Chapter 48
Vehicle Extrication and
Special Rescue
National EMS Education
Standard Competencies
EMS Operations
Knowledge of operations and responsibilities
to ensure patient, public, and personnel
safety.
National EMS Education
Standard Competencies
Vehicle Extrication
• Safe vehicle extrication
• Use of simple hand tools
Introduction
• EMS departments
must be prepared
to respond to a
variety of special
rescue situations.
− Paramedics are
often first on the
scene.
Awareness
• All EMS providers require training in rescue
techniques.
− Focus of training is awareness.
− The paramedic’s function on-scene varies
depending on the company.
Awareness
• A technical rescue incident (TRI) is a
complex rescue incident.
• Three levels of TRI training:
− Awareness
− Operations
− Technician
Guidelines for Rescue
Operations
• Be safe.
• Follow orders.
• Work as a team.
• Think.
• Follow the golden rule of public service.
Steps of Special Rescue
• Preparation
• Access
• Response
• Disentanglement
• Arrival and scene
size-up
• Removal
• Stabilization of the
scene
• Transport
Preparation
• Train with other fire departments and
special rescue teams.
• Assess the following:
− Personnel and equipment
− Who will respond
− Familiarity with hazard area
Response
• If your department has its own TRI team, it
will respond.
− Often the rescue squad comes from an outside
agency.
− Contact utility companies as needed.
Arrival and Scene Size-Up
• Information received from initial dispatch
call is critical.
− Responders must:
• Identify/mitigate life-threatening hazards.
• Inform IC of special resources needed.
• Determine whether the situation is a search, rescue,
or recovery.
Stabilization of the Scene
• Be sure all hazards are identified.
• First arriving responder assumes command.
− Establish objectives.
− Coordinate resources.
− Unify command between agencies.
Stabilization of the Scene
• Three guidelines to follow:
− Approach the scene cautiously.
− Position apparatus properly.
− Assist specialized team members.
Stabilization of the Scene
• Emergency vehicles
− Safety is the primary consideration.
• Disrupting traffic creates a hazard.
• Emergency vehicles can act as a barrier.
• Use only essential warning lights.
Stabilization of the Scene
• Control zones
− An outer perimeter protects against public and
media; inner perimeter surrounds incident site
− Set up three control zones:
• Hot zone
• Warm zone
• Cold zone
Stabilization of the Scene
• Specific hazards
− Use the DOT’s
Emergency
Response Guide
(ERG) as a
resource
• Shut off utilities.
Stabilization of the Scene
• Protective equipment
− Considerations include:
• Visibility of PPE
• Footwear designed for the environment
• ANSI-approved safety glasses or goggles
• Puncture- or cut-resistant gloves
• Flame- or flash-protective clothing
Stabilization of the Scene
• Accountability
− System tracks personnel on the scene.
− Can be used to:
• Track resources
• Task assignments
• Ensure personnel safety
Stabilization of the Scene
• Patient contact
− Maintain eye contact.
− Be truthful.
− Communicate at a level that can be understood.
− Be aware of body language.
Stabilization of the Scene
• Patient contact (cont’d)
− Speak in laymen’s terms.
− Address the patient properly.
− Give time to respond to questions.
− Make the patient comfortable.
Access
• Simple access requires hand tools.
• Complex access requires special tools.
• Gaining access depends on:
− Type of incident
− Nature and severity of injuries
Disentanglement
• Emergency medical care should begin as
soon as the patient is accessed.
• A team member should stay with the patient
while they are being disentangled.
• Involves freeing a patient from whatever is
trapping them
Removal
• Preparing for
removal involves:
− Controlling lifethreatening
problems
− Dressing wounds
− Immobilizing
fractures and
spinal injuries
Removal
• Expedite removal if:
− Patient is deteriorating rapidly.
− Hazards are present.
• Packaging: Preparing the patient for
movement as a unit
Removal
• Using a basket stretcher helps move
patients to safety.
