DOCUMENT RESUME CE 002 470 AVAILABLE FROMDOCUMENT RESUME ED 098 381 CE 002 470 TITLE Crash Victim Extrication Training Course: Emergency Medical Technician; Course Coordinator's Guide.

DOCUMENT RESUME

ED 098 381 CE 002 470

TITLE Crash Victim Extrication Training Course: EmergencyMedical Technician; Course Coordinator's Guide.

INSTITUTION National Highway Traffic Safety Administration (DOT),Washington, D. C.

PUB DATE [74]NOTE 44p.; For the course guide, see CE 002 471AVAILABLE FROM Superintendent of Documents, U. S. Golernment

Printing Office, Washington, D. C. 20402 (Stock No.5003-00165, $0.95)

EDRS PRICE MF-$0.75 HC-$1.85 PLUS POSTAGEDESCRIPTORS Adult Education; Course Content; Course Objectives;

*Curriculum Guides; *Emergency Squad Personnel;*Health Occupations Education; Medical Assistants;*Medical Education; Medical Services; *ResourceUnits

ABLTRACTThe extrication course is part of a planned program

of c-)urses designed to upgrade the training of ambulance attendantsin life-s 'ing and life-sustaining techniques. Contents includeobjectives and scope; a course outline; comments on instructors,students, class size, training facilities; and wrecked vehiclesources, safety precautions, and security. Other topics are simulatedcasualties, material and equipment, and testing and grading students.Visual aids, texts, and supplementary references are listed. Themajor part of the document, designed as a course coordinator's guide,contains five lesson plans: Basic Considerations, to inform studentsof the purpose, ecope, and requirements of the course; RemovalProblems, to teach entry techniques, emergency medical care,stabilizing and securing techniques, and techniques of removingvictim in different positions from the vehicle; Demonstration ofForcible Entry, Disentanglement, and Safety Techniques, to develop abasic understanding of how to evaluate situations, safetyprecautions, gaining access to the victim, and releasing the victimfrom entrapment; practice, to provide practice and skills training inentry, emergency medical care, disentanglement, and removal; andConclusions, to evaluate the training course and give certificatesand awards. (NH)

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EMERGENCY MEDICAL TECHNICIAN

CRASH VIC111

MOTION TRAINING COURSE

COURSE COORDINATOR'S CUR

US OEPARTMENTOFMEALTMEDUCATION iNELFARENATIONAL INSTITUTE OF

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U.S. DEPARTMENT OF TRANSPORTATIONNATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION

RESCUE & EMERGENCY MEDICAL SERVICES DIVISION

For sale by the Superintendent of Documents. U.S. Oovernmerit Printing OfficeWashington. D.C. 20402 - Price 95 cents

Stock Number 5033-0010

PREFACE

he goal of the National Highway Traffic Safety Administration(NHTSA) Department of Transportation. pursuant to theHighway Safety Act of 1966 and the Emergency MedicalServices Standard 11. has been to upgrade and professi.)nalizethe ambulance field, enhance its life-sustaining quality, and

encourage its establishment where it does not now exist. With regard toupgrading, it is tie view of the Administration that the ambulanceattendant or tecli-Ocian does not properly fall into the category ofunskilled labor as has tended to be the practice. Rather, this should be aperson highly trained and skilled in both lifesaving and life-sustainingtechniques. Consequently,, the Administration has devoted specialeffort to plan, develop, and provide the training courses necessary toachieve this end and goal. This Extrication Course is a part of the totalplanned program of courses. It is the hope of the Administration that itwill receive extensive use and further enhance the care of the crashvictim.

James E. WilsonAssociate AdministratorTraffic Safety Programs

ACKNOWLEDGEMENTS

he assistance of many individuals and organizations were vital toae development of this course on EMT Crash Victim Extrica-

tion. We are grateful and wis:h to thank the U. S. Public HealthService, the Associate Ambulance Service, Phoenix, Arizona;Phoenix Fire Department, Phoenix, Arizona; Emergency Medi-

cal Services, Arizona State Department of Health; Emergency MedicalServices, Indiana Department of Public tlealt:1; Emergency MedicalServices Division, Maine State Department of Health and Welfare; andespecially the Emergency Medical Services Program staff, Departmentof Health, Commonwealth of Virginia. Our gratitude also goes out tothe Westvaco, Petersburg and Manassas Rescue Squads of Virginia, whopilot tested the course and assisted in the development of the soundslide portion of the training course. We want to especially thank Mr.0. B. Streeper and others who graciously contributed illustrative! mate-rial to this course.

We are especially grateful and wish to thank Dr. Louis C. Koss:zth,Commissioner, Arizona State Department of Health, who served asconsultant in the development of this training program, to Mr. RobertE. Motley of the NHTSA, Rescue and Emergency Medical ServicesDivision, who served as technical advisor, and to Mr. Leo R. Schwartzof the NHTSA, Rescue and Emergency Medical Services Division, whocontributed to the organization of this material.

eitt .12.1

Dawson A. Mills, M. D.Chief, Rescue and Emergency

Medical Services Division, OSDITraffic Safety Programs

CONTENTS

Page

Preface iii

AcknowledgementsForeword ixPurpose 1

Objectives and Scope 1

Course Outline 1

InstructorsStudents 3

(lass Site 3

Training Facilities 3

Wrecked Vehicle Source 4Safety Precautions and Security 4Simulated Casualties 4Material and Equipment 5

Testing and Grading Students 6Visual Aids, Texts and Supplementary References 7

Lesson Plan No. 1 Basic Considerations 8

Lesson Plan No. 2 Removal Problems 10(Slide Presentation) 10

Lesson Plan No. 3 Forcible Entry, Disentanglementand Safety Techniques, and Illustrative Stories 37

Lesson Plan No. 4 Practice (Skills and Training) 39Lesson Plan No. 5 Conclusion 40

ix

FOREWORD

ationz:1 guidelines for emergency medical care in the UnitedStates were established in the landmark document Standard No.

11 Emergency Medical Serrices, published by the NationalHighway Traffic Safety Administration (NIITSA). following thepassage of the Highway Safety. Act of 196(). The Standard

clearly identifies the responsibility of ambulance and rescue services toprovide more than transportation alone. It is based primarily onguidelines and recommendations of the National Academy of Sciences(NAS) Committee on Emergency Medical Servioes in their publicationtitled -Training of Ambulance Personnel & Others Responsible forEmergency Care of the Sick and Injured at the Scene and DuringTransport." Consequently, both NAS and NIITSA recommend that allzimbulances he equipped with certain lifesaving equipment and mannedby at least two persons trained in specified areas of emergency medicalcare, i.e., NIITSA Basic 81-hour Training Program for EmergencyMedical Technician Ambulance. Specifically, all ambulance servicesshould furnish skilled emergency medical care to victims of all injuriesand medical emergencies. Additionally, the Standard identifies the needto establish an emergency medical career pattern which providesattractive compensation, prestige, and recognition commensurate withthe services provided by these personnel.

Following the publication of Standard No. 11, the Nationa: HighwayTraffic Safety Administration moved to assist the States in implementa-tion of the national standard in emergency medical services. A firststep, to provide the States with guidelines on programs of instructionfor ambulance and rescue personnel, resulted in the development of an81-hour study course, Basic Training Program for Emergency MedicalTechnician Ambulance and associated Refresher Course. The Courseencompasses the knowledge and skills required to perform all emer-gency care procedures short of those rendered by physicians oremergency care personnel under the supervision of a physician.

