Vehicle Extrication Chapter 1

Introduction to Vehicle Extrication

• Vehicle extrication is the removal and treatment of patients trapped by machinery or equipment.
• Disentanglement is the manipulation of vehicle or machinery components to provide for the removal of a packaged patient(s).
• Rescue is the removal of a patient from an untenable or unhealthy situation or atmosphere.

Phases of Extrication

• Hazard Assessment & Size-up
• Hazard Control & Incident Stabilization
• Gaining Access & Patient Assessment
• Disentanglement
• Patient Packaging
• Extrication

Organizations Specific to Extrication

• USDOT: Develops and coordinates policies and programs designed to protect and improve the U.S. transportation system.
• NHTSA: Sets and enforces safety standards, and funds state and local highway safety programs.
• IIHS: Evaluates crash avoidance and crashworthiness of vehicles, and evaluates physical and environmental factors.
• ANSI: Manages voluntary standardization and facilitates development of standards.
• NFPA: Develops technical consensus standards, and develops fire training and public education materials.
• Transport Canada: Primary regulatory agency of vehicle and highway safety in Canada, and works with other partners to provide vehicle safety information.
• TERC: Provides guidance on transportation for emergency services, and has several goals.
• NTSB: Responsible for determining probable causes of transportation accidents.

Rescue Organization Responsibilities

• Conform to laws and regulations, and ensure member training is nationally recognized and appropriate.
• Conduct hazard/risk assessment surveys, and develop written response plans (SOP/SOG).
• Set minimum entrance requirements, and determine response/operational capabilities.
• Provide training opportunities for personnel, and provide required equipment and PPE.
• Establish a Safety Program.

AHJ and SOP Concepts

• AHJ: Authority Having Jurisdiction, and SOP: Standard Operating Procedures.

Hazard and Risk Assessment

• A formal review of potential and probable hazards and risks that may be encountered while performing key functions during a rescue/extrication emergency.
• Identify potential hazards, assess the level of risk within the response area, and determine the possible and probable rescue situations that could occur within the response area.
• Many levels of government perform Regional Vulnerability Studies.

Written Response Plans

• Provide a method for implementing changes and revisions, and must be formally reviewed and adopted.
• Updated as required, and provide a method for implementing changes and revisions.

Operational Capabilities

• Hazard/risk assessment, personnel training, and internal/external resources.

Extrication Equipment

• Identify equipment and resources available internally and externally, and acquire equipment applicable to the organization's response level and capability.
• Maintain equipment in accordance with manufacturer's recommendations.

Extrication PPE

• Must be selected and suited for the anticipated hazards and risks, and personnel should be trained in the capabilities and limitations of their PPE.
• Personnel require training in inspection, care and maintenance, and use and operation of PPE.

Respiratory Protection

• May be required for certain extrication incidents, such as WMD, fire & explosion potential, bio-hazards, and IDLH environments.
• Types of respiratory equipment commonly used at rescue/extrication emergencies include SAR, APR, PAPR, and SCBA.

After Action Reports

• Serve two main purposes: improve organizational operations and processes, and identify strengths and weaknesses.
• Also known as Post Incident Analysis (PIA), and an evaluation tool used for project or incident improvement.

Size-up

• Defined as an ongoing evaluation process of the incident and response efforts, and results in a dynamic plan of action.
• Assesses all possible conditions, contributing factors, and resource requirements.

Size-up Considerations

• Rescue or Recovery, risk/hazard analysis, and safety & survival priorities (self, fellow rescuers, bystanders, and patients).

• An effective risk assessment and hazard identification and control process sets the stage for success.### Vehicle Extrication

• Vehicle extrication involves most emergency response organizations, emphasizing the importance of following regional and national standards for safety.

Critical Skill Sets

• Safe use of equipment and tools for rescuer protection
• On-scene medical care and patient packaging
• Accessing patients, assessing, and transferring them to EMS in safe condition

Extrication Incident Action Priorities

• Life Safety: personnel safety, patients, and bystanders
• Incident Stabilization: scene control, vehicle stabilization, patient stabilization, and hazard elimination
• Property & Environmental Conservation: minimizing damage, implementing non-destructive methods, and securing unprotected property
• After Action Review: evaluating response actions, identifying strengths and weaknesses, and learning from experiences

Incident Roles & Responsibilities

• Rescue Group: vehicle stabilization, patient access, stabilization, disentanglement, and packaged patient removal
• Law Enforcement Group: traffic control, crowd control, and investigation
• EMS Group: patient evaluation, treatment, and transportation
• Fire Suppression Group: fire protection, ignition control, and scene protection

Extrication Incident Management

• Identify standards that relate to managing an extrication incident
• Identify basic facts about safety requirements for extrication incidents
• Describe the importance of training to extrication incident safety

Learning Objectives

• Identify key components of an extrication operation
• Describe the duties performed by extrication personnel
• Identify facts about the early stages of an emergency extrication response
• Describe the duties performed by outside agencies during an extrication operation

