Vehicle Extrication and Special

Rescue

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 Introduction
 EMS departments must be prepared to
respond to a variety of special rescue
situations.

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 As a paramedic, you may not be responsible
for special rescue and extrication.
Nevertheless, you must be prepared for it and
be aware of the associated hazards.

 Rescue awareness and operations education

help you avoid rescue situations that you are
not trained to handle.
 Introduction (cont’d)
 Types of special rescue incidents include:
 Vehicle extrication
 Confined space ‫مكان ضيق‬
 Trench ‫خندق‬
 Water
 Hazmat ‫المواد الخطرة‬
 Agricultural ‫الزراعية‬

 Paramedics are often first on the scene.

 Rescue means: to deliver from danger.
 Rescue Training
 All EMS providers must have some formal
education or training in rescue techniques.
 Education and training focus on awareness,
enabling paramedics to identify hazards and
secure the scene.
 The function of a paramedic on the scene at a
rescue incident depends on the company.
 Safety is the primary concern.
 Providers must wear personal protective
equipment (PPE).
 Rescue Training (cont’d)
 A technical rescue incident (TRI) is a complex rescue
incident.
 TRI involves:
 Vehicle extrication
 Water/ice/confined spaces rescue
 Trench collapse
 Structural collapse
 High-angle rescue
 Hazardous materials incidents
 Wilderness search and rescue ‫البرية‬
 b. TRIs require specially trained personnel and
special equipment.
 Rescue Training (cont’d)
 Three levels of TRI training include:
 Awareness
 recognizing hazards, securing the scene, and calling for
appropriate assistance.
 No actual use of rescue skills
 Operations
 Geared toward working in the area directly surrounding the
hazard (the warm zone)
 Assist those conducting the operation
 Technician
 Direct involvement in the rescue operation, including use of
equipment, patient care, and incident management
 Guidelines for Rescue Operations
 Follow these guidelines when assisting rescue
team members:
 Be equipped, prepared, and ready to meet the
expectations of your role.
 Ensure you have the proper protective gear,
equipment, and training, and ensure you coordinate
with other rescuers.
 Maintain situational awareness.
 Remain aware of your situation and the conditions
under which you are working.
 Determine whether the situation or conditions pose
an immediate or eventual threat.
Guidelines for Rescue Operations(cont’d)

 Work as a team.
 Even though the rescue team is trained in
specific tasks, they still require the support of
others.
 Follow the golden rule of public service.
 It’s easy to concentrate only on the technical
aspects of the rescue, forgetting about the
patient.
 Stay with the patient whenever possible,
providing updates about the rescue actions.
 Steps in Special Rescue
 Eight steps to ensure safety, effectiveness, and
efficiency:
 Preparation
 Response
 Arrival and scene size-up
 Scene stabilization
 Access
 Disentanglement ‫التفكك‬
 Removal
 Transport
 Preparation
 Training with fire departments and special
rescue teams allows you to:
 Be prepared to respond to mutual aid calls
 Learn the skill level of other departments’
personnel and their equipment
 Practice using key terminology to communicate
better in the field
 Preparation (cont’d)
 Assess the following issues before
responding to TRIs:
 Does the department have the personnel and
equipment needed to handle a TRI?
 Which equipment and personnel will be first on
scene on a TRI call?
 Are department personnel familiar with the hazard
areas in their response area?
 Have personnel visited those areas with local

representatives?
 Response
 If your department has its own technical rescue
team, it will usually respond with:
 Rescue squad ‫فرقة االنقاذ‬
 Ambulance or emergency vehicle
 Fire engine company
 Chief officer
 In some EMS units, the rescue squad will come
from an outside agency.
 The EMS department itself provides the primary
technical rescue services.
 Arrival and scene size-up
 Information received during the initial dispatch call is critical to
the success of the rescue operation.
 Location and nature of the incident
 Condition and position of each patient
 Number of patients trapped or injured
 Specific injuries
 Hazards at the scene
 Scene size-up includes the initial evaluation of:
 Scope and magnitude of the incident
 Nature of the incident
 Potential number and severity of patients
 Hazards
 Access to and egress ‫ الخروج‬from the scene
 Environmental factors
 Operating and immediately available resources
Arrival and scene size-up (cont’d)
 Hazards
 At a TRI, you may be tempted to immediately
approach the patient or the accident area.
 Your own safety is paramount, and you must also protect
your partner and the public.
 Consider the hazards, such as utilities and environmental
conditions that may be immediately dangerous to life and
health.
 Do not rush ‫ تتعجل‬into the incident scene until you have
completely assessed the situation.
 Arrival and scene size-up (cont’d)
 Traffic incident management is the method of controlling
the flow of motor vehicle traffic.
 Ongoing traffic is perhaps the most common and dangerous
hazard .
 All emergency responders should know the crucial
components of traffic incident management to identify when
it is needed and whether it is being managed correctly.
 Individuals are at risk of being injured or killed due to

crashes that may occur as traffic flows through and

around rescue scenes.
 Rescue operations can operate more efficiently when

traffic flow in the area is properly managed.