To assist the States further in implementation of the Standard, theNHTSA developed two additional courses, Dispatcher LMT TrainingCourse and EMT Crash Victim E.vtrication Training Course.

The purpose of this course is to upgrade the skills and knowledge ofthe emergency medical technician (EMT), in the methods of extricatingvictims from crashed vehicles. The course also is designed to developthe EMT's ability to establish priorities for removing the victims safely.Although it is designed specifically as an adjunct to the course, BasicTraining Program for Lmergency Medical Technician Ambulance, thiscourse meets most requirements for teaching light and medium dutyextrication methods as an independent course of study. Additionaldocuments produced as part of this course include a detailedInstructor's Lesson Plan, and a Student Guide. which serves as thecourse text.

x

FOREWORD (Coal)

The extrication techniques described herein are those methodsconsidered most appropriate by emergency medical service organiza-tions that assisted in the development of the course. The methods andthe equipment identified are endorsed by the U. S. Government butshould not be construed as the only possible techniques or tools ofextrication.

J. D. Farrington, M. D.Committee on InjuriesAmerican Academy of Orthopaedic Surgeons

andCommittee on TraumaAmerican College of Surgeons

EMERGENCY MEDICAL TECHNICIAN

CRASH VICTIM EXTRICATION TRAINING COURSE

COURSE COORDINATOR'S GUIDE

Purpose This course guide has been prepared to assist course coordinators andof the Guide other individuals in organizing and implementing & course of study on

Crash Victim Extrication. It contains an outline of the course.instructor and student qualifications, classroo and demonstrationequipment requirements and guidelines for cone. Lg the course.

Objectives and The purpose of the course is to upgrade the EMT 's skill, knowledge andScope of Course ability to establish priorities for removing ,ersons from crashed

vehicles. Although designed basically as an ad:anct to the NHTSA81-hour Basic Training Program for Emergency Medical TechnicianAmbulance, this course also meets the requirements for teaching lightand medium duty extrication methods as an independent subject.The course emphasizes the development of the EMT skills in gainingentry, freeing and removing an injured and trapped individual withoutcausing further trauma. Specific objectives of the course are:

1. To teach EMTs their role and responsibilities in extrication.2. To develop EMTs skill in analyzing the accident situation, gaining

access, instituting lifesaving emergency medical care techniques,stabilizing, disentangling, an removing the injured victim fromthe wreckage.

3. To develop EMTs skill in the use and care of extrication andrelated tools and equipment.

4. To develop EMTs awareness of the hazards he may encounter atthe accident scene.

Course The course consists of five lessons involving 16 hour of instruction,Outline demonstration, individual participation and testing. The first lesson

introduces students to the basic considerations of extrication, i.e., therole of the EMT, emergency medical care measures involved inpreparing the victim for safe removal, and a description of extricationtools and equipment. Subsequent lessons contain demonstrations of theproper use of the equipment, a sound slide presentation on variousextrication skirts used by the EMT.Lesson titles, objectives and the time for each follow :

1

LESSON TIME REQUIRED

Basic Considerations 3 Hours

Inform the s'adents of the purpose, scope and requirements ofthe course.Provide an overview of the role of the EMT in extrication.Develop an understanding of the principles of and consider&tions in extrication.Introduce the EMT to extrication tools and equipment.

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COURSE COORDIMOR'S GIME

2

3

4

5

Removal Problems 2 Hours

Teach the following skills:Entry techniques.Immediate emergency medical care principles.Victim stabilizing and securing techniques.Techniques of removing victim in different positions from thevehicle.

Demonstration of Forcible Lettry,Disentanglement, and Safety Techniques

Develop a basic understanding of the following:Evaluate situations.Safety precautions.Gaining access to victim.Releasing victim from entrapment.

Practice (Skills Training)

Provide practice of the following skills:Entry.Emergency medical care.Disentanglement.Removal.

3 Hours

6 Hours

Conclusion 2 Hours

Class evaluation of :raining course:Certificates and :.wards.

lnsttuctors The lead instructor and instructor aides utilized should be certifiedEmergency Medical Technicians thoroughly knowledgeable with theinformation and skills of the p..rticular lesson perioe Since mostextrication is performed by fire departments, rescue squads, andambulance services, personnel from these services with extensiveexperience in extrication procedures should be utilized as leadinstructor and instructor aides. It is suggested that emergency medicalcare procedures in the course be taught by physicians if at all practical.Physician participation will afford him an opportunity to becomeacquainted with the problems the EMT is confronted with at the sceneof the accident. Once exposed to the problems the physician may bemore receptive to assist in on-going training programs for the localambulance and rescue personnel. Hopefully he will also identify theambulance services as an extension of the hospital emergency depart-ment and rightfully a part of the medical community. Guidance forinstructors on effective teaching techniques is provided in Appendix B,Instructor's Lesson Plans. Basic Training Program for Emergency

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COURSE COORDINATOR'S WIDE

Aledial Technician Ambulance. The student's demonstration ofextrication skills should he the primary factor in the grading process.

Students This course has been developed for all ambulance and rescue personnelwho provide light and medium duty extrication services. Heavy dutyrescue operations is considered a specialty by itself. A separate coursein heavy duty rescue operations will be developed at a later date if thereis a sufficient demand. Desirable qualifications for EMTs to attend theCrash Victim Extrication Course are:

1. Have satisfactorily comploed the NHTSA 81-Hour Basic TrainingCourse for EMT Ambulance or equivalent.

2. Possess an interest and desire to expand on their basic extricationknowledge.

3. Be able to work as a team member and insure calm, deliberate andsensible action.

4. Be able to analyze a situation accurately and take or suggest aneffective course of action.

5. Meet qualification standards imposed by the State in which thecourse is offered.

Class Size It is recommended the class sire be limited to 24 students in order thatmaximum student participation can be achieved in the lecture,demonstration and practice periods. It is recommended also that atleast one instructor aide for each eight students be provided duringpractice and demonstration periods; the most favorable ratio being oneinstructor aide for each four students.

Training The training facility for classroom instruction should be indoors.Facilities Outdoor facilities may be better suited for demonstration and practical

work sessions unless the time of year would create a problem due toinclement weather. Good indoor locations are armories, schools,garages, airport hangars. firehouses and fairground exposition buildings.If indoor space for demonstration and practice sessions is not availablean adjacent or nearby parking lot, school yard, vacant lot orauto-salvage yard may be used. Try to avoid excessive transportation ofstudents and equipment.When the training facility is selected, consideration should be given toadequate parking, lighting, heating, ventilation, public address systemand electrical outlets for projection equipment."I nere should he sufficient floor space for the following:

1. A classroom area for 24 students seated at desks or tables withwriting surfaces for notetaking and equipment examination.

2. A lecture area containing a lecturn, chalkboard, and a stand forcharts and.other visual aids.

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COURSE COOROMAMR'S 61t E

3. A projection area for a 35mm elide projector and screen.4. An exhibit area where extrication equipment and supplies may be

displayed on tables.5. A demonstration and practice area with space for a minimum of

four wrecked automobiles lone for demonstration and three forstudent drills).

6. The front seat of an automo", e mounted on a sturdy platform isan excellent means of demon.strating backboard techniques to theclass.

Wrecked The minimum number of wrecked vehicles required for this course isVehicle Source one for demonstration purposes and one for each practice team. Cars

may usually be obtained from law enforcement compounds, used cardealers, cab companies, city salvage yards, and automobile insurancecompanies. It is suggested that two front doors, one from a modelbefore 1967 and one after 1967 be obtained to demonstrate thedifference between the regular and safety door latches. Or, theinstructor may have available one of each of the door lockingmechanisms to illustrate this point. The wrecked automobiles should becarefully selected to permit full application of all extrication tools.Towing to and from the training site by police, private towing service orAAA affiliates with police cooperation is recommended. Normallywrecked vehicles and towing services will be provided as a publicservice.

