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Extrication and Rescue Methods for the Ambulance and Emergency team of OHMRI DR. SMRUTIRANJAN PATANAIK CHIEF CONSULTANT - OHMRI
General Principles All operations include 7 basic steps Form a mental picture of how the operation will be carried out
Size-Up Begins at moment of dispatch; continues throughout rescue In route: Think through the steps Decide what you are going to do first When you arrive: Avoid being caught up in the situation Step back, survey scene
Size-Up Safety Are there potential hazards to you? Are bystanders at risk? Is the patient in danger? Dead Rescuers Don’t Help Anyone!
Size-Up Outside Help Is additional assistance needed? If you need something, call for it! Stay ahead. If you routinely work with other agencies, have plan of operations worked out in advance.
Size-Up Significant Information What kinds of vehicles? How many? What kind of collision? How many patients? Any potential for hazardous materials? Anyone ejected?
Hazard Control Traffic Park on same side of highway as collision Park up highway, beyond scene if possible Have someone spotting traffic at all times Wear reflective clothing at night Provide clear visual signals to drivers well in advance of reaching scene
Hazard Control Power Lines Consciously look for lines on ground Use particular caution when vehicle has struck utility pole or tree Tell patients to stay in vehicle Call the power company!
Hazard Control Gasoline or Fuel Spillage Shut off vehicle ignition keys Remove all ignition sources from area Ask Fire Department to get a charged hose line on the ground Disconnect battery cable (+)—weigh risks vs. benefits
Hazard Control Unstable Vehicles Any vehicle that does not have all 4 wheels touching the pavement is unstable! Never push back into position Stabilize as found Maximize number of contact points with ground; spread over as wide an area as possible
Hazard Control Hazardous Materials Assume presence at all incidents until proven otherwise Base decision to attempt rescue on best available information about product(s) and on expert advice
Gaining Access Objective is to get to patient. Try before you pry! Work from simple to complex.
Gaining Access: Residences Check for open windows, doors Ask if anyone else (neighbors, relatives) has key If a window is open, cut through screen If no windows are open, break smallest window through which access can be obtained
Gaining Access:Vehicles Upright vehicle Enter through doors When you open door, be sure patient is not against it If door is locked, ask patient if he can open it If door will not open, break furthest window away from patient to gain access
Gaining Access Vehicle on Side Stabilize vehicle Enter through top door If door will not open, break rear window
Gaining Access Vehicle Upside Down Gain access through windows Doors may be supporting vehicle body Careless opening, removal may cause vehicle collapse
Gaining Access Glass can be broken quickly andeffectively with a sharp blow to thecorner of a window about 2 inches from the edge of the glass.
Life-Saving Care Rapidly evaluate patient’s condition Immediate threats are: Hypoxia Shock At this point, why patient isn’t oxygenating or perfusing is irrelevant
Life-Saving Care If ABCs compromised, correct problem! If you cannot correct problem: Support oxygenation, ventilation Extricate patient to long board ASAP Rapidly transport
DisentanglementRemove vehicle from patient, NOT patient from vehicle!
Disentanglement Patient-centered Keep someone with patient to: Monitor condition Ensure that attack on vehicle does not endanger patient
Disentanglement Do NOT do anything to vehicle unless you know EXACTLY what result will be Protect patient at all times Cover blanket for protection Talk to him Explain what is happening
Preparation for Removal Packaging = Preparing patient for removal as unit All injuries stabilized Patient moves as single unit through route of egress
Preparation for Removal Any lower extremity injury can be stabilized temporarily by securing it to other extremity Any upper extremity injury can be stabilized temporarily by securing it to the chest KEDs are used to keep head-neck-torso in line during extrication; patient must be extricated onto a long board.
Preparation for Removal Do NOT attempt complete packaging of patients with compromised ABCsThere in NO value in a well- packaged corpse!
Removal Through doors if vehicle is upright. Through roof if vehicle is on side. Through window if vehicle is overturned.
Conclusion Successful rescues are based on planning, practice. Know what community’s target hazards are. Have plan for managing them. Know who you will be working with; train with them. Know what kinds of help are available. Do NOT be afraid to call for help if you need it!
ConclusionThe challenge is NOT to be innovative in a crisis. The challenge is to be well-trained and well-disciplined enough to FOLLOW THE RULES!