Vehicle extrication



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VEHICLE EXTRICATION
As adapted from
The Central Virginia Vehicle

Rescue School

Table of Contents


  • 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


Steering Columns 29

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


Vehicle Rescue

As a

Systematic Approach
The official text for VAVRS Vehicle Rescue Course is Vehicle Rescue by Harvey

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.


However, the eleven phase approach to vehicle rescue is as valid today as it was in

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:


Preparation

Response/Arrival

Size-Up

Safety


Establishing Command

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.


EQUIPMENT
It has been said that tools should never limit the rescue effort. In other words, you should never be unable to perform a needed task because you are missing an essential piece of equipment. That is why we are always suggesting new equipment for the squads. We must have the right tools and be proficient in their use. Tools must be maintained in good working order. We use competitions and parades as opportunities to clean, repair and use equipment that otherwise sees little service.
Never, ever be ashamed of homemade equipment. Many of the fancy things we have now started out somewhere as a homemade trick of the trade. Why pay $500.00 for something you can have made for you for $10.00? Many rescue squads and fire companies that have limited budgets have an amazing array of homemade equipment with which they can put the "store-bought" people to shame.
No ambulance weighs 33,000 pounds. Recent federal legislation has brought equipment weight into question, and in one Virginia locality the insurance carrier has weighed a truck, found it to weigh more than the gross vehicle weight of the chassis and it is having to be replaced after 5 years of service! (Normal life for fire apparatus is 20 years.) Clearly planning in vehicle bidding is required to avoid a $250,000 mistake.
Planning of compartment layouts and for future equipment needs is of vital importance given the service life of the truck. Planning for accessing equipment must take place to avoid having to pull out everything in a compartment to reach a needed item.
ROLES AND RESPONSIBILITIES
Agencies routinely work side by side at an accident benefit by developing assigned responsibilities for each agency to fulfill. The following example illustrates how standardized operating procedures and responsibilities can be established. The time to identify these roles and responsibilities is to sit down and discus which agency will be responsible for which task before the response. Establishing these responsibilities before the response will increase the effectiveness and prevent any confusion how to responsible for what. Listed below are the some of the roles and responsibility of each of the agencies:
Rescue:

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.



Emergency Medical Services:

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.


Law Enforcement:

Investigate the accident

Establish and maintain crowd and traffic control

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


Because the simultaneous arrival of law enforcement, fire, emergency medical services, and rescue rarely happens, each agency must be prepared to deal with the situation alone until additional crews arrive. When a particular response agency is absent from the accident scene, command personnel may have to be assigned from a branch of service temporarily to fulfill of the other services. However, no member of any branch of services should become involved in another agency realm of responsibility without full knowledge, consent and direction of command personnel. For example, if paramedics abandon a patient to direct traffic at the accident scene, the care of the patient is lost. In all cases, every agency must reflect consideration for safety all times.
RESPONSE / ARRIVAL
Proper placement of apparatus on an emergency incident is an important part of site management. The goal is to get the vehicles that will perform the most action as close to the incident scene. Because not all units will arrival on the incident scene at the same time, it is critical that all drivers, officers, police and other responders need to be trained to understand proper placement of their respective vehicles on the incident scene.
Unlike that of a structure fire where a rescue vehicle is parked a block away from the incident scene, since much of the equipment that is used on a fire scene is portable or operates in a support role. In many cases positioning of apparatus is opposite of that of the fire scene. On an accident scene it is critical that placement of the rescue vehicle to be as close as possible to allow the extrication team to have readily access to all it’s tools and equipment. Certainly, placement of vehicles on the extrication scene depends on a number of variables. On the extrication scene, the rescue and EMS vehicles should have the spot closest to the scene. The following is a guideline as to placing apparatus on the scene:
Place the vehicle close enough to the accident scene to make equipment removal easy and to keep carrying distance to a minimum. Some rescue vehicles have tools that operate off the vehicle such as hydraulic and air lines, cranes, A-frames and/or winches. This must be considered.

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


fuel leaks

downed power lines not seen earlier

hazardous materials

unstable vehicles or structures

traffic

crowds


Medical needs

How many people are involved in the accident?

Where are the patients?

in car


in road/ditches

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?


SCENE SURVEY
There are several methods that are acceptable to obtain this information. One such method is generally referred to as the "scene survey". In the scene survey, the IC walks around the incident gathering information from what he/she sees and then decides an appropriate course of action. It is important to remember that an accident scene may change, therefore the IC should be flexible and be ready to change the rescue plan should some unforeseen event occur or if the rescue plan does not work.
During scene survey work, the IC has a close opportunity to observe hazards that exist in, on and around the rescue scene. The IC completes and full circle around all involved vehicles, maintaining about a 10-foot distance from the closest vehicle. This distance identifies the action circle and takes on an important significance as the rescue unfolds. (The action circle is where the extrication takes place.) During the scene survey, the unknown becomes the known, and both real and potential scene hazards are identified, as are existing or anticipated rescue and medical problems. Scene survey information should be shared with other emergency personnel and a game plan for the actual rescue should then be formulated.
ESTABLISH CONTROL ZONES
Proper management reduces congestion and confusion around the rescue scene. In order to do this, establish “zones” or areas where only certain personnel are allowed to function. These zones should be circular, their size depending on the size of the rescue scene and what is required. The area closest to the extrication should be labeled the “hot zone” and only those personnel actually performing the extrication work or attending directly to victims should be allowed. The next area, the “warm zone” is where rescuers who are directly aiding the working extrication team should be allowed. This includes personnel who are handling hydraulic tool power plants, fire personnel handling charged hose lines, and personnel providing lighting. The most outer circle is called the “cold zone” and this is where equipment and manpower are staged, as well as the command post and the press information area. The cold zone should be cordoned off with scene tape to prevent the entry of unauthorized people.

