Best practices in vehicle rescue fdic 2010 pp03

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Best Practices of Vehicle Rescue 2010. The melding of proper operational practices with vehicle technology concerns

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  • Sanson: high percentage of entrapped patients require advanced life support (ALS), including on scene intubation and chest decompression. Aggressive field resuscitation and immediate transport to a level 1 trauma centre is associated with a mortality lower than that predicted by TRISS in spite of the prolonged prehospital time Reines: TRC felt prehospital care was beneficial in 85% of cases Lies EurNCAP Segui-Gomez: 1206 eligible drivers in newer vehicles presented significantly fewer and less severe injuries than their 3827 pre-1998 model year counterparts
  • Best practices in vehicle rescue fdic 2010 pp03

    1. 2. "Best Practices" Vehicle Rescue
    2. 4. "Best Practices" Vehicle Rescue
    3. 5. Me? <ul><li>David Dalrymple </li></ul><ul><li>26 years in emergency services </li></ul><ul><li>Career- RWJUH EMS </li></ul><ul><li>Volunteer- Clinton EMS/Rescue </li></ul><ul><li>Rescue Instructor for 16 years- Vehicle Rescue is my specialty </li></ul><ul><li>TERC US – Education Chair </li></ul><ul><li>International certified Extrication judge-judged & lectured in US, Canada, UK, Europe & SA </li></ul><ul><li>2007 Harvey Grant award recipient </li></ul><ul><li>International registered SAVER instructor by ICET </li></ul><ul><li>Extrication Tactics columnist Fire Engineering Magazine </li></ul><ul><li>Team Captain-World Champion Vehicle Rescue Team 1998 </li></ul><ul><li>Educator- RoadwayRescue </li></ul>
    4. 6. NVT N ew V ehicle T echnology <ul><li>Vehicle materials, components, construction and concerns that will directly impact emergency responders while providing emergency services and pre hospital care. </li></ul>
    5. 10. Command & Control
    6. 11. Command & Control <ul><li>Officer identifies any NVT concerns and/or issues. </li></ul><ul><li>Communicates information to the crew </li></ul><ul><ul><li>Ensures all personnel are aware of hazard(s) </li></ul></ul><ul><li>Officer identifies & documents debris containing NVT hazard(s). </li></ul>
    7. 12. <ul><li>Access to NVT information is during training & scene operations. </li></ul>
    8. 15. <ul><li>All Hybrid models have a guide for emergency responders to deal with various emergencies </li></ul><ul><li>How to shut down, extrication concerns, firematic & towing concerns </li></ul>ERG Emergency Response Guide
    9. 16. Safety
    10. 17. Safety <ul><li>All personnel, especially those performing size up & evaluation, inspect vehicles completely for NVT concerns/hazards. Such hazards, when identified, are communicated to the rest of the crew </li></ul>
    11. 18. <ul><li>Space is observed as possible when interacting with SRS and patients. </li></ul>
    12. 20. DUAL STAGE
    13. 28. 2011 Ford Rear Seatbelt SRS
    14. 30. <ul><li>As part of power isolation, the vehicle is shut down & keys removed & secured. Such action is documented. </li></ul>
    15. 31. Shut down <ul><li>Each vehicle has unique emergency procedures-however-if you do the following 2 actions they will disable the HV circuit & disarm/discharge the SRS system(s): </li></ul><ul><ul><li>Turn the key to the OFF position and remove the key and keep it AWAY from the vehicle </li></ul></ul><ul><ul><li>Disconnect the 12V battery (both + & -) </li></ul></ul>
    16. 32. Vehicle Pwr Button No Mechanical Key System
    17. 33. Where are the keys?
    18. 37. 40% of batteries live outside engine compartment
    19. 39. Power Shut Down ASAP!
    20. 40. <ul><li>When severing wires, use of a hand cutter – not a power hydraulic cutter – is indicated. </li></ul>
    21. 41. Cut wiring with a HAND cutter-not a power hydraulic tool!
    22. 42. <ul><li>Interior trim is displaced to evaluate if potential NVT hazards are present. If such hazards are present their identification is made to the entire crew & documented. </li></ul>
    23. 46. Where do we cut?
    24. 47. <ul><li>When vehicle components are displaced/removed care is given due to potential NVT concerns. </li></ul>
    25. 50. <ul><li>Use of pertinent personal protective equipment at all times. </li></ul>
    26. 52. <ul><li>Use of respiratory protection is required when performing glass management. </li></ul>
    27. 56. Tool Usage/Evolutions
    28. 57. Rescuer Safety – Tool Handling <ul><li>Always be situationally aware </li></ul><ul><li>DO NOT get between the vehicle & tools - Especially power hydraulics! </li></ul><ul><li>Always unplug electric tools prior blade/bit changes! </li></ul><ul><li>Treat air chisels as a loaded gun when pressurized </li></ul><ul><li>Watch where your hands/arms/feet are at all times </li></ul><ul><li>Warn interior rescuer when operating tools that will intrude and/or have effect on patient care </li></ul><ul><li>Always use a tool-not your hands-when removing glass </li></ul>
    29. 58. <ul><li>Management of vehicle stabilization during the incident and especially during tool operations. </li></ul>
    30. 60. A Stabilization thought… <ul><li>Ever thought about “run flat” tires.. </li></ul><ul><li>Two thought processes </li></ul><ul><ul><li>Solid insert </li></ul></ul><ul><ul><li>Stiffened sidewall </li></ul></ul><ul><li>How low will the tire deflate now? </li></ul>