Safety Precautionsand Security

Special safety precautions should be taken for the demonstration andpractice periods of extrication. The wrecked vehicles should be securelyshored and blocked to prevent the danger of tipping. The gas tank, fuellines, carburetor and oil pans should be drained and flushed; and thebattery should be deactivated. These precautions will minimize thedanger of fire or explosion. Either foam, CO2 , or dry chemical fireextinguishers must be present. It is also suggested that charged firelinesare laid and personnel with firefighting knowledge be on hand at all times.

Students and instructors should be equipped with hard hats, gloves andgoggles. This requirement should be included in the course announce-ment as the EMTs will usually be a member of an active service andhave their own safety equipment.

If the wrecked vehicles are outdoors, security measures should be takento avoid vandalism and possible injury to youngsters who might betempted to play in the vehicles.

Simulated The use of simulated casualties is suggested for the demonstration andCasualties practice periods of instruction. Moulages and cosmetic applications can

present the students witrvielims who have suffered a variety of

5

COURSE CO4ROIRATOR'S CUE

common vehicle injuries. This realism may help to develop the student'sability to recognize various injuries and better prepare him for hisencounter with actual victims.Whenever possible it is recommended that experienced EMTs be used asaccident victims. They have first hand knowledge on how the injuredvictim reacts to mishandling, improper application of splints and otherdevices.

The "victims" should be instructed to wear old clothing that may betorn and stained to add realism to the makeup.Simulated casualties acted out by the EMT "victims," may be used asan effective public relations tool. The realistic demonstration orpractice could be an informative story for the community through thenews and TV media. A well informed general public can be instru-mental in backing the ambulance and rescue services in the passage orupdating of legislation to upgrade services.

Material The folio% -g extrication and emergency medical care equipment isand Equipment suggested for this course. It is suggested that each practice team be

provided with a complete set during the practice phase of theinstruction. The students will be expected to make their own choice oftools during the various "drills." The instructors should grade theindividual student on his choice of equipment. It is understood thatmany ambulance and rescue services will not have all of the equipmentidentified in this training course. The instructor should select and placeemphAis on the equipment most commonly used by the ambulanceand rescue personnel he is instructing. He should however, introduceand train students in the use of new tools. This will serve in upgradingextrication and rescue operations in his area. The suggested list for eachwork group is as follows:

(1) Wrench, 12" adjustable, open end(1) Screw driver, 12", regular blade(1) Screw driver, 12", Phillips blade(1) Hacksaw with 12 wire (carbide blades)(1) Sledge hammer, 4-6 lb., with 15" handle(1) Fire axe, pick head, 36" handle(1) Wrecking bar, 24"(1) Pry bar 6-8'(1) Crow bar, 5', pinch point(1) Boltcutter with jaw opening 1" or better(1) Shovel, 49", pointed blade(1) Channel pliers(1) Porta-power kit complete, two-ton(1) Double action tin snip, hand operated, 8"(1) Cold chisel, 1/2" x 12"(1) Cold chisel, 1" x 12 "(1) Seat belt cutter(2) Linesman's knife

6

COORS! COORDINATOR'S SOME

Testing andGrading Students

(2) Baling hooks(?) Goggles. 1 for each student and instructor(?) Hard hats. I for each student and instructor(?) Leather palm working gloves, 1 for each student & instructor(12) Wood shoring blocks. 2" x 4" x 10", with rope handles(4) Wood shoring blocks. 4" x 4" x 10". with rope handles(4) Wood shoring blocks, wedge shaped, with rope handles(2) Blankets(I) Come-a-long. I or 2 ton, ch :iin type( I ) Alloy steel rescue pull chain, 6 foot(1) Air cutting gun kit. 220 lb( 1 ) Auto jack(6) Sand bags(2) Extrication straps, 9' long and 2" wide with buckles(I) Emergency medical care supply(1) Hemp rope 100'. and linesman's gloves (hot line)(1) Short backboard with accessories( I) Long backboard with accessories( I) Extrication rope sling. 6' of manila rope(1) Scoop type orthopaedic stretcher(1) Thomas half ring splint(4) Padded board splints 3" x 15"(4) Padded board splints 3" x 36"( 2) Sets air splints(1) Cervical collar(2) Push paddle ita x 1" x 15" wood, all sides beveled (optional,

used to liusn cravat under the victim when applyingbackboard).

(10) Cravats

EMTs taking the course should be given both written and practical testsof knowledge and skills. Since it is inadvisable to standardize written orpractical tests, questions will need to be developed each time the courseis conducted, with special emphasis on local problems. Each instructorshould be responsible for developing and submitting questions coveringthe lesson, and the course coordinator responsible for consolidating allthe submitted questions into a balanced test and for administering andgrading the examination. Guidance for developing and scoring tests isprovided in the Instructor's Lesson Plans. Basic Training Program forEmergency Medical Technician Ambulance. Appendix A.

Sufficient time has been provided in Lesson No. 4 for practical testsand evaluation of skills. Critiques by the team instructor and fellowstudents is an excellent method of evaluating skills.

It is suggested that the State agency design a special arm patch for thosecompleting thi course to stimulate a sense of competition and a markof distinction ong ambulance and rescue personnel.

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COURSE COORDINATOR'S OWE

)2J1)011Y)0')IYJt Yal )

Visual Aids, Slides: A set of 35mm sound slides is provided with this extri, ationTexts and training course. These slides are numbered to ma,, a the

Supplementary References sequence in which they are used in the Instructor's LessenPlans.

Films: Time for film showing should be held to a minimum. Forextrication training it is essential that as much time as possibleis spent in "hands on" training. Films are more useful asrefresher in-service training aids.

Texts and Supplementary Reading for Instructors and Students Stateand Local Option:

Basic Training Program for Emergency Medical 'TechnicianAmbulance. Instructor's Lesson Plans. Superintendent of Docu-ments, Washington, D.C. 20402 $2.50. Order No. TD2.208:EM3/3.Basic Training Program for Emergency Medical TechnicianAmbulance. Course Guide and Course Coordinator OrientationProgram. Superintendent of Documents 354. Order No. TD2.208:EM3/2.Patient Handling Manual for Emergency Medical TechniciansAmbulance. Superintendent of Documents 604. Order No.TD8.8: EM3 /3.EMergency Care and Transportation of the Sick and Injured.American Academy of Orthopaedic Surgeons, $4.95 each, Chicago.Emergency Victim Care. Edited and distributed by InstructionalMaterials Laboratory, Trade and Industrial Education, Ohio StateUniv. College of Education, Columbus, Ohio 43210First Aid and Emergency Rescue. Lawrence W. Erven, Glenco Press.1970, Beverly Hills, California.Emergency Care. Harvey Grant & Robert Murry. Robert J. BradyCo., 130 Que Street. N. E., Washington, D. C. 20002.

8

Lour.. Crash Victim Extrication instructionalAids

Iti 1 ,ti Basic Considerations

Chalkboard, chalk, eraser, 35mm slide projector, recorder,screen, and slides

T an. 3 Hours iveN 1. Inform the EMTs of the purpose, scope aria requirements ofthe course.

Instructor'sLessonPlan

1TEACHING POINTS

2. Provide an overview of the role of the EMT in extrication.3. Develop an understanding of the principles of and considera-

tions in extrication.4. Introduce the EMTs to the operation and function of all ex-

trication tools and equipment.

