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Slide 1-

Chapter 38 Vehicle Extrication and Special Rescue
Slide 2-

National EMS Education Standard Competencies EMS Operations Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety. Vehicle Extrication Safe vehicle extrication Use of simple hand tools
Slide 3-

Introduction You will usually not be responsible for rescue and extrication. Rescue involves many different processes and environments. Requires training beyond the EMT level This chapter teaches basic extrication concepts.
Slide 4-

Safety (1 of 2) Extrication requires mental and physical preparation. Priority is to provide patient care Consider the safety of yourself and team first. Safety begins with the proper mind-set and personal protective gear. Equipment and gear should be appropriate to anticipated hazards.
Slide 5-

Safety (2 of 2) Protective gear may include: Turnout gear Helmets Hearing protection Fire extinguisher Blood- and fluid-impermeable gloves Leather gloves over disposable gloves © Jones & Bartlett Learning. Courtesy of MIEMSS.
Slide 6-

Vehicle Safety Systems (1 of 3) Can become hazards after a collision Shock-absorbing bumpers may be “loaded” and can release and injure you. Approach vehicles from the side. Manufacturers are required to install air bags in all new cars. Air bags fill with a nonharmful gas on impact and quickly deflate.
Slide 7-

Vehicle Safety Systems (2 of 3) Air bags are located in the steering wheel and the dash in front of the passenger. Side-inpact air bags may be located in the doors or seats. Air bags should be deployed and deflated by the time you arrive. Non-deployed air bags may spontaneously inflate while you provide patient care.
Slide 8-

Vehicle Safety Systems (3 of 3) Haze inside vehicles in which the air bags have deployed is caused by cornstarch or talc. Used to prevent minor skin irritations by reducing the friction between the occupant’s skin and the airbag. Use protective gear, including eye protection, to reduce the risk of eye or lung irritation from this substance.
Slide 9-

Fundamentals of Extrication (1 of 3) Your primary concern is safety. Your primary roles are to: Provide emergency medical care. Prevent further injury to the patient. You may provide care as extrication goes on around you.
Slide 10-

Fundamentals of Extrication (2 of 3) Extrication is the removal from entrapment or a dangerous situation or position. Entrapment is a condition in which a person is caught within a closed area with no way out or has a limb or other body part trapped.
Slide 11-

Fundamentals of Extrication (3 of 3) © Jones & Bartlett Learning.
Slide 12-

Roles and Responsibilities (1 of 4) EMS personnel are responsible for: Assessing and providing medical care Triaging and packaging patients Providing additional assessment and care as needed once patients are removed Providing transport to the ED
Slide 13-

Roles and Responsibilities (2 of 4) The rescue team is responsible for: Securing and stabilizing the vehicle Providing safe entrance and access to the patients Extricating any patients
Slide 14-

Roles and Responsibilities (3 of 4) Law enforcement personnel are responsible for: Controlling traffic Maintaining order at the scene Establishing and maintaining a perimeter
Slide 15-

Roles and Responsibilities (4 of 4) Firefighters are responsible for: Extinguishing fire Preventing additional ignition Ensuring scene safety Removing spilled fuel © Mark C. Ide.
Slide 16-

Preparation Preparing for an incident requiring extrication involves preincident training with rescue personnel. Various types of rescue situations Rescue personnel must routinely check extrication tools and their response vehicles. Reduces the possibility of equipment failure at an emergency scene
Slide 17-

En Route to the Scene Procedures and safety precautions similar to those in the phases of an ambulance call are used when responding to a rescue incident.
Slide 18-

Arrival and Scene Size-up (1 of 9) Position the ambulance to block the scene from oncoming traffic. Use only essential warning lights. Do not park where you will be blocked in. Back of the ambulance should point toward scene to facilitate patient transport. At a hazardous materials incident, park uphill and upwind from the hazard. Put on PPE and look for passing cars before exiting your vehicle.
Slide 19-

Arrival and Scene Size-up (2 of 9) Make sure the scene is properly marked and protected. Request assistance from law enforcement; they should ensure the road is closed. Your job is patient care, but you may need to direct traffic until other units arrive. Size-up is the ongoing process of information gathering and scene evaluation. Pay attention to downed electrical lines, leaking fluids, fire, and broken glass. Identify additional resources needed.
Slide 20-