− Lifted by rope
− Carried by vehicles
− Hand carried
Transport
• Transport varies depending on:
− Severity of the patient’s injuries
− Distance to the medical facility
Vehicle Anatomy and
Structural Parts
• Use standardized
terminology when
describing.
• Roof posts add
support to the roof.
Vehicle Anatomy and
Structural Parts
• There is an engine compartment and a
passenger compartment.
− Hood covers engine compartment
− Bulkhead divides compartments
− Firewall protects passengers
Vehicle Anatomy and
Structural Parts
• Two frame types:
− Body-over-frame construction
− Unibody construction
Alternative Powered Vehicles
• Powered by:
− Electricity
− Electricity/gasoline
hybrid
− Fuel
• Secure vehicle as
soon as possible.
• Identified by
special markings
© GIPhotoStock Z/Alamy Images
Hazardous Materials
• A car wreck may have additional hazards.
• Follow proper size-up and evaluation
processes.
− Responders trained at awareness level may
assist special responders.
Hand Tools
• Categories include:
− Striking tools
− Leverage/prying/ spreading tools
− Cutting tools
− Lifting/pushing/ pulling tools
Hand Tools
© 2003 Berta A. Daniels
Courtesy of Dave Sweet
Vehicle Stabilization
• Cribbing
− Designs include:
• Step chocks
• Wedges
Courtesy of David Sweet
• Shims
Vehicle Stabilization
• Vehicles may still move after cribbing.
− Horizontal
− Vertical
− Roll
− Pitch
− Yaw
Vehicle Stabilization
Vehicle Stabilization
Gaining Access to the Patient
• Open the door.
− Try all doors first.
− Ensure locks are
released.
• Break tempered
glass.
− Use side and rear
windows not in
close proximity to
the patient.
Courtesy of AAOS
Gaining Access to the Patient
• Break tempered glass (cont’d).
− Wear proper PPE.
− First, lower the windows as far as possible.
− Aim for a low corner.
− Give other EMS personnel warning.
Gaining Access to the Patient
• Provide initial
medical care.
− Spine
immobilization
− Assessment and
management of the
ABCs
Disentangling the Patient
• Study the scene before taking action.
− The order of procedures will be determined by
the specifics of the incident.
− Main objective = maintain spinal alignment and
immobilization
Disentangling the Patient
• Air bag safety
− Identify
undeployed air
bags.
− Disable airbags by
disconnecting
power.
Disentangling the Patient
• Air bag safety (cont’d)
− Most vehicles contain an air bag.
− If the air bag has deployed, it is not a hazard.
− If it did not deploy, disconnect the battery.
− Some newer vehicles have a switch that allows
shutting off of the air bags.
Disentangling the Patient
• Air bag safety (cont’d)
− Do not place a hard object between the patient
and an undeployed air bag.
− Do not cut a steering wheel if the air bag has
not deployed.
− Never get in front of an undeployed air bag.
− Check for side-mounted air bags or curtains.
Disentangling the Patient
• Displacing the seat
− Relieves pressure
on the driver
− Gives rescuers
more room to work
− Try simple steps to
displace a seat.
Disentangling the Patient
• Removing the
windshield
− Allows for better
communication
− Remove in one
large piece.
− Essential before
removing the roof
Disentangling the Patient
• Removing the roof
− Increases space
for care and
disentanglement
− Protect the patient
and rescuers
inside the vehicle.
• Support the roof
when cutting posts.
Disentangling the Patient
• Displacing the
dash
− Use the dash roll
technique.
• Requires a
hydraulic cutter
and ram
− Must be done by a
trained rescuer
Confined Spaces
• Location surrounded by a structure that is
not designed for continuous occupancy.
− Limited ventilation
© Joan Stabnaw/ShutterStock, Inc.
© Tyler Boyes/ShutterStock, Inc.
Confined Spaces
• Oxygen deficiency and poisonous gases
− Hydrogen sulfide (H2S)
− Carbon monoxide (CO)
− Carbon dioxide (CO2)
− Methane (CH4)
− Ammonia (NH3)
− Nitrogen dioxide (NO2)
Confined Spaces
• Safe approach
− Gather information from bystanders.
