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A C C I D E N T  R E S C U E  T R A I N I N G  M O D U L E  F O R  A M B U L A N C E  A N D  E M E R G E N C Y  S E R V I C E S  O F  O H M R I
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A C C I D E N T R E S C U E T R A I N I N G M O D U L E F O R A M B U L A N C E A N D E M E R G E N C Y S E R V I C E S O F O H M R I

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  • 1. Extrication and Rescue Methods for the Ambulance and Emergency team of OHMRI DR. SMRUTIRANJAN PATANAIK CHIEF CONSULTANT - OHMRI
  • 2. General Principles All operations include 7 basic steps Form a mental picture of how the operation will be carried out
  • 3. 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
  • 4. Size-Up Safety  Are there potential hazards to you?  Are bystanders at risk?  Is the patient in danger? Dead Rescuers Don’t Help Anyone!
  • 5. 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.
  • 6. Size-Up Significant Information  What kinds of vehicles?  How many?  What kind of collision?  How many patients?  Any potential for hazardous materials?  Anyone ejected?
  • 7. 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
  • 8. 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!
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. Hazard Control Appropriate Protective Clothing  Atleast helmet, gloves  Eye protection  Work boots  Turnout coat
  • 13. Gaining Access Objective is to get to patient. Try before you pry! Work from simple to complex.
  • 14. 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
  • 15. 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
  • 16. Gaining Access Vehicle on Side  Stabilize vehicle  Enter through top door  If door will not open, break rear window
  • 17. Gaining Access Vehicle Upside Down  Gain access through windows  Doors may be supporting vehicle body  Careless opening, removal may cause vehicle collapse
  • 18. 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.
  • 19. 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
  • 20. Life-Saving Care If ABCs compromised, correct problem! If you cannot correct problem:  Support oxygenation, ventilation  Extricate patient to long board ASAP  Rapidly transport
  • 21. DisentanglementRemove vehicle from patient, NOT patient from vehicle!
  • 22. Disentanglement Patient-centered Keep someone with patient to:  Monitor condition  Ensure that attack on vehicle does not endanger patient
  • 23. 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
  • 24. Preparation for Removal Packaging = Preparing patient for removal as unit  All injuries stabilized  Patient moves as single unit through route of egress
  • 25. 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.
  • 26. Preparation for Removal Do NOT attempt complete packaging of patients with compromised ABCsThere in NO value in a well- packaged corpse!
  • 27. Removal Through doors if vehicle is upright. Through roof if vehicle is on side. Through window if vehicle is overturned.
  • 28. 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!
  • 29. 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!