Arrival and Scene Size-up (3 of 9) Situational awareness is the ability to recognize possible issues and act proactively to avoid a negative impact. During a 360-degree walk around, look for: Mechanism of injury Downed electrical lines Leaking fuels or fluids
Slide 21-

Arrival and Scene Size-up (4 of 9) During a 360-degree walk around, look for (cont’d): Smoke or fire Broken glass Trapped or ejected patients The number of patients and vehicles involved
Slide 22-

Arrival and Scene Size-up (5 of 9) While looking at the vehicle, note damage. Bent steering wheel may indicate significant face and/or thoracic trauma. Imprints in the dashboard may indicate lower extremity injuries. Lift deployed airbags to see if there is deformity to the steering wheel or dashboard, which may indicate the patient struck the structure after the air bag deflated.
Slide 23-

Arrival and Scene Size-up (6 of 9) Note damage to vehicle (cont’d) Unrestrained patients may have contact injuries as well as secondary injuries. Check windshield for a spider-web pattern of shattered glass, indicating possible head, face, or neck injuries. Include findings in your documentation. Use the information to maintain a high index of suspicion.
Slide 24-

Arrival and Scene Size-up (7 of 9) Evaluate the need for additional resources, such as: Extrication equipment Fire department Law enforcement HazMat unit Utility company Advanced life support units Air transport
Slide 25-

Arrival and Scene Size-up (8 of 9) Other potential hazards Look for spilled fuel and other flammables Electrical short or damaged battery Rain, sleet, snow Crashes that occur on hills Violence
Slide 26-

Coordinate your efforts with rescue teams and law enforcement. Communicate with the rescue team. Start talking to the incident commander as soon as you arrive. You become a member of the rescue team. Arrival and Scene Size-up (9 of 9)
Slide 27-

Hazard Control (1 of 6) Downed electrical lines are a common hazard at vehicle crash scenes. Never attempt to move them. Instruct the patient to remain in the vehicle until power is shut off. Remain in the safe zone, outside of the danger zone (hot zone).
Slide 28-

Hazard Control (2 of 6) A hot zone is an area where individuals can be exposed to: Sharp metal edges Broken glass Toxic substances Radiation Explosion of hazardous materials
Slide 29-

Hazard Control (3 of 6) © Jones & Bartlett Learning. Courtesy of MIEMSS.
Slide 30-

Hazard Control (4 of 6) Family members and bystanders can also create hazards. The danger zone is off-limits to bystanders. The vehicle can also be a hazard. Automobile on its side or roof can be a danger. Rescue personnel can stabilize the car. Ensure that the car is in “park” with the parking brake set and the ignition turned off. Both battery cables should be disconnected to minimize the possibility of sparks or fire.
Slide 31-

Hazard Control (5 of 6) Alternative fuel vehicles Powered by electricity and electricity/gasoline hybrids, or fuels such as propane, natural gas, methanol, or hydrogen. Disconnect the battery in all cases. Batteries may be in the trunk or under the seats. May be more than one battery
Slide 32-

Hazard Control (6 of 6) Hybrid vehicle systems Have batteries with a higher voltage May take up to 10 minutes to de-energize after the main battery is turned off. Avoid high-voltage cables (typically orange) and components. Damaged high-voltage batteries may give off toxic fumes. Do not approach the vehicle if unusual odor is detected. Retreat if you experience burning in eyes or throat.
Slide 33-

Support Operations Support operations include: Lighting the scene Establishing tool and equipment staging areas Marking helicopter landing zones Fire and rescue personnel will work together on these functions.
Slide 34-

Gaining Access (1 of 9) Critical phase of extrication Make sure that the vehicle is stable and hazards are eliminated or controlled. Check with the incident commander and enter only after these conditions are met. Exact way to gain access depends on the situation Identify safest, most efficient way to gain access. If there are multiple patients, locate and rapidly triage each patient.
Slide 35-

Gaining Access (2 of 9) © Mark C. Ide.
Slide 36-

Gaining Access (3 of 9) To determine the exact location and position of the patient, consider: Is the patient in a vehicle or in some other structure? Is the vehicle or structure damaged? What hazards exist that pose a risk? In what position is the vehicle? On what type of surface? Is it apt to roll or tip?
Slide 37-