    31. 61. <ul><li>Attention given to appropriate space making evolutions in relation to patient care/outcome. </li></ul>
    32. 62. “ WHY WE EXTRICATE” <ul><ul><li>Physical Entrapment </li></ul></ul><ul><ul><ul><li>Encasement in metal </li></ul></ul></ul><ul><ul><ul><li>Pinned VS Trapped </li></ul></ul></ul><ul><ul><li>Nature of Injuries and Restricted Space “Medically Entrapped” </li></ul></ul><ul><ul><ul><li>Making space in order to prevent further injury by manipulating the patient during removal </li></ul></ul></ul>
    33. 63. Interior Considerations <ul><li>Cockpit </li></ul><ul><li>Seats? </li></ul><ul><li>Seating positions </li></ul><ul><li>Vehicle concerns </li></ul><ul><li>Injury patterns /considerations </li></ul><ul><li>Packaging concerns </li></ul><ul><li>Safety/protection </li></ul>
    34. 64. Creating Space <ul><li>Medically entrapped = space needed </li></ul><ul><li>Creating Space is important </li></ul><ul><li>Creating Space is your insurance that no further harm will done to the patient </li></ul><ul><li>Think Space to…… </li></ul><ul><ul><li>Have adequate room to work </li></ul></ul><ul><ul><li>Have adequate room to provide patient care </li></ul></ul><ul><ul><li>Have adequate room to properly remove the patient </li></ul></ul>
    35. 65. Door pop or side removal Is this enough space today?
    36. 66. Rescue Real Estate concept Who &quot;owns&quot; what on the vehicle Engine Co Hazard control Rescue Team Extrication EMS Patient Care
    37. 67. <ul><li>Whenever using tools in the area of the passenger cell appropriate protective barriers are placed between the patient(s) and the interior rescuer. </li></ul>
    38. 69. <ul><li>Use of strategic cutting evolutions to enhance space making operations. </li></ul>
    39. 70. <ul><li>Cutting hinges/latches is a good tactic today </li></ul><ul><li>Less “stress” on patients </li></ul><ul><li>Can be easier to facilitate than spreading apart </li></ul><ul><li>Need to get blades around device </li></ul><ul><li>Can the tool do the job? </li></ul>“ Cutting” Hinges/Latches
    40. 73. <ul><li>When performing tool operations, you need have both spreading & cutting tools available & ready for use. </li></ul>
    41. 74. Door “Shred” <ul><li>“ Outer” door materials tear easy </li></ul><ul><li>When they do, they leave little to push against </li></ul><ul><li>We need to get the spreader tips past the hinges/latch to minimize tear </li></ul><ul><li>Have cutters ready to go </li></ul>
    42. 75. <ul><li>Concern given to cutting material(s) with possible NVT concerns with respective tools </li></ul>
    43. 76. Material & Construction <ul><li>Construction advances don ’ t prevent entrapment </li></ul><ul><li>Entrapped patients require aggressive management </li></ul><ul><li>Construction advanced do effect major injury </li></ul>
    44. 77. B-Post reinforcement
    45. 78. B-Post reinforcement
    46. 79. Carbon Fiber Body Panels
    47. 82. <ul><li>Care & concern given to vehicle design and component concerns in relation to space making. </li></ul>
    48. 83. Crush Zones
    49. 85. What tool Evolutions will be difficult? Does this look familiar?
    50. 87. 70% of incidents Hybrids & Alternative Fueled Vehicles
    51. 89. Stay away from BRIGHT ORANGE CABLE
    52. 90. Stay away from BRIGHT BLUE cable!
    53. 91. Review - Hybrid 101 <ul><li>All hybrids start on electric power alone </li></ul><ul><li>Some travel on electric power alone up to certain speeds </li></ul><ul><li>HV power is direct current DC </li></ul><ul><li>Some hybrids also generate 110 AC </li></ul><ul><li>HV circuit is self contained – does not ground out to the vehicle chassis </li></ul><ul><li>Drivetrain power is computer controlled and managed </li></ul><ul><li>Gas/Diesel side of drivetrain is load dependant </li></ul><ul><li>All Hybrids have a HV drivetrain circuit as well as a normal 12v automotive electric system </li></ul><ul><li>Even when the hybrid is shut down and secured there will ALWAYS be power in the HV battery </li></ul><ul><li>As emergency responders there is NO NEED to interact with the HV battery – leave it alone! </li></ul><ul><li>Crayola colors to remember > bright orange = HV power </li></ul><ul><ul><ul><ul><ul><li>Bright blue = “intermediate” HV power (GM products) </li></ul></ul></ul></ul></ul>
    54. 92. Impact disarms Hi-Voltage
    55. 93. Tool Evolutions are NOT an issue!
    56. 94. 2010 Prius Solar Roof Use caution in cutting/spreading in this area if curtain is undeployed
    57. 100. Let’s summarize…. <ul><li>Safety systems are more wide spread & comprehensive </li></ul><ul><li>Construction, materials & components will impact rescue efforts more & more </li></ul><ul><li>Motive power will make dramatic strides in the next 33-38 months </li></ul><ul><li>Rescue teams will need to “think & work smart” </li></ul><ul><li>“ Silent”cars are NOT just hybrids and electrics </li></ul><ul><li>More background information will be needed about vehicles & their components </li></ul><ul><li>Vehicle size issues </li></ul><ul><li>Training issues & concerns </li></ul>
    58. 102. In the time we have spent together today 172 people have died in road traffic accidents worldwide

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