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Gaining AccessGaining Access

Chapter 32Chapter 32


Case HistoryCase History

You respond to a motor vehicle crash and find two You respond to a motor vehicle crash and find two teenagers trapped in a burning car. The fire is teenagers trapped in a burning car. The fire is contained to the engine compartment but the flames contained to the engine compartment but the flames are widespread and pose a threat to the occupants.are widespread and pose a threat to the occupants.


Rescue and ExtricationRescue and Extrication

Rescue is a specialized field in prehospital care.Rescue is a specialized field in prehospital care.

EMTs must work closely with rescue teams.EMTs must work closely with rescue teams.

Primary responsibility is patient care.Primary responsibility is patient care.

Some systems include dual clinical and rescue Some systems include dual clinical and rescue responsibilities.responsibilities.


Situations That Situations That May Require RescueMay Require Rescue

Motor vehicle crashesMotor vehicle crashes

High-angle incidentsHigh-angle incidents

Confined space incidentsConfined space incidents

Water incidentsWater incidents

Collapsed buildingsCollapsed buildings


Role of the Non-Rescue EMTRole of the Non-Rescue EMT

Administer necessary care to the patient before Administer necessary care to the patient before extrication.extrication.

Ensure that the patient is removed in a way to Ensure that the patient is removed in a way to minimize further injury.minimize further injury.

Patient care precedes extrication.Patient care precedes extrication. Unless delayed movement would endanger life of the patient Unless delayed movement would endanger life of the patient

or rescueror rescuer


Role of the Non-Rescue EMTRole of the Non-Rescue EMT

Working with othersWorking with others Work together with the rescue providers.Work together with the rescue providers. Cooperate with the activities of the rescuers.Cooperate with the activities of the rescuers. Do not allow their activities to interfere with patient care.Do not allow their activities to interfere with patient care.


Rescue EMSRescue EMS

EMS providers may serve as rescue providers.EMS providers may serve as rescue providers.

Chain of command should be established to ensure Chain of command should be established to ensure priorities.priorities.

Administer necessary care to the patient before Administer necessary care to the patient before extrication.extrication.


Rescue EMSRescue EMS

Ensure that the patient is removed in a way to Ensure that the patient is removed in a way to minimize further injury.minimize further injury.

Patient care precedes extrication.Patient care precedes extrication. Unless delayed movement would endanger life of the patient Unless delayed movement would endanger life of the patient

or rescueror rescuer


Approach to the SceneApproach to the Scene Approach hazardous scenes 100 feet, uphill, and upwind.Approach hazardous scenes 100 feet, uphill, and upwind.

Observe scene.Observe scene. How many vehicles are involved?How many vehicles are involved? How many patients are present?How many patients are present? What additional resources do you need?What additional resources do you need?

Perform risk/benefit analysis.Perform risk/benefit analysis. Will scene pose undue risk to you or other rescuers?Will scene pose undue risk to you or other rescuers? If so, consider waiting for appropriate resources (e.g., hazmat If so, consider waiting for appropriate resources (e.g., hazmat

team).team).


Windshield SurveyWindshield Survey Are the patients moving?Are the patients moving?

Are they conscious?Are they conscious?

Are they attempting to exit vehicle?Are they attempting to exit vehicle?

Check for downed electrical wires.Check for downed electrical wires. If present, do not touch anything.If present, do not touch anything. Retreat to position of safety.Retreat to position of safety. Advise occupants not to exit.Advise occupants not to exit.


Evaluate Vehicle StabilityEvaluate Vehicle Stability Can vehicle be entered safely?Can vehicle be entered safely?

Will vehicle turn over?Will vehicle turn over?

Is vehicle on its side or wheels?Is vehicle on its side or wheels?

Is it in a secure position?Is it in a secure position?

Does vehicle rock?Does vehicle rock? Block frame of vehicle, if needed.Block frame of vehicle, if needed. Ensure stabilization.Ensure stabilization.


The 12 “Nevers”The 12 “Nevers” Never enter a potentially hazardous rescue scene without Never enter a potentially hazardous rescue scene without

appropriate PPE.appropriate PPE.

Never operate on an active roadway until traffic flow has been Never operate on an active roadway until traffic flow has been controlled.controlled.

Never enter an unstable vehicle until it has been appropriately Never enter an unstable vehicle until it has been appropriately stabilized.stabilized.

Never enter a fire scene unless directed by fire rescue.Never enter a fire scene unless directed by fire rescue.


The 12 “Nevers”The 12 “Nevers” Never enter a confined space unless directed by rescue.Never enter a confined space unless directed by rescue.

Never attempt deep water rescue without support of water Never attempt deep water rescue without support of water rescue personnel.rescue personnel.

Never enter a toxic scene until cleared by fire and rescue Never enter a toxic scene until cleared by fire and rescue personnel.personnel.

Never enter a structural collapse unless directed by rescue Never enter a structural collapse unless directed by rescue personnel.personnel.


The 12 “Nevers”The 12 “Nevers” Never enter a violent scene before arrival of police.Never enter a violent scene before arrival of police.

Never attempt rescue from height without high-angle rescue Never attempt rescue from height without high-angle rescue team.team.