NOTES ANDVISUAL AIDS

A. INTRODUCTORY REMARKSI. Introduce self and instructor aides.2. Welcome students and guests.3 Describe the purpose of the course:

a. Upgrade skills and knowledge of individuals concernedwith extrication.

b. Briefly review the scope of the course identifying what willbe covered in each lesson.

B. ADMINISTRATIVE MATTERSI. Hand out and have students complete registration form.2. Identify time and place for each lesson. Telephone number

for emergency calls. Rest rooms. eating facilities. etc.3. Discuss requirements for satisfactory completion of course:

a. attendance.h. testing.c. attitude and conduct.

4. Solicit questions regarding the proceedings of the course. andrequest written recommendations for course improvement.

C. BASIC CONSIDERATIONSI. Discuss role of EMT in extrication.

a. Make general survey of total accident scene.h. Account for all victims.c. Administer necessary emergency medical care to victims

before and duni!-ig extrication.d. Select appropriate tools and equipment to gain access to

victims.e. Establish and maintain a safe working environment.f. Assure that victims are removed from vehicles in such a

way as to minimize further injury.g. If heavy duty rescue crews and other emergency services

arc present. cooperate with their activities. and designateon-the-scene authority for coordination.

2. Explain management of vehicle injuries.a. Be calm and deliberate.b. If victim is conscious. identify yourself as an emergency

medical technician and explain what you are going to do.c. Check for and establish an airway.d. Check for dangerous bleeding.e. Examine victim for other injuries, particularly fractures.f. Apply appropriate emergency medical care measures.

9LESSON 1 (Con't)

TEACHING POINTS NOTES ANDVISUAL AIDS

g. With maximum gentleness. remove individual( s) on appro-priate carrying device.

3. Review emergency medical care measures involved in pre-paring patient for removal:a. Dressing and bandaging wounds.h. Immobilizing extremity fractures.c. Use long and short backboards with appropriate acces-

sories.4. Introduce to the students the operation and purpose of each

tool that will he used during the extrication course. It isrecommended that a complete set of tools (listed previously)he made available to each team and spread out on worktables or on the :loon The Team instructor aides shoulddemonstrate how each tool operates, identify safety features,and explain th,..e function it serves in the extrication orforcible entry procedures. Each student should he able tooperate all tools, know their use and be required todemonstrate his proficiency in their operation before the drillsessions. This practice session is essential for the preventionof possible injury to the student or to his team mates duringthe practical sessions. Also, there will be less chance for thestudents damaging the tools due to improper application.

10 BEST COPY AVAILABLEc,,e Crash Victim Extrication

Lesson Title Removal Problems

instructional Lighted podium, 35mm slide projector, screen,Aids slides and recorder.

Time 2 Hours Objectives


2

Teach the following skills:a. Entry techniquesb. Immediate emergency medical care principlesc. Victim preparation techniquesd. Techniques of victim removal from different positions in

the vehicles


The instructor has the option of using the sound slides with theprepared text or he may use the slides with his own presenta-tion.

CRASH VICTIMEXTRICATION

O41 $ Proporalwi of Um...0Mo'40464 Homy Test% Selo, AM.00.044Maw I worm" 164dast *Rows 0.....

Slide ICRASH VICTIM EXTRICATIONIt would be impossible to characterize a typi-cal accident scene by a simple. straight-forwardreview of events and procedures performed byvarious personnel. It is a matter of chance as towho is available and willing to report the acci-dent to the proper authorities.

Slide 2Many vehicle accidents are discovered and re-ported by persons passing who are not involvedin the accident themselves. Hov.ever, theremight be individuals within the involved vehicleswho are able to egress from the vehicle and tomake their way to a telephone or other means ofsummoning help.

Slide 3Law enforcement officers on patrol, a routineambulance, fire truck or a tow truck may befirst at the scene of an accident. Dependingupon personal background, training, responsi-bilities and financial interests, varying reports onthe condition of the accident victims and de-scriptions of the vehicle will be made. In ruralareas, a passerby may have to travel several milesto a telephone.

BEST COPY AVAILABLE

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Slide 4Whereas in cities, it may be just a short distanceto a telephone. In some areas, telephone oper-ators are trained to assist the person who wishesto report an accident. Because of long distancesand rural situations, it is very possible that apasserby may attempt to render assistance be-fore going for help on the theory that immediatehelp, although amateur, is more important thanprofessional aid that may be obtained later.

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Slide 5The general public should be emphaticallyadvised that it' they are not trained DO NOTMOVE THE VICTIM. They should comfort thevictim while someone else goes for help.

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Slide 6Seasoned rescuers are firmly convinced that eachextrication problem is different. There havebeen few or no previous attempts to findpatterns from statistical evidence or seriousefforts to record detailed descriptions of ac-tivities at rescue scenes from which such pat-terns might be deduced.

f;I: -

Slide 7Law enforcement agencies are usually con-sidered to have primary responsibility at thescene of an accident. Often the control of trafficis all many can manage. However, many officersmay be well trained in emergency care and willperform minimal urgent care until the arrival ofan ambulance.

111.1=11==FICWo

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..mir"*Slide 8The accident scene may involve personnel froma great mans different agencies for specificfunctions which need to be performed. Therewill be numerous arrivals and departures. Trafficwill have to be controlled to prevent furthercollisions.

Slide 9Curious on-lookers will have to be controlledand kept away from the scene. Ambulances andsometimes fire equipment will be arriving anddeparting the scene. News media such as news-paper men, radio and television reporters may beon the scene.

11

12BEST COPY AVAILABLE

REMOVAL PROBLEMS

Slide 10There will he reports to he made out by police:exchange of names and addresses betweendrivers and all of this adds to the confusion atthe scene. But in most instances, once theambulance or rescue vehicle arrives at the scene.extrication activities will be turned over to themby the policemen.

Slide 11Although most tools and equipment used inextrication are not designed or selected forextrication activities alone, it has been deter-mined that certain functions, procedures andequipment are basic. These are applied in avariety of ways. according to the ingenuity ofthe trained EMT or rescuer, their knowledge,and the advantages and disadvantages of thetools.

Slide 12Some basic tools have been well adapted tocertain jobs in extrication while others maycreate additional hazards, such as fire.

DEGREE OF

EFFECTIVENESS IN RESCUE

1. Gaming *cons2. Training of pervonnel3. Equipment available4. Condition of veetim(s)

Slide 13The degree of effectiveness in emergency medi-cal care rendered is dependent upon gainingaccess to a victim, the training of the personnel,the equipment available and the condition of thevictim. Limited access to the victim may preventthe most effective care and treatment, but allattempts must be made to insure that life ismaintained. Not only must life-threateningmedical problems be resolved, but those thatmay cause unnecessary permanent injury orneedless suffering should be treated as soon aspossible. Methods of gaining access and dis-entangling vehicle parts and debris from aroundthe victim requires alternate approaches andexercises of ingenuity in the use of availablemethods and tools. The primary problem is thatno two accidents are exactly alike althoughsome similarities exist.

GENERAL RULES FOR RESCUE

1. Survey entire ecculeat same2. Identify sod cornet hoards3. Comet hie thieetseffig comedians4. Immobilize vectimIsl

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Slide 14Prior to gaining access to the victim, one shouldsurvey the situation and determine if specialhazards are present. Safety efforts should beinitiated if there is a threat to life during theprocess of extrication. The general rule is thatno patient should be removed until life-threatening conditions are corrected and thepatient's body is immobilize I as one completeunit.