Extrication Standards

• NFPA 1670: Training & Response Levels
• NFPA 1006: Minimum standards for professional certification testing for Technical Rescue
• NFPA 1500: Fire Department Occupational Safety & Health
• NFPA 1561: Emergency Services Incident Management System

Presidential Directive

• HSPD-5: directs federal, state, local, and tribal entities to operate with the NIMS-ICS system

Extrication Incident Safety

• Success is defined by effectiveness and safety
• A safe extrication environment begins with key elements that may expand during the operation
• Incident Action Plans must be dynamic and flexible to meet the challenges of the incident

Training

• Training provides essential knowledge and skill sets to rescue personnel
• Working knowledge of strategies, tools, and techniques
• How to function as a team member
• SOPs and pre-incident plans must be practiced during training

Operational Assignments

• Assignments are based on contributing factors related to the incident
• Match the most qualified and capable crew members to the assigned task(s)
• Ongoing assessment of progress

Medical Component

• Risks are managed through training, experience, probable outcomes, equipment reliability, and procedural safety margins
• Medical component is focused on triage, treatment, and transportation
• BLS unit should be readily available to manage potential rescuer injuries

Rehabilitation (Rehab)

• Rehab stations should be established at every prolonged operation
• Contributing factors: heavy labor, environmental conditions, accumulated activity, and other health & safety factors
• Rehab focus areas: rest, rehydration, medical evaluations, and crew rotation

Mitigating Potential Hazards

• Common extrication hazards: traffic, utilities, vehicle fluids, hazardous materials, and damaged or involved vehicles
• When addressing hazard management strategies, consider the patient(s) condition and exposure
• Scene control is critical to prevent injuries and risks

Incident Safety Officer (ISO)

• An Incident Safety Officer (ISO) is required during extrication operations
• Performs an ongoing assessment of incident actions and conditions
• ISO should have a working knowledge of hazards, strategies, tactics, tools, and equipment

Personnel Accountability

• Required for effective and safe scene management
• Accountability needs to become part of the organization's response culture
• Use accountability procedures during training sessions

Emergency Extrication Response

• Technology enhancements have increased the amount and level of information received during extrication emergencies
• Implementing the response: pre-incident planning, standardized responses, and resource capabilities### Size-up and Incident Assessment
• Observe variables on the scene to decide if more resources are needed
• Assess for specialized resources (task force): Hazmat, Technical Rescue, Suppression
• Consider vehicle(s): position, stability, condition, and mechanism of injury

Assessment of Patients

• Requires a more detailed evaluation of injuries and entrapment factors
• Patients can extend beyond the involved vehicle areas
• Access to patients cannot begin until hazards are controlled and vehicles are stabilized
• Requires a risk/benefit decision-making process

Triage

• Key assessment areas: number of patients, injuries, and entrapment conditions
• Establish medical priorities
• Required transportation services: land, air, water

Extrication Assessment

• Task/resource assessment process
• Goal: execute a safe and quick extrication
• Provides critical information to support response decisions
• Resource management includes both personnel and equipment

Patient Removal Assessment

• Two primary methodologies: normal (standard) extrication and rapid extrication
• Normal extrication: concept of first removing the vehicle or machinery components away from the patient
• Rapid extrication: used only in emergency life-threatening situations, removal of patient in the first priority

Incident Management

• Purpose: organize the response to enhance safety, efficiency, and effectiveness
• Working within an IMS should be routine to responders
• The first arriving unit should initiate an IMS: Single Command Structure, Unified Command Structure

Incident Priorities

• Provide for safety and survival regarding response personnel
• Prevent further injuries to others
• Rescue those who can be saved
• Recover the remains of those who cannot be saved

Control Zones

• Restricted (hot) Zone: high hazard area, limited access
• Limited Access (warm) Zone: limited risk or exposure to hazards
• Support (cold) Zone: unlikely risk or exposure to hazards

Command and Control

• Groups based on incident needs: Rescue/Extrication, Medical, Suppression, Law Enforcement
• The IC establishes the level of command and control

Managing Environmental Exposures

• Identify possible shelter in pre-planning
• Protect patients and responders from environmental hazards
• Temporary shelters: provide protection from the environment

Apparatus Placement

• Shadow vehicle: place apparatus in a safe location
• Protect patients and responders from apparatus hazards

Traffic Control

• Control traffic to prevent hazards to responders and patients
• Route traffic into unobstructed lanes or areas
• Be cautious when moving about the incident

Control Zones

• Restricted (hot) Zone: high hazard area, limited access
• Limited Access (warm) Zone: limited risk or exposure to hazards
• Support (cold) Zone: unlikely risk or exposure to hazards

Extrication

• Performed after all potential hazards are mitigated
• Patient considerations: access, egress, disentanglement, and extrication
• Develop an extrication plan: prioritize patient access and removal, develop a treatment and patient packaging strategy

Vehicle Stabilization

• Goal: prevent unwanted movement of the vehicle
• Utilize ropes, chains, cribbing, shoring, and chocks

Vehicle Access and Egress Points

• Determine the best strategy to provide vehicle access for medical personnel
• Determine the safest route for removing packaged patients