 When possible, rescue operations should be moved

away from flowing traffic.

 Cont’d
 Traffic should typically be diverted around the
rescue work zone.
 Flares, cones, flags, and signs should be used.
 All rescuers should wear compliant reflective high-
visibility garments.
 Flashing lights, vehicle headlights, or scene lighting
aimed in the direction of oncoming traffic is likely to
confuse, blind, or even attract drivers.
 A large vehicle such as a fire engine should be
positioned to protect the rescue work area if rescue
operations must occur close to flowing traffic.
 Scene stabilization
 Stabilization of the incident once additional
resources are on the way
 Observe the geographic area.
 Identify routes of access and exit.
 Note weather and wind ‫ الرياح‬conditions.
 Consider evacuation problems ‫ مشاكل اإلخالء‬and
transport distances.
 Scene stabilization (Cont’d)
 Assumption of command
 The first arriving responder begins using the incident
management system.
 At any TRI, follow the incident commander’s ‫قائد الحادث‬
(IC’s) orders.
 It is critical to follow the IC’s orders.
 Three guidelines should be followed at every rescue
scene:
 Approach the scene cautiously.
 Position apparatus properly.
 Assist specialized team members as needed.
Scene stabilization (Cont’d)
 Emergency vehicles
 When determining where to locate your vehicle, take
into account the safety of emergency workers, patients,
and other motorists.
 Disrupting traffic flow creates a hazard.
 Request road closures as necessary.
 Large emergency vehicles can be positioned to provide
a barrier against unobservant motorists.
 Use only essential warning lights.
 Too many lights tend to distract or confuse drivers.
 Law enforcement can coordinate traffic control.
 Scene stabilization (Cont’d)
 Outer and inner circle surveys
 As you approach the rescue area, begin with the outer
circle survey.
 Involves evaluating the area surrounding the TRI
 Important step in identifying any life-threatening hazards and
taking measures to avoid or mitigate them
 Determine whether the situation is a search, rescue, or
recovery.
 Perform an inner circle survey on the heart of the TRI
once the outer circle survey is complete.
 If possible, conduct a 360° evaluation around the center of the
incident.
 Scene stabilization (Cont’d)
 Control zones
 The IC should coordinate with law enforcement and the fire
department to secure a perimeter surrounding the scene.
 Establish three controlled zones:
I. Hot zone
 This zone is for entry and rescue teams only.
 The hot zone immediately surrounds the scene.
 The size is proportional to hazards.
II. Warm zone
 For properly trained and equipped personnel only
 Decontamination and hot zone support
III. Cold zone
 For staging vehicles and equipment
 Contains the command post ‫مركز القيادة‬
 Scene stabilization (Cont’d)
 Scene management
 Ensuring your own safety and the team’s
safety is the first priority.
 You must also ensure the patient’s safety and
the safety of any bystanders.
 use of personal
 Patient assessment and care
 protective equipment (PPE)
 Patient assessment and care
 Scene stabilization (Cont’d)
 Specific hazards
 Motor vehicle stabilization
 Any motor vehicle involved in a crash must be stabilized before
you gain access to the patient.
 Simple ways of stabilizing a motor vehicle after a crash include:
 Engaging the parking brake, Placing the vehicle in park & Shutting
off the engine
 Utility hazards
 Maintain distance from utility hazards such as downed lines, which
require the assistance of specially trained personnel.
 Scene stabilization (Cont’d)
 Protective equipment
 Specialized teams should use devices approved
for the rescue environment.
 Considerations include:
 Visibility of PPE
 Flame- or flash-protective PPE for certain rescue
situations
 Footwear designed for the environment
 Protective head gear
 American National Standards Institute–approved safety
glasses or goggles
 Puncture- or cut-resistant gloves
 Scene stabilization (Cont’d)
 Access
 Once the scene is stabilized, focus on how to access
the patient.
 Simple access requires hand tools.
 Complex access requires special tools.
 Communication with patients during the rescue is
essential to ensure they are not injured further by the
rescue operation.
 Gaining access to a patient depends on the type of
incident and the nature and severity of the patient’s
injuries.
 Means of access may change during the rescue.
 Scene stabilization (Cont’d)
 Disentanglement
 Emergency medical care should begin as soon as the
patient is accessed.
 A team member should stay with the patient while he
or she is being disentangled in order to direct the
rescuers.
 Disentanglement involves freeing a patient from
whatever is trapping him or her (eg, cutting the vehicle
away from the patient in vehicle extrication) .
 Scene stabilization (Cont’d)
 Removal
 Preparing a patient for removal involves:
 Maintaining control of life-threatening problems

 Dressing wounds

 Stabilizing suspected fractures and spinal injuries

 Expedite removal if:

 The patient is deteriorating rapidly & Hazards are

present
 Packaging involves preparing the patient for movement as a
unit.
 A basket stretcher (Stokes litters or Stokes baskets) helps
move patients to safety.
 Hand carrying can be physically demanding for rescuers.
 Scene stabilization (Cont’d)
 Transport
 Transport varies depending on:
 Severity of the patient’s injuries
 Distance to the medical facility
Questions?

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