ChapterChapter

Gaining AccessGaining Access

andand

RescueRescue

Twenty-SevenTwenty-Seven

Extrication: 10 fundamental phases

Role of the EMT-B at an extrication

How to size-up and recognize potential hazards at rescue scene

What personal protective equipment should be worn at the rescue scene

How to determine the need for extrication

CORE CONCEPTSCORE CONCEPTS

(Continued)(Continued)

ChapterChapter

Twenty-SevenTwenty-Seven

Importance of safety equipment at rescue scene

How to stabilize vehicle and gain access to patient

Typical disentanglement action plans used at a vehicle rescue

CORE CONCEPTSCORE CONCEPTSChapterChapter

Twenty-SevenTwenty-Seven

Fundamental Phases Fundamental Phases of Extricationof Extrication

Prepare for the rescue.Prepare for the rescue. Size up the situation.Size up the situation. Recognize and manage hazards.Recognize and manage hazards. Stabilize the vehicle or structure prior to entering.Stabilize the vehicle or structure prior to entering. Gain access to the patient.Gain access to the patient. Perform an initial patient assessment and aPerform an initial patient assessment and a focused trauma exam. focused trauma exam.

(Continued)(Continued)

Disentangle the patient.Disentangle the patient. Immobilize and extricate the patient.Immobilize and extricate the patient. Provide ongoing assessment, triage, treatment, Provide ongoing assessment, triage, treatment,

and transport. and transport. Terminate the rescue.Terminate the rescue.

Fundamental Phases Fundamental Phases of Extricationof Extrication

Provide patient care beforeProvide patient care before

without further injury.without further injury.

Ensure that patient is removedEnsure that patient is removed

extrication.extrication.

endangers patient or rescuer.endangers patient or rescuer. Extricate first Extricate first onlyonly if delay if delay

(Continued)(Continued)

Role of Nonrescue EMT-BRole of Nonrescue EMT-B

Work with others:Work with others:• Cooperate with non-EMS personnel.Cooperate with non-EMS personnel.• Prevent any of their activities fromPrevent any of their activities from

injuring patient.injuring patient.

Role of Nonrescue EMT-BRole of Nonrescue EMT-B

Follow chain of command.Follow chain of command.

Ensure patient care beforeEnsure patient care beforeextrication unless delay extrication unless delay endangers patient/rescuer.endangers patient/rescuer.

Remove patient withoutRemove patient withoutinflicting further injury.inflicting further injury.

Role of Rescue EMT-BRole of Rescue EMT-B

Top priority for EMS workers.Top priority for EMS workers. Wear appropriate protectiveWear appropriate protective

• HeadgearHeadgear• Eye protectionEye protection• Hand protectionHand protection• Body protectionBody protection

clothing:clothing:

Personal Safety EquipmentPersonal Safety Equipment

Protective Clothing for ExtricationProtective Clothing for Extrication

Remind new EMT-Bs that traffic and spectators can become hazards if not controlled. A number of EMT-Bs have been killed at the scene of collisions by drivers who were watching the collision rather than the EMT-B crossing the street.

PPRECEPTOR RECEPTOR PPEARLEARL

Patient SafetyPatient Safety Next priority for EMS providers.Next priority for EMS providers.

Keep patient informed of Keep patient informed of

activities and what to expect.activities and what to expect.

Protect patient from glass, sharpProtect patient from glass, sharpmetal, other hazards.metal, other hazards.

Unstable collision vehicles pose aUnstable collision vehicles pose a hazard to rescue workers. hazard to rescue workers.

Tires can be deflated by pulling Tires can be deflated by pulling valve stems. valve stems.

Vehicle StabilizationVehicle Stabilization

Make sure engine is turned off.Make sure engine is turned off.

Step chocks (cribbing) are often used.Step chocks (cribbing) are often used.

Tell new EMT-Bs that when placing cribbing, they should never kneel. They should always squat, staying on both feet so they can quickly move away from the vehicle if necessary.

PPRECEPTOR RECEPTOR PPEARLEARL

Try opening Try opening eacheach door. door.

Roll down windows.Roll down windows.

Have patient unlock doors.Have patient unlock doors.

Simple AccessSimple Access(No Equipment Needed)(No Equipment Needed)

Beyond scope of EMT-B course.Beyond scope of EMT-B course.

Courses are available forCourses are available forinterested EMT-Bs:interested EMT-Bs:• Trench rescueTrench rescue• High-angle rescueHigh-angle rescue• Basic vehicle rescueBasic vehicle rescue

Complex AccessComplex Access(Special Equipment Needed)(Special Equipment Needed)

Maintain cervical Maintain cervical spine stabilization.spine stabilization.

Complete initial assessment.Complete initial assessment.

Provide critical interventions.Provide critical interventions.

(Continued)(Continued)

Removing the PatientRemoving the Patient

Immobilize spine securely:Immobilize spine securely:• Short spine boardShort spine board• Rapid extricationRapid extrication

Lift and move Lift and move patientpatient, not short, not shortspine spine boardboard..

(Continued)(Continued)

Removing the PatientRemoving the Patient

Use sufficient personnel to liftUse sufficient personnel to lift

and move patient.and move patient.

Choose path of least resistance.Choose path of least resistance.

Continue to protect patientContinue to protect patient

from hazards.from hazards.

Removing the PatientRemoving the Patient

1. Name the 10 phases of the extrication 1. Name the 10 phases of the extrication process.process.

2. What is the role of the nonrescue EMT-B 2. What is the role of the nonrescue EMT-B at a rescue scene?at a rescue scene?

RREVIEW QUESTIONSEVIEW QUESTIONS

4. Describe the complex access plan.4. Describe the complex access plan.

3. Describe the simple access plan.3. Describe the simple access plan.