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LIFE THREATENING SITUATIONS

1 FIN2 Excesses» emoting Of chemical spellege

3 Gasoline or chemical vaporin confined wok

4 Esokssrres Or hatardout malarial%6 Canape at ureeltened structure

Slide ISProblems bearing on extrication which havebeen cited by physicians discussing the subjectinclude the following:

First. the failure to institute life-saving tech-niques such as:

a. Establishing an airwayb. Maintaining an airway and artificial

respirationc. Control of bleeding andd. Closed-chest heart compression

The second problem was poorly trainedpersonnel responding to emergency calls.The third problem was long delays in re-sponding to emergency calls.The fourth. insufficient or inadequate designsof equipment.The fifth, movement of the victim by un-trained personni.I.

ACTION PRIOR TO EXTRICATION

I Check worseStop were bleeding

3 Splint fracturest Cover all woundsContinue Shock trOatment

Slide 16This sequence of action must be followed by theemergency medical technician prior to extrica-tion:

1. Check to insure the airway is open, andthat the victim is breathing. If not, supportthe victim's breathing by the appropriatemeans.

2. Stop severe bleeding.3. Splint all suspected fractures or disloca-

tions.4. Cover all other wounds to prevent contam-

ination.S. Continue shock treatment even if you do

nothing more than reassure the victim.

Slide 17However, the general rule must be disregarded ifthe victim's life and well-being are endangered.This would apply for the EMT as well. In thefollowing cases the patient should be moved outof danger at once if possible:

1. Fires.2. Excessive gas spillage that could he ignited

by a spark or flame.3. Gasoline or chemical leaking on the victim

or creating vapors in a closed area.4. Explosives or other hazardous materials.S. Weakened structures.

Im

"FIVE STAGES OF EXTRICATION"

1. Gonsesp We*

Slide 18Extrication is divided into five stages. The firststage would be gaining access to the victim.Gaining access to the victim depends on thelocation, :Ind position of the automobile, itsdamage end the position of the victim. It may beas simple as opening a dour or as difficult ascutting op.:i a severely damaged vehicle.

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Slide 19Typical procedures for simple cases will involveprying tools of various kinds to spread metal,open up doors or provide an opening throughthe vehicle in some manner.

13


REEK PROBLEMS

Slide 20

Slide 21It could also involve cutting off the roof, jackingthe vehicle off a victim, sawing through a tree,breaking glass or removing debris.

Slide 22Generally speaking, most EMTs feel that thebest procedure is to use devices, such as the aircutting gun which does not create sparks, heat,or flame because of the danger of spilled fuel inthe vicinity of the accident. The vehicle con-struction and the deformation of the vehicle areof primary importance and directly affect, first,the manner in which a victim is trapped orpinned; and second, the means of disentangle-ment. Factors such as vehicle orientation, accessroutes, injuries and environmental conditions,natural as well as crash-induced, will also havean influence during this first phase of extrica-tion. Time of day and weather conditions willalso affect the operation. Certainly the same jobwould seem more difficult if it had to be per-formed at night during a severe storm. Gainingaccess may be dangerous both for the victim aswell as the EMT, and it may consume a greatdeal of time and resources.

Slide 23Hazard control activities such as a charged lineare needed to mitigate the dangers and trafficcontrol problems may be affected. The victimmay or may not be injured and the means ofgaining access must take this into account.

BEST COPY AVAILABLE

RIMY& NORM

Slide 24Safe* must he kept foremost in mind, and thissometimes compounds the complicationsbecause most extrication equipment, partic-ularly access equipment. may generate a hazardof fire due to sparks. heat. or explosion.

FIVE STAGES OF EXTRICATION

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Slide 25The second stage of extrication is called "givinglife-saving emergency medical care." Such pro-cedures do not contribute directly to the processof extrication in terms of physically removing oruntangling the wreckage or debris from thevictim, but they are essential to the properaccomplishment of extrication procedures, andto their primary goal of saving human lives.

Slide 26The simplest form of emergency medical caremight be a swift visual check and questions toascertain absence or presence of injuries. First-aid might be initiated immediately upon dis-covery of the crash by the first person on thescene.

Slide 27Such immediate care should be directed towardinsuring that a clear airway exists and that it ismaintained by artificial respiration if necessary.

Slide 28Bleeding should then be controlled and progres-sive emergency medical care should protect allwounds, insure that all fractures are splinted andprotect against the effects of shock.


1. Coning mans2. Lai wag earngsalcy ctiodocal cuea 121senuniftentat

Slide 29The third stage of extrication is called "Dis-entanglement." Disentanglement of the victimfrom his immediate surroundings is ac-complished after access has been gained. Aidmay be rendered prior to, during and afterdisentanglement, although primary concern isnaturally directed toward the removal of thevictim from the vehicle.

15

18 BEST COPY AVAILABLE

AMU. PROMS

Slide 30The concept of removing or disentangling thevehicle from the victim should he more properlyemphasized in order to prevent further injury.

Slide 31Great care must he exercised during the dis-entanglement process because it is at this timethat tools and equipment are in the closestproximity of the victim and their effect uponhim must be carefully considered. The effects ofexcessive heat. pressure and force on the victimmust he minimized.

Slide 32Other possible injuries must be taken intoaccount. The possibility of a fractured spinemust he a primary consideration when a victimis moved to free him from the wreckage.

Slide 33As disentanglement proceeds, efforts to renderemergency care may continue as additional bodyareas become accessible for treatment. If theEMTs are well trained and experienced, theywill minimize additional injuries. Passersby maybe tempted to pull a victim when removing himwithout consideration of further damage.

'Slide 34Tools and equipment may be required to free avictim from his entrapment or involvement withthe vehicle. However. many times gaining accessto the victim is accomplished in such a mannerthat disentanglement occurs simultaneously. Insome cases careful movement of the body as aunit, preferably after proper preparation, willfree the victim.

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Slide 35Other times, the vehicle's chassis and body maybe so twisted that it will have to be cut, pried orjacked away from the victim.

BEST COPY AVAILABLE

. REMOVAL PROBLEMS

FIVE STAGES 03 EXTRICATION

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Slide 3cr,

The fourth stage of evtriation is "preparationfor reoval." One the structure and otherimpedMients have been disengaged from thevictim and other physical restraints in or aroundthe %chicle have been removed

Slide 37the victim should be carefully prepared forinitial movement from the vehicle. .Vow thispreparatort ac tirily has a two-fOld purpose. Thefirst would he the protection of the victim fromfurther injury during transport or removal fromthe wreckage. 77w second purpose would he tofacilitate the removal of the victim.

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Slide 38Preparation of the victim should include themaintenance of an airway. the dressing of allwounds and the splinting of all known orsuspected fractures. In other words. the patientmust be packaged as a unit prior to lifting ormoving.

Slide 39The fifth stage of extrication is "removal."During or prior to the removal phase. somechoice of pathway, method. personnel andequipment will have to be made.

Slide 40Plans and preparations for removal will havepreconditioned these choices to a great extent.Therefore, these two phases should be consid-ered together. If the victim ha: been properlyprepared for removal and the proper equipmentwas used, then very few problems should arisefrom this point on. At least not like the onesfaced while gaining access to the patient.

IMPORT "NIT POINTS

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trotsportottolt

Slide 41Two very important points must be rememberedin extrication. The first, patient care precedesextrication efforts unless delayed movementwould endanger the life of the patient or theEMT: -3d the second, once life supportingmeasures have been initiated, they must becontinued during preparation, removal andtrangportation of the patient to the hospital.Certain basic rescue tools must be standardequipment in every ambulance whether it is inrural, suburban or urban service.

