Vehicle extrication

• 
  Vehicle Rescue as a Systematic Approach 4
  

Preparation 4

Response/Arrival 7

Size-Up 8

Safety 10

Establishing Command 12

Stabilization 15

Patient Access 17

Extrication 17

Removal & Transfer of Patient to Ambulance 21

Termination 22

• 
  New Vehicle Technology 22
  

Basis for Vehicle Safety 22

Vehicle’s of the 90’s 23

Frames 23

Bumpers 25

Fuel Systems 26

Catalytic Converters 27

Batteries 27

Glass 27

Doors 28

Cylinders on Hatchbacks 30

Composition Car Body 30

Supplemental Restraints 30

Air Conditioner Systems 33

Suspension Systems 33

Individual Car Problems 33

Totaled vs. Totally Destroyed 34

The Future 35

• 
  Vehicle Rescue Equipment 38
  

Airbags 38

Bottle Jacks 42

Cribbing 42

Electrical Generators 44

Power Winches 48

Come-alongs 51

Chains 52

Chain Saws 54

Porto-Powers 55

Power Hydraulic Tools 56

Sawzalls 61

• 
  Picket Anchor Systems 62
  

• 
  Random Thoughts on Vehicle Extrication 63
  

• 
  Glossary of Common Terms 65
  

Grant. This book was written in 1975, and obviously there have been substantial changes in vehicle construction and equipment and rescue techniques since that time.

1975, and it is essential that you know all eleven phases to plan and implement a strategic and tactical game plan for your extrication problem. The eleven phases of vehicle rescue, in the order they are to be considered and followed, are as follows:

Response/Arrival

Size-Up

Safety

Stabilization

Patient Access

Emergency Medical Care

Extrication

Removal & Transfer of Patient to Ambulance

Termination
PREPARATION
PERSONNEL
Physical - turnout gear, which is required for safe operation, can weigh over 20 pounds.

Hurst spreaders can weigh 50 - 75 pounds. Obviously you must be physically fit enough to lift and maneuver these tools. With the Americans with Disabilities Act, the National

Registry and other organizations that do job functions, analysts are developing criteria for the various EMS positions. It might interest many of you to know that one suggested standard is that the employee be able to lift 150 pounds! It is important for you to maintain physical strength and stamina, for the chance of injury increase as you become more and more tired.
If you are out of shape you should start an exercise program and get in shape.
Mental - You must have training on the vehicle extrication system, on the equipment, and you must practice and get experience in extrication. Every extrication is different. Training itself is perpetual. You must keep on training and practicing and training and practicing. Be wary of the "once-trained/always trained" mentality that rears its ugly head so often in the fire service. There are always new tricks, new pieces of equipment, new vehicle designs, and new problems to learn from. It will not be long before you can tell those who continue to train from those who talk about continuing to train. You must have training and experience to be a good vehicle rescue technician. Neither is sufficient on its own.
TRAINING
Training starts now, with this class. But this class is only an introduction to the principles of vehicle extrication. It takes much practice, as well as additional training to be truly proficient at vehicle rescue. Start by knowing the location of every piece of rescue equipment on your apparatus. Know how it works, its specifications, and how to fix it should it become disabled. Visit your local junkyard regularly to practice those techniques you will learn. Set up scenarios and run through them with other rescue technicians. Limit the number of tools you are able to use so you will learn how to adapt and overcome problems like that in the real world. Respond to as many working extrications as possible to see how the rescue was performed and what worked, (and what did not). Take additional vehicle rescue classes from knowledgeable instructors.
Additional classes that are recommended are:

• 
  Bus Rescue
  
• 
  Farm Vehicle Extrication
  
• 
  Hazardous Materials Awareness
  
• 
  Heavy Truck Rescue
  
• 
  Rope Rescue I
  
• 
  BTLS or PHTLS
  

If your organization has a vehicle rescue competition team, observe how they practice and ask if you can participate. If you do not have a team, organize one. By competing against other rescuers, you will quickly learn a lifetime’s worth of information in a very short time. Vehicle rescue teams have to do it safe, fast, smart and right.

Establish Command

Make assessment of rescue needs and extrication techniques

Provide initial and sustained patient access as necessary.

Initiate disentanglement procedures as necessary.

