Questions and Answers
What should be done before accessing the patient in a vehicle stabilization scenario?
Why should you try to open doors before using tools in vehicle access?
What type of glass should be broken in a vehicle access scenario?
What should you do when breaking a window in a vehicle access scenario?
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What should be done simultaneously with extrication in a patient extraction scenario?
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What should you do with undeployed airbags in a vehicle stabilization scenario?
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Why should you relieve pressure on the driver by moving the seat backwards on its track?
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What is the purpose of removing the roof in a vehicle extraction scenario?
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What is a characteristic of hydrogen sulfide?
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What should you assume about trenches?
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What should you do in cold water rescue?
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What is the purpose of the 'reach, throw, row, go' approach?
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What is the primary difference between low-angle and steep-angle operations in rope rescue?
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What is a characteristic of carbon monoxide?
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What should you do during a wilderness search and rescue?
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What is a hazard in confined spaces?
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What is a characteristic of ammonia?
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What is the goal of the 'search' part of wilderness search and rescue?
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When responding to a structure fire, what should you do upon arrival at the scene?
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In agricultural industrial rescue, what is crucial to master?
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In tactical environments, what should tactical EMS personnel carry?
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What is the primary cause of compartment syndrome?
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When packaging patients, what should be considered?
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Why is it important to visit local farms and industrial plants in agricultural industrial rescue?
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In tactical environments, what should be done immediately after treating a patient?
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What type of equipment is commonly used in patient packaging?
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Study Notes
Vehicle Stabilization and Access
- After cribbing, vehicles can still move, including horizontal, vertical, roll, bounce, and yaw movements
- Ensure parking brake is set, vehicle is in park, and turned off before accessing the patient
- Try to open doors before using tools, and release locking mechanisms to gain access
- Break tempered glass (side and rear windows) instead of laminated glass (windshields)
Glass Management
- Break a window that is not close to the patient to avoid glass shards
- Wear appropriate PPE and lower the window as far as possible before breaking
- Aim for a low corner and give a verbal warning before breaking glass
- Use a hand tool to clean out remaining glass fragments
Patient Extraction
- Begin initial care, assessment, and management of ABCDs and Es simultaneously with extrication
- Disentangle the patient by removing sheet metal and plastic, without cutting them out of the vehicle
- Protect the patient before disentangling and inform them of the process
- Perform only necessary procedures to disentangle the patient, determined by the incident specifics
Airbag Safety
- Identify any undeployed airbags, which are controlled by computers and may retain power for up to 30 minutes
- Disconnect the battery to allow the airbag capacitor to discharge if an airbag did not deploy
- Avoid placing hard objects between the patient and undeployed airbags, which can become projectiles
- Do not cut the steering wheel if the airbag has not deployed
Seat Displacement and Removal
- Relieve pressure on the driver and create more room to work by moving the seat backwards on its track
- Immobilize the patient and use manual seat releases or power adjustments if possible
- Perform a seat displacement if necessary, following a simple to complex approach
Windshield and Roof Removal
- Remove the windshield to improve communication, assessment, and patient removal
- Use specialized saws or axes to remove the windshield
- Remove the roof to increase space, provide a larger exit route, and improve air circulation
- Use hydraulic cutters and rams to displace the dashboard with the dash roll technique
Vehicle Stabilization and Access
- Vehicles can move in multiple directions after cribbing, including horizontal, vertical, roll, bounce, and yaw movements
- Ensure parking brake is set, vehicle is in park, and turned off before accessing the patient
- Try to open doors before using tools, and release locking mechanisms to gain access
- Break tempered glass (side and rear windows) instead of laminated glass (windshields) for safer access
Glass Management
- Break a window that is not close to the patient to avoid glass shards
- Wear appropriate PPE and lower the window as far as possible before breaking
- Aim for a low corner and give a verbal warning before breaking glass
- Use a hand tool to clean out remaining glass fragments after breaking
Patient Extraction
- Begin initial care, assessment, and management of ABCDs and Es simultaneously with extrication
- Disentangle the patient by removing sheet metal and plastic, without cutting them out of the vehicle
- Protect the patient before disentangling and inform them of the process
- Perform only necessary procedures to disentangle the patient, determined by the incident specifics
Airbag Safety
- Identify any undeployed airbags, which are controlled by computers and may retain power for up to 30 minutes
- Disconnect the battery to allow the airbag capacitor to discharge if an airbag did not deploy