17


IIMOVAL NORMS

` Et: .101 *Oriii 44---130

Slide 42Ambulances meeting DOT ambulance designcriteria have the space and capacity for the basicextrication equipment which might be necessaryin an emergency before a rescue unit or a morecapable unit arrives. Every EMT must be welltrained in their use.

Slide 43Some agencies have a rescue vehicle accompanythe ambulance on every accident. In such casesthe tools would be carried on the rescue vehicle.This is the only permissible exception to havingthem on the ambulance itself because theelement of time is so critical in life-threateningsitu Lions that delayi while waiting for tools andequipment cannot be tolerated. Lives that couldbe saved may be lost because of the delay.

The following series of slides will show some ofthe small and basic tools that can be carriedeither on the ambulance or in a light duty rescuevehicle.

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Slide 44Keeping in mind the safety of the rescuer as wellas the victim, note the helmet, the gloves, andthe safety glasses.

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Slide 4SHere we have basic but very useful items such asan assortment of pliers, screwdrivers, and adjust-able wrenches.

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Slide 46Hammers and various sizes of chisels.

Slide 47A simple pry tool made from a spring leaf of anautomobile and tapered on one end.

REMOVAL PROM

Slide 48Another improvised tool made from a spring leafof an automobile. This is a good cutting toolmade by sharpening one edge for cutting, andflattening the opposite edge for hammering.

Slide 49Hack-saws with at least twelve (12) carbideblades.

Slide 50A medium sized wrecking bar.

Slide 51pry bar.

BEST COPY AVAILABLE

Slide 52Medium or large sized hook and chains.

Slide 53This slide shows a cable hoist. A slightlydifferent version of this item is commonlyreferred to as a come-a-long.

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REMOVAL IBS

Slide 54A pair of bolt cutters. A jaw opening of 11/4inches is suggested.

Slide 55

Small. medium, and large size jacks and blocks.Note the platforms for the jacks. These arenecessary to prevent the jack from sinking intothe ground.

Slide 56This slide shows all the components to theport-a-power and come-a-long units.

Slide 57This is an electrical reciprocal or saber saw.

Slide 58The air chisel is becoming a very popularextrication tool for several reasons. First, andforemost, it is a very safe tool becaus.e it doesnot create sparks or heat as most other tools do.It is small and easy to store and it does a veryeffective job in a minimum of time. Here thechisel is being operated off' an air tank. whichwill give you enough air for approximately liveminutes operation. This gives you a completelyportable cutting tool in ease you would have toleave the highway and work in a ravine or overan embankment. The air chisel can also beoperated from an air compressor mounted onthe crash truck or from the air tank of the crashtruck it' it has air brakes.

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Slide 59This slide shows a baling hook which is good forprying and lifting.

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Slide 60The electrical or linesman's knife.

MEAL PROBLEMBEST COPY AVAILABLE

Slide 61A seat belt cutter.

Slide 62Within each phase of the extrication processthere is a variety of possible methods orprocedures. These, in turn, require a set of toolsor equipment with capabilities to perform agroup of general functions. For example, duringthe phase of "gaining access." one may use themethod of opening a door or taking off a roof.In either method, the general functions of"severing" or "distorting" may also be required.However, the function of "distorting" may alsobe used during the phase calkd "disentangle-ment." Therefore. there will be considerableinteraction, overlapping and duplication ofspecific equipment functions during the dif-ferent phases of extrication.The following set of slides is arranged to showmore than one method of gaining access inseveral situations.

Slide 63This series of slides shows the air chisel beingused to open a jammed trunk lid.

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Slide 64Once the cut has been made, a prying tool canbe used to pry the latch open.

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Slide 65Here, a prying tool made from a leaf of anautomobile spring is being used. A large screw-driver would also work as well.

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22 BEST COPY AVAILABLE

REMOVAL PROBLBAS

trSlide 66This series will show a victim pinned underneaththe car. The vehicle will he raised using blocksand a pole for lifting the car from the victim.

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Slide 67The pole or metal pipe is placed or, tip of theblocks and under the vehicle. By pushing downon the opposite end of the pipe. the car is raised.

Slide 68As the car is raised, more blocks are placedunder the raised car to prevent it from fallingand causing further injury to the victim.

Slide (i9

This next series will show a victim pinned underthe wrecked automobile. The vehicle will beremoved by using a hydraulic jack and cribbingblocks. Notice that the jack is placed on aplatform and then blocks used to build up to thelevel of the car frame. This wiq allow you morelength on the jack and you will he able to raisethe car farther.

11%111111lRIIIIIIL_... Nadi-- .......r....- %Ammo.

Slide 70As the car is raised, blocks are placed under it toprevent falling. Note the manner in which theblocks are stacked to prevent slipping.

Once the length of the jack has run out, it canbe removed and the car held by the blocks. Youcan then build up under the jack and start again.

REMOVAL PROBLEMS

E 3-1 COPY AVAILABLE

Slide 71Here, the rescuers have put additional blocksunder the jack and raised the car farther. Noticethat the blocks are criss-crossed tsee color) toprevent slipping.

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Slide 72This slide shows a good method of constructinga set of cribbing blocks. Notice the small ropesfor quick handling. The set includes a variety ofdifferent site blocks.

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Slide 73This series of slides shows the EMTs removing afront windshield to gain access to a victim. Thisslide shows the chrome stripping being removedusing the baling hook.A lineman's knife previously illustrated is also agood tool for use in removing the molding fromaround the glass.

Slide 74Once the chronic stripping and rubber moldingare removed, the glass can be pried and liftedout with the baling hook. Notice that the EMTis prying and lifting from the bottom.

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Slide 75Sometimes you-May find that the windshield isstuck and cannot be broken loose by pryingfrom the outside. In that case, if one of thewindows should be down, an EMT can crawlthrough the window and push on the windshieldwith his feet as shown here. This, too, dependson victim location inside the vehicle.

Slide 76Here, the windshield has been popped out and isbeing removed to allow plenty of room forremoving the victim on a backboard through thefront of the car when necessary.

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24BEST COPY MAILABLE

REMOVAL PROBLEMS

Slide 77This series of slides simulates a victim trappedbehind a steering wheel. A bolt cutter will beused to cut away part of the steering wheel toallow for more room to work oa the victim andfor removal.

Slide 78In this slide, the EMT is using a pair of channellock pliers to remove the hard plastic coating.

Slide 79With the plastic removed, the bolt cutters areused to cut away the bottom half of the steeringwheel. If the bolt cutters are large, as used here,it will not be necessary to strip off the plastic.

Again while one EMT makes the cut, anotherone should protect the victim by placing some-thing between the victim and the wheel.

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Slide 80In this slide an overturned car is used to showhow a chain is fastened to some solid objectunderneath the car. Notice the cribbing blockused under the chain to support the metal.

Slide 81This slide shows a very handy tool, a large hook,which eliminates the need to crawl under a carto attach a chain. This tool could save a lot ofprecious time.

Ar,

Slide 82This slide shows one place where it could behooked. It would also hook over the axle, or inthe front of leaf springs.

REMOVAL PROBLEMS

er.ST COPY AVAILABLE

Slide 83Another chain should be secured around thesteering wheel with a cribbing block under it.

Side MNow the come-a-long is placed between thechain which was attached under the front of thecar and the chain attached around the steeringwheel. One or two additional cribbing blocksmay he used to prevent the chain from catchingon the metal. By tightening the come-a-long, thesteering wheel is pulled away from the victim.