SAFETY
KNOW YOUR PRIORITIES”
You are number one.

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!)


PERSONAL PROTECTIVE CLOTHING
Should consist of the following:


  • 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.


Know your tools and their limitations. (Ex. Knowing that air bags can slip and cause the load to fall may save your life one day). Take breaks and drink lots of water. Stay hydrated.
If you want to be brave, heroic, and professional, then be SAFE. The rest will follow. We do not and cannot trade lives for lives.
SCENE HAZARDS
VEHICLES ON FIRE
A very serious safety threat for everyone, especially us. Hydraulic piston units in the bumper, strut suspension units, hydraulic-pressurized lifting cylinders for hatchback, hood, and trunks are all potential hazards. When they become heated, pressure builds that causes them to become a rocket. You don't want to be around when that happens. Pressurized fuel systems may explode. Plastic gas tanks will melt, releasing their contents. This usually takes about 30 minutes of fire exposure to cause this to happen. Plastic is far safer than metal tanks since they are less likely to explode. Burning plastics give off hydrogen cyanide gas. This poison is skin absorbed so it doesn't matter if you have a SCBA on or not.
Insurance Companies consider auto fires as a "write off". You should too. Don't fight them unless you are well trained and you have a real need to. If the engine catches fire and the victims are still inside the car, then punch a hole through engine grill and knock fire down using a dry-chemical fire extinguisher. If you use a pressurized water extinguisher, be careful to not to push the fire toward the passenger compartment. Remove the occupants by the "rapid take-down" method of extrication. Isolate the battery only if it represents a danger. This is rare. Cars do not explode when they are on fire; tires will though and will scare you.
VEHICLES LEAKING FUEL
The fire department should handle, unless they are not yet on the scene. If this is the case, kick dirt on the puddle and cover it. Make sure no one is standing around smoking! Try to stem the leak with plugs, gum, etc. Keep all bystanders away. Do not step into the foam blanket the fire department puts down. This eliminates the protection it provides. Forget about working inside foam. It won't offer any protection from ignition unless it covers the spill completely and it is left undisturbed.
Pull a portable fire extinguisher and have someone man it until the fire department arrives. On working extrications have firefighters charge a 1 3/4" line and man it. Do not rush anything, it is only a hazard and is not considered an imminent life threat.
DOWNED WIRES
Did you know that 1/10 of an amp can kill and the average downed electric line has 190 amps, (which is 1,900 times the amount needed to kill!). Back off and call the Power Company. Trying to remove the power line yourself will result in an act of stupidity. The proper distance to position you rescue vehicle is one full span of wires away. Fire boots offer no protection against electricity. They have extra carbon added for strength and this makes them better conductors for shock. Watch for a tingling sensation in feet. If you feel that as you approach a vehicle, what do you think it means?
If someone is inside the vehicle and it catches fire, issue "Jump and Roll" instructions. If they are bleeding, give them instructions on how to control it. Only get them to leave the vehicle as a last resort when their life is in IMMINENT danger.
HAZARDOUS MATERIALS
What is a hazardous material? It is something that when released will harm those things that it touches regardless if it is people or the environment. Park no closer than 2,000' to a hazardous materials incident.
Take hazardous materials awareness classes.
TRAFFIC CONTROL SAFETY
In 1988, 11 rescuers were killed by traffic at MVA's nationwide. Most fatalities occurred in dark or poor weather, but some happened in broad daylight. You want to properly position your rescue vehicles to protect you from traffic. Do not allow the police to put you off the road just to facilitate the movement of traffic. Block the road with your apparatus if you feel the need. Turn off the headlights on your emergency vehicles to prevent blinding oncoming drivers. Do not park any closer than 50' to the accident. This provides a minimum safe working distance and diverts your vehicles exhaust fumes.

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


SAFETY OFFICER
Every working incident should include a safety officer. The role of this person is simple, to monitor and assess hazards and unsafe situations and develop measures for ensuring personnel safety. The safety officer should be someone who is knowledgeable of rescue procedures and techniques and must have the training and background to recognize real and potential hazards. The safety officer should be identified by an ID vest and should not take part in any activity other than the monitoring of the rescue scene.
ESTABLISHING COMMAND
STRATEGIC GOALS AT MOTOR VEHICLE ACCIDENTS
Preventing further injury or death

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.


Indications of a poorly managed scene include:
Lack of a clearly identifiable commander; fragmented efforts by 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.



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