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.