Idaho EMS Vehicle Extrication Awareness Instructor Guidelines

Version 2016-1 / Effective July1, 2016

Table of Contents

Vehicle Extrication Awareness…………………………………………………………..………....6

1.  Welcome and Introductions…………………………………………………….……...…6

2.  General House Keeping……………………………………………………………………..6

3.  Course Overview…………………………………………………………………….………...6

Chapter One: Introduction…………………………………………………………….…….…....….6

1.  What Is Extrication?...... 6

2.  What the Course Is……………………………………………………………….………..….7

3.  What the Course Is Not………………………………………………………….….…….…7

4.  Course Objective…………………………………………………………………….……...….7

5.  Extrication Primer………………………………………………………………….…...…….7

6.  What Is A Rescue Team?...... 8

Chapter Two: Safety…………………………………………………………………………...……...…8

1.  What Is “Safety”?...... 8

2.  Personal Protective Equipment (PPE)……………………………………..…….……8

3.  Can You Spot the Missing PPE?...... 10

4.  Safety Expectations……………………………………………………………….…....……10

5.  Scene Safety………………………………………………………………………….….…..….10

6.  Roadside Safety…………………………………………………………………….….…..….10

7.  Roadside Safety – Traffic Flow and Vehicle Positioning……………..…..…...10

8.  Roadside Safety – Emergency Lighting…………………………………..…….…….11

9.  Roadside Safety – Vehicle Markings…………………………………….…….….…...11

10.  Roadside Safety – Visibility Safety Apparel……………………….……..………11

Chapter Three: Scene Size-up………………………………………………………….……...... 11

1.  Scene Size-up…………………………………………………………………………..……..11

2.  Scene Size- up Considerations…………………………………………………………12

3.  When Does Scene Size-up Start?...... 12

4.  Pre-Arrival Conditions………………………………………………………..….…….….12

5.  Arriving At the Scene…………………………………………………………..…….….….12

6.  Incident Command System (ICS)……………………………………………....…..…..15

7.  Extrication………………………………………………………………………….….………17

8.  Extrication Tools…………………………………………………………………..…….….17

Chapter Four: Collision Forces……………………………………………………….….…..….18

1.  What Are “Collision Forces”?...... 18

2.  Head-on Collisions………………………………………………………………....……….18

3.  Forward Momentum of the Patient…………………………………………….……18

4.  Rollovers……………………………………………………………………………..…………19

5.  Unrestrained Occupants………………………………………………………………….19

6.  Side Impact Collisions……………………………………………………………………..19

7.  Rear End Collisions…………………………………………………………………..…….20

Chapter Five: Vehicle Stabilization…………………………………………………….………20

1.  What Is Vehicle Stabilization?...... 20

2.  Disable Vehicle Controls……………………………………………………...………….20

3.  Cribbing and Chocking……………………………………………………………….….….20

4.  Vehicle on Its Roof……………………………………………………………………….…..21

5.  Doors and Windows………………………………………………………….….…...…....21

6.  Vehicle on Its Side………………………………………………………….….….…...…...22

Chapter Six: Vehicle Safety Systems…………………………………………………………..22

1.  What Are vehicle safety systems?...... 22

2.  History of Vehicle Safety Systems…………………………………………………....22

3.  Vehicle Safety Systems Overview…………………………………………………….23

4.  Identification of An Airbag………………………………………………………………23

5.  System Review…………………………………………………………………………...... 24

6.  Staying Out of the Zones………………………………………………………………….24

7.  Supplemental Restraint System (SRS)……………………………………………..25

8.  Front Airbags………………………………………………………………………………....25

9.  Side Impact Airbags………………………………………………………………………..25

10.  Thorax/Head Side Impact Bags…………………………………………………….25

11.  Side Protection System (SPS)……………………………………………………….25

12.  Incident With Undeployed Airbag(s)…………………………………………….25

13.  Airbag Deactivation……………………………………………………………………...26

14.  Bag Busters Are Time Wasters………………………………………………...... 26

15.  Rollover Protection System (ROPS)……………………………………………....27

16.  Seatbelts and Pre-tensioners…………………………………………………….…..27

17.  Active Seatbelt Systems…………………………………………………………...... 27

18.  Automatic Roll Bars…………………………………………………………………..…28

Chapter Seven: Patient Care……………………………………………………………………………….28