Gaining Access (4 of 9) As patients’ conditions change, you may have to change your course of action. Rapid vehicle extrication may be needed to quickly remove a patient if the environment is threatening or if the patient needs CPR. CPR is not effective if the patient is sitting up. You may have to move a patient to a supine position on a long backboard. A team of experienced EMTs should be able to perform rapid extrication in 1 minute or less.
Slide 38-

Gaining Access (5 of 9) Keep the patient safe. A heavy, fire-resistant blanket can protect from breaking glass, flying particles, tools, or other hazards. A long backboard may be used as a shield. Talk to the patient and explain your steps. Keep heat, noise, and force to a minimum.
Slide 39-

Gaining Access (6 of 9) © Jones & Bartlett Learning. Courtesy of MIEMSS.
Slide 40-

Gaining Access (7 of 9) Simple access Trying to access the patient as quickly and simply as possible without using tools or breaking glass. Cars are built for easy entry and exit. The rescue team should provide access. If the rescue team has not yet arrived, use tools available on the ambulance. Use all door handles or roll down the windows before using other methods.
Slide 41-

Gaining Access (8 of 9) Complex access Requires special tools, such as hand, pneumatic, and hydraulic devices Requires special training Includes breaking windows or removing roof These advanced skills are typically performed by a specialized team.
Slide 42-

Gaining Access (9 of 9) © Keith D. Cullom/www.fire-image.com.
Slide 43-

Emergency Care Perform a primary assessment and provide care before further extrication: Provide manual stabilization to the spine. Open the airway. Provide high-flow oxygen. Assist or provide for adequate ventilation. Control any significant external bleeding. Treat all critical injuries. Address life-threatening external hemorrhage before airway and breathing.
Slide 44-

Removal of the Patient (1 of 4) Coordinate with rescue personnel to determine the best removal route. Multistep process that is intensive in terms of the number of rescue personnel involved, the equipment used, and the effort required to prevent further injury or harm.
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Removal of the Patient (2 of 4) © Jones & Bartlett Learning.
Slide 46-

Removal of the Patient (3 of 4) You should participate in the preparation for patient removal. Determine the urgency of extrication. Determine the position to best protect the patient. Determine how you will move the patient to the backboard and then the stretcher. Determine the extent of the injuries.
Slide 47-

Removal of the Patient (4 of 4) Your input is essential so that the rescue team plans an extrication that protects the patient from further harm. Impractical to apply extremity splints within the vehicle. Often you will be placed in the vehicle alongside the patient. Be sure to wear proper PPE.
Slide 48-

Transfer of the Patient (1 of 3) Perform a complete primary assessment once the patient is free. Make certain that the spine is manually stabilized. Apply a cervical collar if not already done. Move the patient in a series of smooth, slow, controlled steps with designated stops.
Slide 49-

Transfer of the Patient (2 of 3) One person should be in charge. Choose a path that requires the least manipulation. Ensure that everyone understands the steps and is ready. Move only on the team leader’s command Move the patient as a unit. Continue to protect the patient from any hazards.
Slide 50-

Transfer of the Patient (3 of 3) © Keith D. Cullom/www.fire-image.com.
Slide 51-

Termination Termination involves returning emergency units to service. All equipment used on the scene must be checked. Check and clean the ambulance, replacing used supplies. Complete all necessary reports.
Slide 52-

Specialized Rescue Situations (1 of 3) Sometimes a patient can be reached only by special teams. Specialized team skills include: Cave rescue Confined space rescue Cross-field and trail rescue (park rangers) Dive rescue
Slide 53-

Specialized Rescue Situations (2 of 3) Specialized team skills include (cont’d): Missing person search and rescue Mine rescue Mountain-, rock-, and ice-climbing rescue Ski slope and cross-country or trail snow rescue Structural collapse rescue
Slide 54-

Specialized Rescue Situations (3 of 3) Specialized team skills include (cont’d): Special weapons and tactics (SWAT) team Technical rope rescue (low- and high-angle rescue) Trench rescue Water and small craft rescue White-water rescue
Slide 55-