Assist EMS as necessary

Implement necessary safety measures on damaged vehicles to prevent further injuries to patients or operating procedures.
Fire Department:

Establish and maintain scene safety by control of safety hazards including but not limited to the following:

Extinguishing Fires

Preventing Fires

Handling spill or leaks

Performing vehicle safety surveys including the following:

Energy-absorbing bumpers

Electrical system

Fuel and fuel system

Basic vehicle stabilization

Assist law enforcement agency in establishing and maintaining control of traffic and crowds in the immediate vicinity, if requested and assigned.

Assist EMS personnel as requested and assigned.

Establish and maintain medical personnel/ patient contact throughout the incident.

Evaluate condition of patients.

Prioritize and administer necessary patient medical care.

Assess need for disentanglement activities to free trapped patient.

Advise rescue personnel of interior entrapment conditions as necessary.

Properly package injuries and injured patients.

Transport patient to medical faculty.

Investigate the accident

Establish and maintain crowd and traffic control

Preserve the accident scene for accident reconstruction and investigation teams

Place the vehicle upwind and uphill from the scene, whenever possible. This will prevent exposure to hazardous vapors and keep flammable fuels from running beneath the vehicle.

Do not place vehicles so close that it will cramp the scene or expose victims to vehicle exhaust or noise.

If public utilities have been involved in the incident, be cautious of such things as downed power lines, dangling transformers, or escaping natural gas.

Do not block the scene. Allow for passage of ambulances and other emergency vehicles.
When working in areas of heavy traffic, such as freeways or intestates, the most desirable option is to stop the flow of traffic. Unfortunately, this is not always possible. To provide the most efficient means of protection for the emergency crews, when traffic must be allowed to continue to flow, position emergency vehicles so they provide a barrier between traffic and the emergency scene. If it is possible to close only certain lanes of traffic, the lane the accident is in as well as the lane next to it should be closed.
Driving to the scene is outside the scope of this class. However, you must consider height and weight limitations in determining your route. You must carefully position your truck at the scene and always chock the wheels, (large trucks do not use the transmission to hold the vehicle in place) You should be uphill and upwind from leaks and spills. You should consider placing the truck so that the truck shields the accident scene. Let them hit the truck before they hit you or the accident scene. Place your response unit 50 feet from the accident scene, 100 feet if the vehicle is on fire, 2,000 feet from a hazardous material incident. Always position one unaffected span away from a downed power line.
SIZE UP
Size up begins with the dispatch information and updates en-route.
INITIAL ASSESSMENT
Once on scene an initial assessment should be performed. This should take about

60 seconds, and you are looking for:

Fire and safety hazards

fire

downed power lines not seen earlier

hazardous materials

unstable vehicles or structures

traffic

crowds

How many people are involved in the accident?

Where are the patients?

in car

Perform a 300-foot scan for possible ejected patients from roll over.

Rescue needs

Will you need to force entry and disentangle?

Do you need additional manpower?

Would you benefit from scene lighting at night?

Your family is number two.

Your department is number three.

Your community is number four.

Your victim is number five.
“WHAT INJURES OR KILLS MOST WOULD-BE RESCUERS?”
Lack of knowledge.

Stupidity.

Lack of discipline.

Compassion. (Compassion starts in the back of the ambulance, not before!)

• 
  HELMET
  
• 
  EYE PROTECTION (safety goggles or glasses)
  
• 
  COAT (with reflective stripes)
  
• 
  PANTS
  
• 
  BOOTS (with steel toe) fire-fighter boots do not protect against electrical shock
  
• 
  GLOVES (not plastic coated) wear plastic gloves underneath
  

If you are hurt at the accident, then someone must care for you and that takes manpower away. Get into shape and stay that way.

Enter the accident site uphill and upwind until you know what you have. Never turn your back on traffic.

Safely stabilizing the incident

Making the patient readily accessible

Treating the patient

Making the patient readily removable

Extricating the patient

Delivering the patient to an appropriate facility within the "golden hour."
COMMAND OF MOTOR VEHICLE ACCIDENTS
Someone MUST take charge. Good commanders have the following:
Training in extrication.

Experience in extrication.

Knowledge of capabilities of personnel and equipment.

Mental preparation for life and death situations.

Knowledge about their own strengths and weaknesses.

Essential criteria of good command are:

Performance of simultaneous functions on scene and quick change by team

members to alternate methods if initial efforts fail.

Anticipation of real and potential needs on scene in order to obtain necessary resources in a timely fashion.

Good communication between command and team members.

who rely on the loudest rather than best person for leadership.

Lack of simultaneous functions.

Delays in receiving badly needed equipment or manpower because of unanticipated immediate of potential needs for resources.

Stressful or argumentative situations resulting from insufficient communication

between command and the team.