1.  What Is “Patient Care”?...... 28

2.  Patient Care – Specific to Extrication……………………………………………29

3.  Equipment Needed………………………………………………………………..……..29

4.  Special Considerations…………………………………………………………………30

5.  Rapid Extrication………………………………………………………………………....31

6.  Requirements For Rapid Extrication……………………………………………..31

7.  Thank You and Credits………………………………………………………………....33

8.  Course Review……………………………………………………………………………..35

Vehicle Extrication Awareness

1.  Welcome and Introduction

The following information coincides with the web-based IDHW-EMS: Extrication Awareness training course:

  1. Location: www.train.org
  2. Course ID: 1040205
  3. Course Number: C02991

2.  General Housekeeping

Provide students with course and facility specific information:

  1. Course schedule
  2. Breaks
  3. Lunch
  4. Restrooms
  5. Fire exits
  6. Smoking areas

3.  Course Overview

Give the students buy-in with a short applicable story that is designed to draw them in and focus them on the importance of this training.

  1. Chapter 1: Introduction
  2. Chapter 2: Safety
  3. Chapter 3: Scene Size-up
  4. Chapter 4: Collision Forces
  5. Chapter 5: Vehicle Stabilization
  6. Chapter 6: Vehicle Safety Systems
  7. Chapter 7: Patient Care
  8. Optional in class video with overview
  9. Thank you and Credits

Chapter One: Introduction

1.  What Is Extrication?

National Fire Protection Association (NFPA) 1670 defines it as “the removal of trapped victims from a vehicle or machinery.” All efforts to free the victim from further entrapment must focus on preventing further injury to the victim. Therefore, extrication requires the ability to apply extreme force in a precise direction to manipulate debris, while at the same time, another member of the rescue team, an EMS provider, stabilizes the patient.

2.  What the Course Is:

The intent of this course is to provide information so that those who respond to motor vehicle accidents will be able to function safely as part of a “rescue team” as directed by the incident commander.

3.  What the Course Is Not:

This is an “awareness” level course and therefore it is not intended to teach extrication techniques or patient care procedures.

4.  Course Objective

At the end of this course, you will gain an awareness level knowledge of:

  1. Managing your own safety and that of the rescue team.
  2. Size-up and secure the accident scene.
  3. Recognizing and protecting against hazards at the scene.
  4. Basic principles of vehicle stabilization.
  5. Vehicle safety system issues.
  6. Extrication of the accident patient(s).
  7. Patient care as it applies to an extrication.

5.  Extrication Primer:

  1. Without causing further harm:
  2. Anyone can clear wreckage and debris from a site, but it takes a properly educated rescuer to stabilize, disentrap, and remove a patient from an entrapment without causing further harm.

B.  In a wide range of situations:

I.  Extrication situations and scenarios are wide ranging. They may involve anything from entrapment caused by natural disasters to vehicular collisions. Fire, hazardous materials, unstable structures, or any number of other hazards may further complicate them.

C.  Extrication requires a great deal of experience, knowledge, and training, including an understanding of mechanical maneuvering and mechanical tool practices:

I.  Personnel who perform extrications must possess a great deal of experience, knowledge and training. The rescuer must be familiar not only with extrication procedures, but also have a working knowledge of forcible entry tools, first aid, and rescue procedures.

II. The rescuer should possess an understanding of mechanical maneuvering and mechanical tool practices. Although not everybody on the team will be an EMS provider, the background in first aid and other areas of training, will be beneficial to the team.