Technical Rescue Situations (1 of 3) Personnel need special technical skills and equipment. May contain hidden dangers Not safe to include untrained personnel A rescue group is trained and on call for certain types of technical rescues. Made up of individuals from one or more departments Many members are also trained as EMTs.
Slide 56-

Technical Rescue Situations (2 of 3) Check with the incident commander to see if the technical rescue group has been summoned. The incident commander has overall command of the scene in the field. One member must clearly be in charge. A lack of identifiable leadership hinders rescue efforts. If no incident commander is present, follow local guidelines.
Slide 57-

Technical Rescue Situations (3 of 3) When you arrive, you will be directed or led to the staging area. Take a long backboard and/or a basket stretcher, jump kits, and other equipment. Set up your equipment at the staging area. Perform a primary assessment as soon as the rescue team brings the patient to you. Packaging and carrying the patient back to the ambulance requires a joint effort.
Slide 58-

Search and Rescue (1 of 3) An ambulance is usually summoned to the command post when a person is lost outdoors and a search effort is initiated. Your role is to stand by at the command post until the missing person or persons are found. Once you are briefed on the situation, isolate and prepare the equipment you may need. Leave the prepared equipment in the back of the ambulance to protect it from the weather.
Slide 59-

Search and Rescue (2 of 3) You may be asked to stay with the family of the lost individual. Gather medical history and communicate to those in charge. Only the incident commander should communicate any news or progress to the family. Set your radio at a discreet volume.
Slide 60-

Search and Rescue (3 of 3) Once the missing person is found, you will be guided by search personnel to the location where you can begin treatment. You may need to relocate the ambulance or use an all-terrain vehicle. Ensure that the equipment is evenly distributed among providers. Ensure a pace is maintained such that all can stay together easily.
Slide 61-

Trench Rescue (1 of 4) Many cave-ins and trench collapses have poor outcomes for victims. Collapses usually involve large areas of falling dirt that weigh approximately 100 lb per cubic foot. Victims cannot fully expand their lungs and may become hypoxic.
Slide 62-

Trench Rescue (2 of 4) Risk of secondary collapse is a concern. Safety measures can reduce the potential for injury. Park response vehicles at least 500′ from the scene. All vehicles should be turned off. Road traffic should be diverted from the 500′ area.
Slide 63-

Trench Rescue (3 of 4) Other hazards include downed electrical wires and broken glass or water lines. Construction equipment may be unstable and could fall into the cave-in or trench. Witnesses to the incident should be identified. May be valuable in providing information.
Slide 64-

Trench Rescue (4 of 4) Assist nontrapped individuals from the area. Do not enter a trench deeper than 4′ without proper shoring in place. During extrication of survivors, medical personnel trained in cave-in and trench collapse will provide most medical care. Be prepared to receive patients after extrication.
Slide 65-

Tactical Emergency Medical Support (1 of 3) Law enforcement officers usually ensure scene safety. Sometimes a special weapons and tactics (SWAT) team is needed to secure an area. Hostage incidents Barricaded subjects Snipers Many communities have incorporated specially trained EMTs, paramedics, nurses, and physicians into police SWAT units.
Slide 66-

Tactical Emergency Medical Support (2 of 3) When called to the scene, determine the location of the command post and report to the incident commander. Lights and siren should be turned off. The command post is usually located in an area that cannot be seen by the suspect and is out of range of possible gunfire. Remain in this area.
Slide 67-

Tactical Emergency Medical Support (3 of 3) Planning measures are key. Have the incident commander identify the specific location of the incident. The incident commander should determine a safe location to meet up with the SWAT team if an injury occurs. Designate helicopter landing zones. Identify the quickest route to the closest hospital, burn center, or trauma center.
Slide 68-

Structure Fires (1 of 4) In most areas, an ambulance is dispatched with the fire department apparatus. A fire in a house or other building is considered a structure fire. Determine if any special route is needed because of the fire.
Slide 69-

Structure Fires (2 of 4) Ask the incident commander where the ambulance should be staged. Far enough away from the fire to be safe Cannot block or hinder other arriving equipment Cannot be blocked in Should be close enough to be visible so patients can be brought to it easily Determine if there are any injured patients or if you have been called to stand by.
Slide 70-

