM
AZIDE canister which burns producing
nitrogen gas to inflate bags rapidly
– Alkaline substance which may cause minor
irritation
– Mostly non-toxic
– Caution on FORD, Potassium Nitrate used
• Key is to disable electrical system
immediately
– SRS can stay active up to 30 minutes
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Windows
• Front windshield is laminated glass
– 2 pieces of safety glass bonded to plastic
material between
– Made to resist shattering on highway
• Side and rear are tempered glass
– Shatter to pieces the size of fingernail
– Reduce the severe lacerations?
• Rescuer should control breakage of glass
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Vehicle Rescue Life Cycle
Stage 1 - Readiness
• Readiness of Personnel
– Training and experience
• tools, equipment and SOG’s
• Readiness of Equipment and Apparatus
– Maintained and functioning
– Back-ups of primary systems
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Vehicle Rescue Life Cycle
Stage 2 - Accident Stage
• No control over this step
• Golden Hour begins
– 60 minutes to reach appropriate health care
facility
– Into surgery if indicated
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Vehicle Rescue Life Cycle
Stage 3 - Notification Stage
• Starts when accident is reported
– Response SOG’s
– Information recieved about accident
– Size-up enroute
• conditions
• traffic patterns
• Dispatch tones and additional information
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Vehicle Rescue Life Cycle
Stage 4 - Response Stage
• Vehicle responds in safe manner
– Obey traffic law
– Use of visual and audio devices
– Position of apparatus
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Vehicle Rescue Life Cycle
Stage 5 - Arrival
• Staging should be 100’ from incident
– Assessment of immediate threat
– Rescuer caution exiting and operating around
scene
• May be most hazardous time for rescuer safety
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Vehicle Rescue Life Cycle
Stage 6 - Size-Up
• Begin to gather information
– 360 degree view of scene
– Assessment of known hazards
• Wires
• Fuel
• HazMat
– Prediction of possible hazards
– Assessment of capabilities
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Vehicle Rescue Life Cycle
Stage 7 - Incident Command
• Essential to success of operations
– Establish Command
– Stay out of work and run the show
– Stay in outer action circle
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Vehicle Rescue Life Cycle
Stage 8 - Scene Safety,
Stabilization and Support
• Action circle - 10’ around car
– Only those doing ems or rescue
• Outer circle - 10’ - 15’ outside
– Tool and equipment staging on tarps
– ICS
• Identify and control the hazards
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Vehicle Rescue Life Cycle
Stage 9 - Patient Access
• Pathway to get to patient
– Door
– Window
• Qualified EMS provider inside to assess the
patient and the effects of the rescue process
• Begin care inside, calm, reassure and talk to
patient
• Communicate needs
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Vehicle Rescue Life Cycle
Stage 10 - Treatment
• Triage
– Colors and priorities
• Call for additional help
• Begin treatment according to policy
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Vehicle Rescue Life Cycle
Stage 11 - Disentanglement
• The actual removal of the car from the
patient
–
–
–
–
goal is not to cause additional harm and injury
protect patient throughout
stop actions that are causing harm
evaluate progress often
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Vehicle Rescue Life Cycle
Stage 12 - Extrication
• Remove the patient from the vehicle
– Proper splinting and immobilizations
– Exercise rescuer safety
• back injury frequency high here
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Vehicle Rescue Life Cycle
Stage 13 - Transportation
• Appropriate level of care
– Trauma center
– Regional hospital
– Medivac
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Vehicle Rescue Life Cycle
Stage 14 - Termination
• Wrap-up of equipment
– clean and service
– secure scene with police
• Completion of documentation
• Review incident with participants
– learn from every experience
– learn from doing
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