6.  What is a rescue team?

  1. The rescue team is a group of trained and experienced individuals who work together to perform rescue related tasks; each task will vary depending on the situation.
  2. As an awareness level responder you will be expected to function safely as part of the rescue team under the direction of an incident commander regardless of agency affiliation.
  3. Again, no expects you to be able to do something you haven’t been trained to do. This program is intended to provide you with awareness level of training. It is not intended to enable you to enter into a damaged vehicle while extrication operations are underway. Contact your local extrication provider if you wish to have further training.

Chapter Two: Safety

1.  What Is “Safety”?

  1. Safety is an overarching term for taking care of yourself and your team.
  2. Safety = taking care of yourself and your team.
  3. Being safe, there are many elements to this; from the clothing and equipment that you ware to controlling the road side traffic environment.
  4. At the completion of this chapter you will be able to:
  5. Understand the use of proper personal protective equipment.
  6. Identify scene hazards.
  7. Understand traffic control methods.

2.  Personal Protective Equipment (PPE)

  1. The most important of all the safety procedures at an extrication scene are the PPE you put on prior to exiting your vehicle. PPE is the clothing and equipment the rescuer wears or uses to protect themselves from the hazards associated with extrication; such as sharp metal, broken glass, and leaking fluids.
  2. Take a detailed look at PPE (show pictures or equipment if available):
  3. The Head - Safety glasses or goggles are required. The face shield of a helmet does not adequately protect the eyes. A helmet and face shield are highly recommended in addition to the above mentioned eye protection. Persons with long hair are required to strictly manage it by means of a helmet, hat or hair style (such as tight braids) that does not allow the hair to become a hazard.
  4. The Hands - Gloves are required. Medium or heavy weight leather gloves are recommended. Light gardening or cotton gloves are not acceptable. Grip and protection is the goal here.
  5. The Upper Body - A long sleeve shirt is required. A heavy long sleeve shirt or wild land type shirt or jacket is recommended. A turnout coat if available is also a very good choice. Sleeves should be down when actively participating in extrication activities.
  6. The Lower Body - Full-length pants are required. Medium or heavy weight denim or canvas type jeans are a good choice. Wild land pants, over pants, or turn out pants will work very well. Shorts or cut-off jeans are not acceptable.
  7. The Feet - Adequate footwear is required. Boots constructed of leather, heavy canvas, or layered leather and canvas are recommended. Steel toes and shank are also a very good idea. Structure boots and wild land boots work very well too. Open toed or light canvas type tennis shoes are not acceptable.
  8. Remember the minimum PPE you should ware is:
  9. A hard hat
  10. Protective eye ware
  11. Gloves
  12. Safety shoes or boots
  13. Other considerations:
  14. While not required, hearing and respiratory protections are recommended. Many tools and machines emit noises at levels that can be harmful for extended periods. You will be working in and around vehicles that have been compromised. Dust, fine glass, and other respiratory hazards will exist.
  15. Body fluid precautions may be needed as well.
  16. Weather is another concern. Extremes in temperature, precipitation, humidity, wind, and sun may have a great effect on you during an extrication operation.
  17. Summary - hazards you may encounter are almost endless:
  18. Dangers from fire and spilled fluid such as fuels and battery acid are very common.
  19. Cut hazards from torn metal or broken glass are almost assured.
  20. Body fluids and hazards carried by patients like common household products to illegal drugs and paraphernalia are often found at extrications.
  21. Natural hazards like weather, water, slopes, and animals should be expected also.
  22. Power lines, barbed wire, livestock, traffic and many other man made hazards are likely to be found.
  23. Good PPE is the first step in being prepared.
  24. Review the items that are considered minimum PPE for an extrication environment
  25. Head Protection
  26. Eye Protection
  27. Hand Protection
  28. Foot Protection

3.  Can You Spot the Missing PPE?

Activity directions: show picture illustration responders at an accident, identify the missing PPE, and discuss:

  1. Firefighter on the far left has no helmet.
  2. Too many responders serving as onlookers.
  3. Only necessary personnel should be in the “hot” zone.