Structure Fires (3 of 4) Search and rescue in a burning building requires special training and equipment. Performed by teams of firefighters in full turnout gear and SCBA. They bring patients out of the burning building to the area where the ambulance is staged. Stay with the ambulance unless otherwise instructed. The ambulance should leave only if transporting a patient or if the incident commander released it.
Slide 71-

Structure Fires (4 of 4) Sometimes a scene may be further complicated by hazardous materials. Hazardous materials pose a threat to you and to others at the scene, as well as a much larger area and population.
Slide 72-

Review Proper protective equipment will vary depending on the hazards encountered. Which piece of equipment should be utilized during all patient contacts? Turnout gear Helmets Blood- and fluid-impermeable gloves Goggles
Slide 73-

Review Answer: C Rationale: The importance of wearing blood- and fluid-impermeable gloves at all times during patient contact cannot be emphasized enough. If you are involved with extrication, you should wear a pair of leather gloves over your disposable gloves.
Slide 74-

Review (1 of 2) Proper protective equipment will vary depending on the hazards encountered. Which piece of equipment should be utilized during all patient contacts? Turnout gear Rationale: This equipment is important, but not necessary for every patient encounter. Helmets Rationale: This equipment is important, but not necessary for every patient encounter.
Slide 75-

Review (2 of 2) Proper protective equipment will vary depending on the hazards encountered. Which piece of equipment should be utilized during all patient contacts? Blood- and fluid-impermeable gloves Rationale: Correct answer Goggles Rationale: This equipment is important, but not necessary for every patient encounter.
Slide 76-

Review What is the first phase of extrication? Arrival Preparation Scene size-up Gaining access
Slide 77-

Review Answer: B Rationale: There are 10 phases of extrication; preparation is the first. Preparing for an incident requiring extrication involves training for the various types of rescue situations your team might face. Just as you must check the equipment on the ambulance, rescue personnel must routinely check the extrication tools and their response vehicle to ensure proper operation. Preparation reduces the possibility of equipment failure at a scene.
Slide 78-

Review (1 of 2) What is the first phase of extrication? Arrival Rationale: This is part of the third phase of extrication. Preparation Rationale: Correct answer
Slide 79-

Review (2 of 2) What is the first phase of extrication? Scene size-up Rationale: This is part of the third phase of extrication. Gaining access Rationale: This is the sixth phase of extrication.
Slide 80-

Review As you approach an unconscious patient who is still in her wrecked vehicle, you note that there is a power line entangled in the wreckage of the vehicle. You should: retreat until the power line has been removed or the power is shut off. carefully gain access to the patient without touching any metal objects. don a pair of rubber gloves and carefully disentangle and remove the power line. call for a tow truck to lift the vehicle off of the power line and then access the patient.
Slide 81-

Review Answer: A Rationale: Never attempt to access a patient until you are certain that the vehicle is stable and that any hazards have been identified and removed. Common hazards at a motor vehicle crash include leaking gasoline, power lines over the vehicle, and engine fires.
Slide 82-

Review (1 of 2) As you approach an unconscious patient who is still in her wrecked vehicle, you note that there is a power line entangled in the wreckage of the vehicle. You should: retreat until the power line has been removed or the power is shut off. Rationale: Correct answer carefully gain access to the patient without touching any metal objects. Rationale: Never attempt to gain access to the patient until all hazards have been removed.
Slide 83-

Review (2 of 2) As you approach an unconscious patient who is still in her wrecked vehicle, you note that there is a power line entangled in the wreckage of the vehicle. You should: don a pair of rubber gloves and carefully disentangle and remove the power line. Rationale: Removal of an electric line should be handled by experts in the power industry, typically electric company personnel. call for a tow truck to lift the vehicle off of the power line and then access the patient. Rationale: Accessing the vehicle before the electrical hazards have been removed can and will result in additional injuries.
Slide 84-

Review A two-door passenger car struck a tree while driving approximately 50 mph. The doors are badly damaged and jammed, and the driver appears to be unconscious inside the vehicle. Entering the vehicle by breaking the back window is an example of: simple access. complex access. technical rescue. disentanglement.
Slide 85-

