Chapter 36

36: Gaining Access
Cognitive Objectives (1 of 2)
7-2.1 Describe the purpose of extrication.
7-2.2 Describe the role of the EMT-B in extrication.
7-2.3 Identify what equipment for personal safety is
required for the EMT-B.
7-2.4 Define the fundamental components of
extrication.
Cognitive Objectives (2 of 2)
7-2.5 State the steps that should be taken to protect
the patient during extrication.
7-2.6 Evaluate various methods of gaining access to
the patient.
7-2.7 Distinguish between simple and complex
access.
• There are no affective or psychomotor objectives
for this chapter.
Safety
• Preparation
– Mental
– Physical
Vehicle Safety Systems
• Shock-absorbing bumpers
• Airbags
Fundamentals of Extrication
• Extrication
– Removal from entrapment or a dangerous
situation or position
• Entrapment
– To be caught within a closed area with no way
out
The 10 Phases
of Extrication (1 of 2)
• Preparation
• En route to the scene
• Arrival and scene size-up
• Hazard control
• Support operations
The 10 Phases
of Extrication (2 of 2)
• Gaining access
• Emergency care
• Disentanglement
• Removal and transfer
• Termination
Preparation
• Training
• Equipment maintenance
En Route to the Scene
• Safe driving practices
• Good steering techniques
• Road positioning and cornering
• Controlled acceleration
• Controlled braking
• Laws and regulations
Arrival and Scene Size-up
• Traffic hazards
• Additional resources
• Coordination within ICS
• Rescue team responsibilities
• EMS responsibilities
Hazard Control
• Law enforcement
– Traffic control
– Investigation
– Scene control
• Fire fighters
– Extinguishment
– Spill control
• Rescue team
– Extrication
Hazards
• Downed power lines
• Sharp metal
• Broken glass
• Toxic substances
• Hazardous substance ignition
• Unstable vehicles
Support Operations
• Lighting
• Tool and equipment
staging areas
• Helicopter landing
zones
Gaining Access (1 of 2)
• Is the patient in a vehicle or other structure?
• Is the vehicle or structure severely damaged?
• What hazards exist that pose risk to the patient and
rescuers?
• What is the position of the vehicle?
• What type of surface is it on?
• Is it stable?
Gaining Access (2 of 2)
• Simple access
– Access without the
use of tools or force
• Complex access
– Requires the use of
tools and force
Emergency Care
• Provide manual immobilization to protect the
cervical spine.
• Open the airway.
• Provide high-flow oxygen.
• Assist or provide for adequate ventilation.
• Control any significant external bleeding.
• Treat all critical injuries.
Disentanglement
• Removal of the motor vehicle from around the
patient
• Disentanglement techniques
– Brake and gas pedal displacement
– Dash roll-up
– Door removal
– Roof opening and removal
– Seat displacement
– Steering column displacement
– Steering wheel cutting
Removal and Transfer (1 of 2)
• Determine urgency of move.
• Plan moves and communicate with the team.
• Once patient is freed, rapidly reassess and recheck
vital signs.
• Make certain spine is immobilized.
Removal and Transfer (2 of 2)
• Move the patient in slow, controlled steps.
• Choose a path that requires the least manipulation
of the patient and equipment.
• Move the patient as a unit.
• If the patient’s condition is critical, perform
remaining steps en route.
Termination
• Check tools and equipment.
• Replace used supplies.
• Clean unit and conform to bloodborne pathogen
standards.
• Complete all necessary reports.
Specialized Rescue Situations (1 of 2)
• Cave rescue
• Confined space rescue
• Cross-field and trail rescue
• Dive rescue
• Lost person search and rescue
• Mine rescue
• Mountain, rock, and ice-climbing rescue
Specialized Rescue Situations (2 of 2)
• Ski slope and cross-country or trail snow rescue
(ski patrol)
• Structural collapse rescue
• Tactical emergency medical support (SWAT)
• Technical rope rescue (low- and high-angle rescue)
• Trench rescue
• Water and small craft rescue
• White-water rescue
Lost Person Search and Rescue
• Primary role will be to take care of patient when
found.
• Prepare equipment and stand by in area
designated by incident command.
• Only incident command should deliver information
to the family unless someone else is designated to
do so.
Trench Rescue
• Poor outcome for victims
• Risk of secondary collapse
• Proper safety reduces potential for injury.
• Stage response vehicles.
Tactical Emergency Medical
Support (1 of 2)
• EMT-Bs, paramedics, nurses, and physicians with
specialized tactical and medical training
• Nonstandard medical procedures similar to
battlefield medicine
• Examples of tactical situations
– Hostage situations
– Snipers
– Barricaded suspects
Tactical Emergency Medical
Support (2 of 2)
• Response procedures
– Shut off lights and siren when approaching the
scene
– Report to the command post
• Planning
– Specific location of the incident
– Rally point with tactical EMS providers
– Helicopter landing zones
– Hospital locations and route of travel
Structure Fires
• Ask incident command where the ambulance
should be positioned.
• Do not block arriving equipment or become
blocked.
• Only leave the scene if transporting a patient or
cleared by incident command.

Chapter 36

Uploaded by

Copyright:

Available Formats

Chapter 36

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chapter 36

Uploaded by

Copyright:

Available Formats

36: Gaining Access

You might also like