Never approach an electrical hazard unless cleared by Never approach an electrical hazard unless cleared by appropriate rescue or utility personnel.appropriate rescue or utility personnel.

Never proceed with any potentially hazardous rescue until you Never proceed with any potentially hazardous rescue until you are fully assured that the scene is safe.are fully assured that the scene is safe.


Traffic ControlTraffic Control

Park vehicle to “fend off” oncoming vehicles.Park vehicle to “fend off” oncoming vehicles.

Wear highly reflective traffic vests.Wear highly reflective traffic vests.

Use reflective traffic cones or road flares at night.Use reflective traffic cones or road flares at night. Never use flares where flammable vapors or liquids are Never use flares where flammable vapors or liquids are

present.present.


Personal Protection –Personal Protection –Turnout GearTurnout Gear

HeadgearHeadgear

Eye protectionEye protection

Respiratory protection, if requiredRespiratory protection, if required

Gloves Gloves

BootsBoots

CoatCoat


Respiratory ProtectionRespiratory Protection

Must have before entering smoke conditions or a Must have before entering smoke conditions or a potentially toxic environmentpotentially toxic environment

Self-contained breathing apparatus (SCBA)Self-contained breathing apparatus (SCBA) Restricted to individuals who have had hands-on trainingRestricted to individuals who have had hands-on training


Patient and Bystander SafetyPatient and Bystander Safety Use of rescue blanketUse of rescue blanket

Needed when shards of glass or metal edges are present at rescue Needed when shards of glass or metal edges are present at rescue scenescene

Bystanders should be kept at a safe distance.Bystanders should be kept at a safe distance.

Victims should be prepared for loud sounds and activities for Victims should be prepared for loud sounds and activities for rescue process.rescue process.

Psychological first aid is an important part of management.Psychological first aid is an important part of management.


Stabilizing the VehicleStabilizing the Vehicle

Prevents unwanted or dangerous movement of Prevents unwanted or dangerous movement of vehiclevehicle

Ensures structural integrity of vehicle is not Ensures structural integrity of vehicle is not compromised during rescue effortcompromised during rescue effort

Never lift a vehicle using bystanders and other Never lift a vehicle using bystanders and other rescue personnel.rescue personnel.


Airbag for StabilizationAirbag for Stabilization


Cribbing for StabilizationCribbing for Stabilization


Gaining AccessGaining Access

Access should be gained in most expedient manner Access should be gained in most expedient manner possible.possible.

Route for access may not be the same as removal of Route for access may not be the same as removal of patient.patient.

Objective is to provide lifesaving care and Objective is to provide lifesaving care and stabilization.stabilization.


Types of AccessTypes of Access

Simple accessSimple access Access in which tools are not requiredAccess in which tools are not required

Complex accessComplex access When tools and other specializedWhen tools and other specialized equipment are necessary equipment are necessary

for accessfor access


Access with Slim JimAccess with Slim Jim


Access with Access with Spring-Loaded PunchSpring-Loaded Punch


Door AccessDoor Access

Door provides a good place to enter vehicle and Door provides a good place to enter vehicle and remove patient.remove patient.

Door openings may have to be widened by “walking” Door openings may have to be widened by “walking” the door back.the door back. Ensure vehicle is stabilized before “walking” door back.Ensure vehicle is stabilized before “walking” door back. One or two rescuers push body weight against door and One or two rescuers push body weight against door and

slowly push beyond its normal operating range.slowly push beyond its normal operating range.


Freeing the DriverFreeing the Driver

Steering wheel may trap driver.Steering wheel may trap driver. Moving seat back is simplest method for freeing driver.Moving seat back is simplest method for freeing driver.

Always disconnect battery during extrication.Always disconnect battery during extrication.

Modern vehicles may have one or more undeployed Modern vehicles may have one or more undeployed airbags that are ready to fire.airbags that are ready to fire.


Supplemental Restraints –Supplemental Restraints –AirbagsAirbags

Virtually every vehicle built since 1990 has one or more airbags.Virtually every vehicle built since 1990 has one or more airbags.

Once airbag deploys, it rapidly deflates.Once airbag deploys, it rapidly deflates.

Types of airbagsTypes of airbags Driver’s bag deploys from steering wheel.Driver’s bag deploys from steering wheel. Passenger bag deploys from the dash.Passenger bag deploys from the dash. Side impact airbags can fire from back of front seat, roof rail area, Side impact airbags can fire from back of front seat, roof rail area,

or from the door.or from the door.

Un-deployed airbags represent a hazard to rescuers.Un-deployed airbags represent a hazard to rescuers.


5-10-20 Safety Rule5-10-20 Safety Rule

Keep back Keep back 55 inches from side bag. inches from side bag.

Keep back Keep back 1010 inches from driver’s airbag. inches from driver’s airbag.

Keep back Keep back 2020 inches from passenger’s inches from passenger’s airbag.airbag.


Patient SafetyPatient Safety Priorities (in order)Priorities (in order)

1. Provider safety1. Provider safety2. Patient safety2. Patient safety

Inform patient of the unique aspects of extrication.Inform patient of the unique aspects of extrication.

Patient should be protected fromPatient should be protected from Broken glassBroken glass Sharp metalSharp metal Other hazardsOther hazards

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