Review Answer: B Rationale: Complex access requires the use of special tools and special training and includes breaking windows or other forcible entry. Simple access does not involve the use of any tools; examples of simple access include opening a door or rolling down a window.
Slide 86-

Review (1 of 2) A two-door passenger car struck a tree while driving approximately 50 mph. The doors are badly damaged and jammed, and the driver appears to be unconscious inside the vehicle. Entering the vehicle by breaking the back window is an example of: simple access. Rationale: Simple access does not involve the use of any tools. complex access. Rationale: Correct answer
Slide 87-

Review (2 of 2) A two-door passenger car struck a tree while driving approximately 50 mph. The doors are badly damaged and jammed, and the driver appears to be unconscious inside the vehicle. Entering the vehicle by breaking the back window is an example of: technical rescue. Rationale: Technical rescue involves the use of specialized teams. disentanglement. Rationale: Disentanglement involves the removal of the vehicle from around the patient.
Slide 88-

Review A 30-year-old semiconscious man is pinned by the steering wheel of his badly wrecked vehicle. Once access has been gained to the patient, the EMT should: have the fire department disentangle the patient and quickly remove him from the vehicle. immediately apply high-flow oxygen to the patient and then allow extrication to begin. perform a primary assessment and provide any needed emergency care prior to extrication. ensure that the patient is not bleeding significantly before allowing the extrication process to commence.
Slide 89-

Review Answer: C Rationale: Unless there is an immediate threat of fire, explosion, or other danger, you should perform a primary assessment and treat all immediate life-threats as soon as you have gained access to the patient. After correcting any immediately life-threatening problems, extrication should begin.
Slide 90-

Review (1 of 2) A 30-year-old semiconscious man is pinned by the steering wheel of his badly wrecked vehicle. Once access has been gained to the patient, the EMT should: have the fire department disentangle the patient and quickly remove him from the vehicle. Rationale: Do this only after correcting immediate life threats to the patient. immediately apply high-flow oxygen to the patient and then allow extrication to begin. Rationale: Oxygen may be applied, but all life threats must be assessed and treated prior to extrication.
Slide 91-

Review (2 of 2) A 30-year-old semiconscious man is pinned by the steering wheel of his badly wrecked vehicle. Once access has been gained to the patient, the EMT should: perform a primary assessment and provide any needed emergency care prior to extrication. Rationale: Correct answer ensure that the patient is not bleeding significantly before allowing the extrication process to commence. Rationale: Bleeding is not the only immediate life threat—airway and breathing must also be assessed.
Slide 92-

Review While the EMT is in a vehicle assessing the patient, the rescue team should be: assessing exactly how the patient is trapped and determining the safest way to extricate. awaiting further instructions from the EMT regarding how to proceed with the extrication. actively extricating the patient using whichever rescue method is deemed necessary by the rescue leader. preparing for a simple extrication process, as the EMT has obviously gained access to the patient.
Slide 93-

Review Answer: A Rationale: While the patient is being assessed, the rescue team should be assessing the degree of entrapment and determining the safest, easiest way to extricate. Once the assessment of the patient is complete, the extrication can commence.
Slide 94-

Review (1 of 3) While the EMT is in a vehicle assessing the patient, the rescue team should be: assessing exactly how the patient is trapped and determining the safest way to extricate. Rationale: Correct answer awaiting further instructions from the EMT regarding how to proceed with the extrication. Rationale: Although the EMT may verbalize the patient’s injuries, which may help in deciding how the extrication can best be handled, the actual extrication is performed by the rescue team.
Slide 95-

Review (2 of 3) While the EMT is in a vehicle assessing the patient, the rescue team should be: actively extricating the patient using whichever rescue method is deemed necessary by the rescue leader. Rationale: The decision on the extrication method must include the assessment of the patient, the degree of entrapment, and the determination of the safest extrication route.
Slide 96-

Review (3 of 3) While the EMT is in a vehicle assessing the patient, the rescue team should be: preparing for a simple extrication process, as the EMT has obviously gained access to the patient. Rationale: The rescue team leader must consider all options—the way the EMT came in may not be the best way for the patient to come out.
Slide 97-