4.  Safety Expectations

  1. You and your crew(s) will be the determining factor for a successful rescue. You are the ultimate rescue tool.
  2. It is critically important not allow your emotions to control your actions.
  3. Situations like this require: professional attitude, mechanical ability, experience, and ingenuity that the rescue crew possess. Teamwork is critical.
  4. Stay focused on potential hazards.
  5. Safety is everyone’s responsibility.

5.  Scene Safety

  1. Remember that as the incident becomes more chaotic, so will the distractions that keep us from identifying the hazards that lie in wait.
  2. Even those incidents that appear to be minor may have life-threatening hazards.
  3. Constant vigilance regarding scene hazards is a primary duty of the rescue team personnel. You will be discussing scene hazards in detail in Chapter 3 called Scene Size Up.

6.  Roadside Safety

  1. Traffic flow is the greatest hazard associated with EMS highway operations. The goal is to limit highway access of the general public and increase rescue vehicle access. EMS and rescue must work closely with law enforcement to ensure traffic control.
  2. Reduce traffic hazards by staging unnecessary vehicles and personnel away from the scene and by having a safe ambulance loading area.
  3. Use traffic cones to redirect traffic. Create a safe zone by moving traffic away from the scene.
  4. At a minimum, take up the lane involved, plus one-half of the adjacent land if possible.

7.  Roadside Safety – Traffic Flow and Vehicle Positioning

  1. Once cones are placed, emergency vehicles should be positioned in a manner which makes them highly visible to approaching traffic and protects responders from oncoming traffic. All agencies need to work together to accomplish this including police, fire, and EMS.
  2. Look at placement:

I.  Additional police, fire, and EMS vehicles should be placed upstream of the accident to alert oncoming drivers of the incident ahead – upwind and uphill if possible.

II.  Park these additional vehicles at 150 to 200 foot intervals.

  1. Maintain a safe buffer between the incident and the protective apparatus.
  2. Establish a safe ambulance loading area.
  3. Designate a traffic-control person.

8.  Roadside Safety – Emergency Lighting

Interestingly, emergency light can actually complicate the accident scene because:

  1. Emergency lighting provides warning, but does not provide traffic control.
  2. Emergency lighting may be blinding or confusing to motorists.
  3. Emergency lighting could actually make the work area more dangerous by hypnotizing drivers.
  4. Minimize flashing lights and opt for floodlighting of the scene.

9.  Roadside Safety – Vehicle Markings

  1. Vehicles should have “high visibility markings.”
  2. If your vehicles are not marked with high visibility “retroreflective” material you should ask your administrator if it is possible to have them properly marked.

10.  Roadside Safety – Visibility Safety Apparel

Effective November 24, 2008 federal regulation CFR 634 Worker Visibility Law states:

"All workers within the right-of-way of a federal-aid highway who are exposed either to traffic or to construction equipment within the work area shall wear high-visibility safety apparel.”

  1. Responders at traffic accidents must wear reflective vests. This law includes fire and EMS responders.
  2. ANSI approved class II vests come in several designs and are also available in fire retardant material.
  3. Fire retardant material should be used as extrication scenes.

Chapter Three: Scene Size-up

1.  Scene Size-up

Scene size-up is the act of surveying the accident scene searching for potential hazards and conducting an initial assessment of the accident patients.

  1. At the completion of this chapter you will be able to:
  2. Describe scene size-up.
  3. Understand the stages leading up to and arriving at the scene.
  4. Understand issues related to vehicle fire.
  5. Understand working as a team member within the Incident Command System.
  6. Describe extrication considerations.
  7. Identify some of the hand tools used for extrication.

2.  Scene Size-up Considerations