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Slide 85The next two series will show how to pull thefront seat backwards to create more workingroom. Both the come-a-long and a chain hoistwill be demonstrated. This slide shows a chainbeing secured underneath the vehicle. Again.notice the use of cribbing blocks.

Slide 86Here. the come-a-long is attached to the securedchain from underneath the car and to a chainsecured under the front seat.

=M111 . wry wry

Slide 87With plenty of cribbing blocks used to supportthe metal. the come-a-long is tightened to pullthe front seat backwards.

1Slide 88This slide shows the use of a small hook which ishooked on support above the floor track andeliminates the time consuming process offastening a chain around the seat.

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26

BEST COPY AVAILABLE

RBIOVAL MOMS

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Slide 89Here, we again see the small hook attached tothe back of the front seat and chain hoist. Thehoist is again secured underneath the rear of thecar. By tightening the chain hoist, the front seatis pulled backwards. Note the EMT steadyingthe victim's head and neck.

Slide 90Now that the victim and seat are removed, wewill show you where to attach the hook andchain. This should he the support by the EMT'sright hand. Do not attach it to the bottom orplatform which is securely attached to the frameof the car.

4

Slide 91The platform should remain with the car and theseat will be pulled away from the platform. Ifthe seat can be slid back on its track manuallybefore removal, it will be easier to strip theremaining teeth.The next series of slides will consider severaldifferent methods of gaining access through thedoor of an automobile. Several tools will bedemonstrated.

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Slide 92In this slide, we have an overturned vehicle.Notice that the automobile was first stabilizedwith cribbing blocks. The EMT is hitting theedge of the door with a hammer. This causes thelip or edge of the door to flare outward, givingthe EMT a place to insert a pry-bar.

MOW PROBLEMSBEST COPY AVAILABLE

dm. APP.

Slide 93This shows the EMT using the pry-bar. A secondEMT is helping to pry with a small wrecking baruntil the door is sprung enough to get a goodhold with the larger pry bar.

tSlide 94This slide shows that the door has been priedopen. Use caution when opening the door andmake sure that the victim does not fail as thedoor is opened.

Slide 95Another way of gaining access through the dooris by cutting the jammed door handle using thesharpened edge of an automobile spring and ahammer.

Slide 96This is a very simple but effective cutting toolwhich will cut out the door handle very quicklyand it requires very little space for storing andtransporting.

Slide 97Once the cut has been made, the EMT cansimply reach in and lift the rod to open thelatch.

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Slide 98Doors to older model cars can be opened withpry-bars and wrecking bars, as shown previously,especially those built before 1965. Automobilesbuilt after 1965 have doors that are equippedwith a new safety lock which cannot be priedopen.

27


ROYAL PROBLEMS

Slide 99As soon as the latch is exposed you can see thatit is constructed differently than those on oldermodel cars.

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.' ..Ai±1.000:14000:4

Slide 100It cannot be pried open so we are using ahammer and chisel to cut the two rivets, not thecold steel safety bar.

Slide 101With the door open we can see the difference inthe two types of latches.

Slide 102Half of the latch mounted on the frame.

Slide 103The other half on the door. Yo see how theyinterlock and cannot be pried open.

11--ialiSlide 104Another tool used quite frequently for openingjammed car doors is the port-a-power.

Slide 105Here, the tool is used as a spreader to pry openthe jammed car door. Do not stand in front ofthe wedge, it could injure the EMT if it sprangloose.

BEST COPY AVAiLABLE

REMOVAL PROMS

Slide 10oOne of the safest and quickest took available forcutting around the handle of a jammed car dooris the air chisel. This series will show the use ofan air chisel to open a door.

-

Slide 107A continuation of the previous scene. Thenecessary cut has been made.

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Slide 108Once the cut has been made, an EMT can reachin and lift the rod unlatching the door.

011.111110MMIJIMP....icApIl

Slide 10')The next series will show a car turned on itsside. Access will be gained by cutting the topwith an air chisel. Be certain to cut the sectionlarge enough to enter and remove the victims onthe appropriate equipment.

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Slide 110Here, the EMT is cutting the entire top off thevehicle.

Slide 11 IWhen the metal has been removed, you will findboth round and flat supports that must be cutaway.

29


PBOVAL PRUE

Slide 11

Bolt cutters. again, arc used here to cut thesupports.

Slide 113Once the supports have been cut away. you willhave to cut or tear away the upholstery and youwill have access to the victim.

Slide 114The following series will show a victim pinned inthe automobile by a crushed top. Several dif-ferent tools and their use will be demonstrated.This slide shows a hack-saw with a carbide bladebeing used. To speed up this operation, onehack-saw could be used on each of the foursupport posts at once.

Slide 115Here, the cutting tool, made from an automobilespring, is used for cutting the thin metal.

Slide 116A reciprocal saw will do the job very quickly ifyou have electricity at the scene. Several bladesshould be available because they break quiteeasily, although no more so than blades to thehack-saw.

16.

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Slide 117As seen here, the reciprocal or saber saw did agood job of cutting completely through thecenter support post.

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Slide 118The next series shows a victim lying in the topof an automobile that has overturned. Therope-loop and long backboard will be used toremove the victim.

RENOIR PROMSBEST COPY AVAILABLE

Slide 119The backboard is placed flush with the frame ofthe window.

Slide 120The rope-loop is placed over the victim's chestand under his arms.

0

Slide 121Traction is applied gently and steadily to pullthe victim out of the window and onto thebackboard. The victim must be guided by extraEMTs or bystanders, especially as he comes ontothe board to prevent injury to the victim.Padding between the end of the board and thewindow could prevent injury to the victim'sback. The victim once cleared of the wreck canbe prepared for final transport.

Slide 122This series shows the proper sequence of actionsin securing a victim to the short backboard. Thehead of the victim is supported by one EMTwhile the other applies a cervical collar.

Slide 123The short hoard is positioned behind the patientwhile the head is still supported.

Slide 124After the head and chin bands are secured.

Slide 125one cravat is tied from the left-lower corner,across the chest to the upper-right corner.

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REMOVAL PROBLEMS

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Slide 126The next cravat is tied from the lowerrightcorner, across the chest to the upper-left cornerof the board.

ISlide 127A third cravat is tied straight across the chest,well up underneath the arms.

Slide 128A fourth cravat is tied across the stomach tosecure the lower portion of the short backboardto the victim's body. Note the forearms havealso been secured to restrict movement. This isthe way the victim looks now that the board isthoroughly secured to his body. With the victimsecured in this manner, you should not have anyfurther problems in transferring him onto thelong backboard for removal.

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Slide 129Occasionally we do have bus wrecks. Therefore,this series of slides is intended to acquaint theEMT with some of the more important featuresof the vehicle The coach usually seats 46passengers. It carries a total of about 130 gallonsof diesel fuel in two tanks located to the rear ofthe bus, just in front of the engine.

Slide 130Looking at the baggage compartment. the frame-work is of tubular steel rods. These rods go allthe way up and over the top for support. Thefuel lines travel under the centLr of the floorfrom the tanks to the engine on all models. The.air conditioning unit is located in front of theengine (see arrow) or to the rear of the baggagecompartment. EMTs should not cut in this areabecause of the danger of freon. The coach is alsoequipped with a rest room which is located inthe rear of the bus. Don't forget to look in thisarea in case you are working such an accident.Be careful of any chemical spills in this area.

ROMVAL PROWS

Slide 131Hoses should ht studied for safety features.There are several built into this particular coach.1-or example. if the switch-key will not turn offthe motor. there is an emergency stop locatedon the instrument panel.