Review Proper removal of a critically injured patient from an automobile involves: moving the patient in one fast, continuous step. utilizing no more than two personnel to avoid crowding. moving the patient in smooth, slow, controlled steps. removing the patient by grasping the immobilization device.
Slide 98-

Review Answer: C Rationale: To ensure that each rescuer is positioned so he or she can lift and properly carry the patient at all times, move the patient in a series of smooth, slow, controlled steps, with stops designed in between to allow for any repositioning or adjustments as needed. Move the patient as a unit, and resist the temptation to move the immobilization device instead.
Slide 99-

Review (1 of 2) Proper removal of a critically injured patient from an automobile involves: moving the patient in one fast, continuous step. Rationale: The removal should be smooth and slow. utilizing no more than two personnel to avoid crowding. Rationale: Use the number of rescuers necessary to allow for a smooth and controlled removal.
Slide 100-

Review (2 of 2) Proper removal of a critically injured patient from an automobile involves: moving the patient in smooth, slow, controlled steps. Rationale: Correct answer removing the patient by grasping the immobilization device. Rationale: Do not grab or pull on immobilization devices. This will prevent loosening or dislodging the devices.
Slide 101-

Review A man has been sucked inside the bin of a grain silo and is trapped. Which of the following rescue teams is the MOST appropriate to request? Trench rescue High-angle rescue Local fire department Confined space rescue
Slide 102-

Review Answer: D Rationale: Of the technical rescue teams listed, a confined rescue team would be the most appropriate to request for help. Grain silos are confined spaces that such teams are specially trained to operate in. Trench rescue teams are trained to deal with cave-ins and trench collapses. If your local fire department is trained in confined space rescue, they should be notified.
Slide 103-

Review (1 of 2) A man has been sucked inside the bin of a grain silo and is trapped. Which of the following rescue teams is the MOST appropriate to request? Trench rescue Rationale: These teams are trained for rescues from trench cave-ins. High-angle rescue Rationale: These teams are trained for rescues on slopes greater than 45.
Slide 104-

Review (2 of 2) A man has been sucked inside the bin of a grain silo and is trapped. Which of the following rescue teams is the MOST appropriate to request? Local fire department Rationale: Confined space rescue is a specialized training course. Confined space rescue Rationale: Correct answer
Slide 105-

Review You respond to a wooded area to help search for a child who has been missing for approximately 24 hours. Which of the following equipment should you leave in the ambulance? Radio Flashlight Jump kit Backboard
Slide 106-

Review Answer: D Rationale: When participating in a search and rescue effort, large equipment that is not easily carried (ie, backboard, wheeled stretcher) should be left in the ambulance.
Slide 107-

Review (1 of 2) You respond to a wooded area to help search for a child who has been missing for approximately 24 hours. Which of the following equipment should you leave in the ambulance? Radio Rationale: Communications via radio in a search and rescue mission is extremely important. Flashlight Rationale: Many rescue situations involve low light conditions and require a flashlight.
Slide 108-

Review (2 of 2) You respond to a wooded area to help search for a child who has been missing for approximately 24 hours. Which of the following equipment should you leave in the ambulance? Jump kit Rationale: The jump kit is necessary for the initial treatment of life-threatening situations, if and when the victim is found. Backboard Rationale: Correct answer
Slide 109-

Review You are dispatched to the scene of a trench collapse. Upon arriving at the scene, your ambulance should be parked at least _____ feet from the incident. 250 500 750 1000
Slide 110-

Review Answer: B Rationale: When arriving at the scene of a cave-in or trench collapse, response vehicles should be parked at least 500′ from the scene. Because vibration is a primary cause of secondary collapse, all vehicles, including on-scene construction equipment, should be turned off. In addition, all traffic should be diverted from the 500′ safety area.
Slide 111-

Review (1 of 2) You are dispatched to the scene of a trench collapse. Upon arriving at the scene, your ambulance should be parked at least _____ feet from the incident. 250 Rationale: 500′ is the recommended distance. 500 Rationale: Correct answer
Slide 112-

Review (2 of 2) You are dispatched to the scene of a trench collapse. Upon arriving at the scene, your ambulance should be parked at least _____ feet from the incident. 750 Rationale: 500′ is the recommended distance. 1000 Rationale: 500′ is the recommended distance.