− Assume IDLH atmosphere.
• Assisting other rescuers
− Share whatever information is discovered.
− Compare conditions with those reported.
Trenches
• Collapse sites are
unstable and prone
to further collapse.
− Patients should be
dug out after
shoring has
stabilized the site.
Courtesy of Captain David Jackson,
Saginaw Township Fire Department
Trenches
• Safe approach
− Stay away from the edges of the site.
− Shut off all heavy equipment.
− Stop or divert nearby traffic if needed.
− Avoid disturbing the spoil pile.
− Prioritize your personal safety.
Water
• Be aware of self-rescue techniques.
− Minimum PPE includes:
• Personal flotation device (PFD)
• Thermal protection
• Whistle
• If immersed in fast-moving water, adopt the
self-rescue position.
Water
• Cold water rescue
− Hypothermia can
quickly progress.
− Assume the heatescape-lessening
position (HELP).
− Patient may
survive underwater
due to the
mammalian diving
reflex.
Water
• Other water rescue
situations
− Special hazards of
surface water:
• Hydraulics
• “Strainers”
• Dams and
hydroelectric sites
Water
• Safe approach
− Wear appropriate PPE.
− Do not exceed your level of training.
− Use the reach-throw-row-go approach.
− Use specialized equipment for ice rescues.
Spinal Injuries in Submersion
Incidents
• Suspect spinal injury if:
− Diving mishap or fall
− Unconscious patient with no information to rule
out neck injury
− Conscious patient reporting weakness,
paralysis, or numbness in arms and/or legs
− You have any other reason to suspect spinal
injury
Rope Rescue
• Types of rope rescue:
− Low-angle operations: slope of the ground is
less than 45°
− High-angle operations: slope of the ground is
greater than 45°
Rope Rescue
• Safe approach
− Set up equipment properly.
− Put distance between you and any loose
materials.
− Move bystanders out of the way.
Wilderness Search and Rescue
• Two parts to search and rescue (SAR)
− Search (looking for lost persons)
− Rescue (removal of patient from environment)
Wilderness Search and Rescue
• Safe approach
− Be aware that factors will vary.
− Bring drinking water, food, clothing, and PPE.
− Use a handheld strobe light.
− Be aware of physical limitations.
Lost Person Search and
Rescue
• Set up a search base.
− Prepare equipment ahead of time.
− Monitor progress via radio.
− Safe approach
• Distribute equipment among personnel.
• Stick together.
• Consider relocating ambulance.
Structure Fires
• Determine route.
• The IC will determine an appropriate
parking spot for the ambulance.
• Determine if there are injured patients or if
you are on stand-by.
Structure Fires
• Safe approach
− Stay with the ambulance.
− Remain present even after the fire is out.
• Unless transporting a patient or released by IC
Agricultural and Industrial
Rescue
• Visit local farms and industrial plants and
learn about:
− Equipment that is used
− How it operates
− How an operator can become entrapped
• Over time, protective shields and guards
may be damaged or removed.
Agricultural and Industrial
Rescue
• Safe approach
− Master cribbing.
− Take apart machines made of strong metal
(rather than cutting).
− Isolate the injury site.
Agricultural and Industrial
Rescue
• Safe approach (cont’d)
− Determine alternative methods of disentangling.
− Assess patient while rescue personnel plan
disentanglement.
− Be aware of differences in industrial and farm
settings.
Tactical Emergency Medical
Support
• Law enforcement
may call in the
SWAT team in
tactical situations.
− Tactical
paramedics
receive additional
training.
Courtesy of John Wipfler
Tactical Emergency Medical
Support
• Tactical paramedics must be able to provide
medical care under adverse circumstances.
− Provide immediate medical care to persons who
become injured during an incident.
• Often before the scene is declared safe
Patient Care
• Many medical and trauma conditions are
assessed during the rescue process.