Slide 132If the emergency stop or switch cannot bereached or fails to work. there are two batteryshut-off switches located in the engine compart-ment. Simply give them a half turn to the right.These are identified by the red paint.

41-

Slide 133If all mentioned procedures fail to stop theengine break or cut the fuel intake line goingto this pump. This will stop the engine.

BEST COPY tkVAILABLE

Slide 134Each coach is equipped with two batterieslocated one on either side, just to the rear of theback wheels. However, they should not have tobe disconnected because the two battery shut-off switches in the engine compartmentaccomplish the same results. The most vulnera-ble places for fire to start in the coach are thebrakes on the rear axle, the transmission, andthe rear engine compartment. To extinguish thefire, use carbonate soda (dry chemical) or CO2.

Slide 135To gain access to the coach through the door incase the motor is not running, there are at leastthree manual releases for the door. One islocated in front and to the left of the driver.

Slide 136Another is located to the right just inside thedoor. Both of these can be operated from insidethe coach.

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REMOVAL RUBIS

Slide 137In case there is no one inside the bus able towork these releases, there is one located underthe door just in front of the right front wheelwhich can be operated by the EMT.

I

Slic.e 138Extrication efforts should be concentrated onremoving passengers through windows when thedoor is obscured. The coach is eouipped withpop-out glasses. Simply place your hands in thelower corners and push firmly.

owl;ea amoommill

Slide 139Of course if no one inside the bus can do thisfor you, a large screwdriver, pinch bar or wreck-ing bar can be placed under the metal framtaround the window to force the window out. 1.3open the front windshield from the outside,take out the rubber locking strip which runsaround the windshield. This strip is forced intoplace between the wide rubber frame, holdingthe windshield in place.

Road*Pow TN% %Aft Illorpasnol

EMERGENCY MEINCAL TECRNICIAN

SLIDE 140

This concludes the slide narration. It is anotherDOT effort to reduce the dead on arrival atthe emergency room and hopefully, total deathsfrom highways. Summarizing, remember thegeneral rule of extrication. No victim should beremoved until all life-threatening conditions arecorrected. The victim's body is immobilized orpackaged as one complete unit. This repre-sents another DOT initiative in the rescue andemergency medical services field.

35

Course. Crash Victim Extrication

Lesson tit!a Demonstration by instructorof forcible entry, disentangle-ment, and safety techniques.

Time 3 Hours


3

InstructionalAids.

Necessary tools, equipment and wrecked vehicles to demonstratethe Teaching Points listed below. (Caution: Check with the localpower company and fire department for any standing orders orlocally-accepted procedures for performing Teaching Points "d"and "e").

Objectives a. Evaluate situationb. Safety precautionsc. Gaining access to victim(s)d. Releasing victim(s) from entrapment

TEACHING POINTSNOTES AND

VISUAL AIDS

DEMONSTRATIONThe instructor and one or more instructor aides shoulddemonstrate to the class the proper use of all extrication toolsand equipment. The instructor should select one or morewrecked cars to clearly demonstrate each accident situation.The situations should include but are not restricted to thefollowing:a. Create a safe environment and evaluate the total accident

sceneb. Account for all accident victims and carry out triage

proceduresc. Extinguish small gasoline and electrical firesd. Remove "hot power lines" from vehiclee. Methods of stabilizing wrecked vehicles1. Pry open doors. trunk and hoodg. Cut around door and trunk locksh. Remove windshield and rear windowi. Pull away crushed posts, seats and steering columnj. Jackup dash board, crushed top of cark. Cut "U" shaped section from top of overturned vehicle1. Methods of removing victims from vehicle on short and long

backboardsNote to instructor:The students should be informed of the safety locking mechanisminstalled in vehicles after 1967. It is almost impossible to pry thesedoors opened with wrecking bars and spreaders. It is necessary tocut a section around the door handle exposing the locking devicewhich can usually be tripped by hand.

ILLUSTRATIVE STORIES

The following stories were excerpted from newspaper accounts ofambulance and rescue squad efforts to save lives. They illustratethe need to always follow professional procedures when humanlives are at stake.

1. During an accident that turned their car on its side, twooccupants of a small foreign car were pinned under the

36

LESSON 3 (Con't)


cowling. The two-man ambulance crew elected to cut. thetop out of the vehicle in order to extricate the victims. Thepower saw started a tire, and the crew's only tire ex-tinguisher was used to put it wit. They continued tocut, and the car again caught fire. Since the tire extinguisherwas empty, the two victims were burned to death.

2. An injured teenage driver of an overturned vehicle regainedconsciousness after 72 hours and inquired as to thewhereabouts of his three friends. Rescuers had found oneteenage girl that arrived at the hospital DOA. The boyexplained that two friends had hidden in the trunk to avoidpaying at the drive-in movie they had intended to see. Policeofficials checked the vehicle at the City impounding lot andfound the two missing boys in the trunk dead.

3. A ton and a half closed van truck missed a turn and ran intoa lake. submerging to the top of the cab. The bodies of thedriver and one other person were recovered from the cab,and the truck removed from the lake. Twelve hours later therear of the closed van was opened and it was discovered that28 migrant workers had also drowned.

37

Course Crash Victim Extrication

Lesson Tale Practice (skills training)

Time 6 Hours


4

Instructional Necessary extrication and patient care equipment bud supplies,Aids appropriate number of wrecked vehicles, and moulage supplies.

Obiect ;Nies Provide practice of following skills:a. Evaluation of accident scene.b. Triage of accident victims.c. Entry into vehicle.d. Victim emergency medical care.e. Disentanglement.f. Removal.

TEACHING POINTSNOTES AND

VISUAL AIDS

1. Students should be divided into rescue teams with an ap-pointed team leader and given an accident problem to solve.

2. Each student on the team should have the opportunity to serveas tlam leader.

3. In practice situations where two EMTs are required to carryout a procedure, i.e., use of the come-a-long or porta-power kit,the students should rotate functions. This will afford eachstudent the opportunity to carry out both functions.

4. All rescue skills with appropriate tools should be carried out inthe practice demonstration by each member of the team.

5. Evaluation of student's emergency care techniques, selection ofappropriate tools and rescue skills should be recorded by theinstructor. ..

6. The students should be made aware of their mistakes in bothemergency medical care procedures and rescue skills. At thecompletion of the practice session the students should beshown how emergency medical care procedures and rescueskills should have been conducted. This procedure should notonly be beneficial to the student concerned but to all students.

7. Students should assist the instructor aide in collecting, check-ing. tagging damaged equipment and packing equipment andsupplies in appropriate boxes. It is suggested that each. set ofequipmmt be marked with a different color paint for easyidentification.

38

Clurse Crash Victim Extrication Instructional Critic forms, and certificatesAids

Lesson title Conclusion

Time 2 Hours

Objectives Recognition for completion of course, and class evaluation oftraining course.


5TEACHING POINTS NOTES AND

VISUAL AIDS

1. To make this standard training course as acceptable andbeneficial to the student as possible and to provide amechanism for contik...al improvement and upgrading of thiscourse of instruction, the NHTSA Rescue & EmergencyMedical Services Division welcomes and encourages a classcritic of each course.

2. Some form of recognition for successful completion of thecourse is recommended, i.e., arm patch or rocker arm patchand a certificate. An NHTSA certificate is available, free ofcharge. designed to identify State and Federal involvement inthis vital program area emergency medical services training.

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3. The local press, radio and TV media should be invited to theaward ceremony. The general public should be made aware thattheir ambulance and rescue services are interested in providingthe best emergency medical care possible to its citizens whenin need. .