- Avoid placing hard objects between the patient and undeployed airbags, which can become projectiles
- Do not cut the steering wheel if the airbag has not deployed
Seat Displacement and Removal
- Relieve pressure on the driver and create more room to work by moving the seat backwards on its track
- Immobilize the patient and use manual seat releases or power adjustments if possible
- Perform a seat displacement if necessary, following a simple to complex approach
Windshield and Roof Removal
- Remove the windshield to improve communication, assessment, and patient removal
- Use specialized saws or axes to remove the windshield
- Remove the roof to increase space, provide a larger exit route, and improve air circulation
- Use hydraulic cutters and rams to displace the dashboard with the dash roll technique
Hazards in Confined Spaces
- Oxygen deficiency can occur due to gases like hydrogen sulfide, found in swamps, sewers, and natural gas wells
- Hydrogen sulfide is heavier than air, displacing oxygen and causing a pungent odor
- Carbon monoxide is odorless, tasteless, and cannot be detected by normal senses, causing headaches, dizziness, and disorientation
- Carbon dioxide displaces oxygen, causing a sour taste and stinging sensation in the nose and mouth
- Methane is not toxic but can cause burns if ignited, and is often used as a fuel
- Ammonia is toxic and corrosive with a pungent odor, rising in the upper atmosphere
- Nitrogen dioxide is a reddish-brown gas with a sharp odor, prominent in air pollution and toxic by inhalation
Safe Approach in Confined Spaces
- Assume the environment is immediately dangerous to life and health (IDLH) and gather information from bystanders
- Test the air and assess atmospheric conditions before making entry
- Assist other responders by providing a situation report, comparing observed conditions, and sharing information
- Evaluate progress continuously and provide resources to the fire company and hazard materials teams
- Handle crowd control, bring rescue equipment, and maintain a charged hose line
Hazards in Trenches
- Trenches are unstable and prone to further collapse, requiring careful excavation and stabilization
- Patients should be carefully dug out after shoring has stabilized the excavation site
- Don't enter trenches until stabilization is complete to avoid secondary collapse
- Maintain personal safety by staying away from edges and shutting off heavy equipment
Water Rescue
- Self-rescue techniques include adopting a face-up arch position in fast-moving water and using hands to change direction
- In cold water rescue, assume the HELP (Heat Escape Lessening Position) to minimize movement and preserve heat
- Hypothermia can cause unconsciousness and death, requiring full resuscitation efforts
- In group victims, huddle together in cold water to conserve heat
- Cold water exposure can activate primitive reflexes, preserving bodily functions
Special Water Rescue Situations
- Swiftwater rescue involves people swept away by moving water, often from vehicles driving through flooded waters
- Hazards in swiftwater rescue include difficulty in determining water depth, hydraulics, and strainers
- Use the reach, throw, row, go approach in swiftwater rescue
- Utilize specialized equipment for ice rescues, such as ladders and flotation devices
Rope Rescue Incidents
- Low-angle operations involve slopes < 35°, using ropes for secondary support
- Steep-angle operations involve slopes between 35-60°, requiring specialized equipment and training
- High-angle operations involve slopes > 60°, relying solely on ropes for support
- Set up equipment appropriately, protect yourself, and move bystanders out of the way
Wilderness Search and Rescue
- Wilderness search and rescue involves two parts: searching for a lost person and removing them from a hostile environment
- Safe approach involves being aware of terrain and environmental factors, bringing necessary supplies, and wearing suitable clothing
- Set up a search base, prepare equipment ahead of time, and monitor progress via radio
- Keep the radio volume low, and only the IC is authorized to update the family
Structure Fires
- Determine a safe route to the scene, considering roadblocks and apparatus positioning
- Find a suitable parking spot for the ambulance, assessing for injured patients
- Remain with the ambulance until directed otherwise, staying present even after the fire is extinguished
- Be prepared to provide medical care to injured firefighters during salvage and overhaul
Agricultural Industrial Rescue
- Conduct pre-incident planning by visiting local farms and industrial plants to understand equipment operation and potential hazards
- Identify pinch points, wrap points, or shear points where operators can become entrapped
- Master cribbing and shoring techniques to create a stable platform for lifting
- Consider alternative disentanglement methods and patient assessment strategies
- Recognize differences between industrial and farm settings, including available resources and EMS response time
Tactical Environments
- Tactical EMS personnel require additional training and PPE identical to law enforcement officers
- Carry a compact kit for traumatic injury management, including bleeding control
- Provide immediate medical care to injured persons, often before the scene is deemed safe
- Follow specific guidelines for tactical responses, including light control, low profile, and proximity to the ambulance
Compartment Syndrome
- Compression of chest, abdomen, or limb for 4-6 hours causes oxygen deprivation and tissue damage
- Treat with positive pressure ventilation, sodium bicarbonate, calcium, and fluid administration
- Manage pain using pharmacologic and non-pharmacologic methods, including splinting and gentle handling
Patient Packaging
- Use Stokes baskets (wire or plastic/fiberglass) for off-road patient transport
- Consider patient needs, including oxygen supply, IV lines, and spinal motion restriction
- Secure patients to a full-body vacuum mattress or Ked/Sked combination when possible
- Avoid gravity-fed systems to minimize package height
- Prioritize patient warmth and provide head and eye protection
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Description
Learn how to stabilize vehicles and access patients safely during emergency response situations. Topics include cribbing, parking brakes, and glass management.