− Crush syndrome: Large muscle groups are
compressed for a prolonged period of time
• High-flow oxygen therapy or positive pressure
ventilations
• Administration of sodium bicarbonate, calcium
chloride, fluid bolus
Pain Management
• Use nonpharmacologic methods in the field
− Splinting
− Gentle handling
− Talking to patients
Medical Supplies
Patient Packaging
• Basket stretcher (Stokes basket)
− Two types of basket stretchers (Stokes)
• Wire basket
• Plastic/fiberglass baskets
Patient Packaging
• Packaging obstacles:
− Patients with fractured pelvises
• Secure to a full-body vacuum mattress
− Spine-immobilized patients
• Place the patient in a Kendrick Extrication Device
(KED)
Patient Packaging
• Consider all patient needs:
− Portable oxygen tank
− IV lines
− Warmth
− Head and eye protection
− KED or KED/SKED
Summary
• “Rescue” means to deliver from danger or
imprisonment.
• The most difficult process in any rescue is
the coordination and balance of rescue and
treatment.
• A technical rescue incident (TRI) is a
complex rescue incident that requires
specially trained personnel and special
equipment.
Summary
• Technical rescue training occurs on three
levels: awareness, operations, and
technician.
• When assisting rescue team members:
−
−
−
−
Be safe.
Follow orders.
Work as a team.
Think.
− Follow the golden rule of public service.
Summary
• All rescuers should perform the following
steps to perform special rescues safely:
− Preparation
− Response
−
−
−
−
−
−
Arrival and scene size-up
Stabilization of the scene
Access
Disentanglement
Removal
Transport
Summary
• At a technical rescue incident, it is critically
important to slow down and properly
evaluate the situation.
• The first arriving officer at a rescue scene
should immediately assume command and
start using the incident management
system.
Summary
• Whenever possible, park emergency
vehicles in a manner that will ensure safety
and not disrupt traffic any more than
necessary.
• Accountability should be practiced at all
emergencies, no matter how small.
Summary
• Basket stretchers facilitate moving patients
to safety and can be used in a variety of
situations.
• Vehicle extrication is commonly necessary.
• There are many hazards associated with
alternative powered vehicles.
• You should have a thorough working
knowledge of the basic simple hand tools.
Summary
• Cribbing should be used regardless of the
position of the vehicle.
• Simple vehicle extrication techniques
include opening the door, breaking
tempered glass, and providing initial
medical care to the patients.
• During disentanglement, responders need
to be mindful of undeployed air bags.
Summary
• Many vehicle extrication techniques require
the use of specialized skills and training.
• A confined space is a location surrounded
by a structure that is not designed for
continuous occupancy.
• Confined spaces may have limited
ventilation to provide air circulation and
exchange.
Summary
• Trench rescues may become necessary
when earth is removed for placement of a
utility line or for other construction and the
sides of the excavation collapse.
• You should know how to properly don a
personal flotation device as well as how to
use the self-rescue position.
Summary
• Rope rescue incidents are divided into lowangle and high-angle operations.
• Wilderness search and rescue (SAR)
missions consist of two parts: looking for a
lost or overdue person and removing a
patient from a hostile environment.
• During lost person search and rescue, your
role is to stand by at the search base until
the lost person or people have been found.
Summary
• You should always stay with your
ambulance during a structure fire.
• If an incident develops into a tactical
situation, law enforcement agencies may
deploy use of specialized law enforcement
tactical units or the SWAT team.
• Pain control in rescue situations should take
the form of nonpharmacologic methods.
Summary
• A number of special patient packaging tools
are available to help extricate patients out of
their situation and up, down, or out to the
ambulance.
Credits
• Chapter opener: © Corbis
• Backgrounds: Green—Jones & Bartlett Learning;
Red—© Margo Harrison/ShutterStock, Inc.; Lime—©
Photodisc; Purple—Courtesy of Rhonda Beck.
• Unless otherwise indicated, all photographs and
illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for
Emergency Medical Services Systems, or have been
provided by the American Academy of Orthopaedic
Surgeons.