1. Extrication and Rescue Methods
for the Ambulance and
Emergency team of OHMRI
DR. SMRUTIRANJAN PATANAIK
CHIEF CONSULTANT - OHMRI

2. General Principles
 All operations include 7 basic steps
 Form a mental picture of how the
operation will be carried out

3. Size-Up
 Begins at moment of dispatch; continues
throughout rescue
 In route:
 Think through the steps
 Decide what you are going to do first
 When you arrive:
 Avoid being caught up in the situation
 Step back, survey scene

4. Size-Up
 Safety
 Are there potential hazards to you?
 Are bystanders at risk?
 Is the patient in danger?
Dead Rescuers Don’t Help
Anyone!

5. Size-Up
 Outside Help
 Is additional assistance needed?
 If you need something, call for it!
 Stay ahead.
 If you routinely work with other agencies,
have plan of operations worked out in
advance.

6. Size-Up
 Significant Information
 What kinds of vehicles?
 How many?
 What kind of collision?
 How many patients?
 Any potential for hazardous materials?
 Anyone ejected?

7. Hazard Control
 Traffic
 Park on same side of highway as collision
 Park up highway, beyond scene if possible
 Have someone spotting traffic at all times
 Wear reflective clothing at night
 Provide clear visual signals to drivers well in
advance of reaching scene

8. Hazard Control
 Power Lines
 Consciously look for lines on ground
 Use particular caution when vehicle has
struck utility pole or tree
 Tell patients to stay in vehicle
 Call the power company!

9. Hazard Control
 Gasoline or Fuel Spillage
 Shut off vehicle ignition keys
 Remove all ignition sources from area
 Ask Fire Department to get a charged hose
line on the ground
 Disconnect battery cable (+)—weigh risks
vs. benefits

10. Hazard Control
 Unstable Vehicles
 Any vehicle that does not have all 4 wheels
touching the pavement is unstable!
 Never push back into position
 Stabilize as found
 Maximize number of contact points with
ground; spread over as wide an area as
possible

11. Hazard Control
 Hazardous Materials
 Assume presence at all incidents until
proven otherwise
 Base decision to attempt rescue on best
available information about product(s) and
on expert advice

12. Hazard Control
 Appropriate Protective Clothing
 Atleast helmet, gloves
 Eye protection
 Work boots
 Turnout coat

13. Gaining Access
 Objective is to get to patient.
 Try before you pry!
 Work from simple to complex.

14. Gaining Access: Residences
 Check for open windows, doors
 Ask if anyone else (neighbors, relatives)
has key
 If a window is open, cut through screen
 If no windows are open, break smallest
window through which access can be
obtained

15. Gaining Access:Vehicles
 Upright vehicle
 Enter through doors
 When you open door, be sure patient is not
against it
 If door is locked, ask patient if he can open it
 If door will not open, break furthest window
away from patient to gain access

16. Gaining Access
 Vehicle on Side
 Stabilize vehicle
 Enter through top door
 If door will not open, break rear window

17. Gaining Access
 Vehicle Upside Down
 Gain access through windows
 Doors may be supporting vehicle body
 Careless opening, removal may cause
vehicle collapse

18. Gaining Access
Glass can be broken quickly and
effectively with a sharp blow to the
corner of a window about 2 inches
from the edge of the glass.

19. Life-Saving Care
 Rapidly evaluate patient’s condition
 Immediate threats are:
 Hypoxia
 Shock
 At this point, why patient isn’t
oxygenating or perfusing is irrelevant

20. Life-Saving Care
 If ABCs compromised, correct problem!
 If you cannot correct problem:
 Support oxygenation, ventilation
 Extricate patient to long board ASAP
 Rapidly transport

21. Disentanglement
Remove vehicle from patient,
NOT patient from vehicle!

22. Disentanglement
 Patient-centered
 Keep someone with patient to:
 Monitor condition
 Ensure that attack on vehicle does not
endanger patient

23. Disentanglement
 Do NOT do anything to vehicle unless
you know EXACTLY what result will be
 Protect patient at all times
 Cover blanket for protection
 Talk to him
 Explain what is happening

24. Preparation for Removal
 Packaging = Preparing patient for
removal as unit
 All injuries stabilized
 Patient moves as single unit through route
of egress

25. Preparation for Removal
 Any lower extremity injury can be stabilized
temporarily by securing it to other extremity
 Any upper extremity injury can be stabilized
temporarily by securing it to the chest
 KEDs are used to keep head-neck-torso in line
during extrication; patient must be extricated
onto a long board.

26. Preparation for Removal
Do NOT attempt complete
packaging of patients with
compromised ABCs
There in NO value in a well-
packaged corpse!

27. Removal
 Through doors if vehicle is upright.
 Through roof if vehicle is on side.
 Through window if vehicle is overturned.

28. Conclusion
 Successful rescues are based on planning,
practice.
 Know what community’s target hazards are.
 Have plan for managing them.
 Know who you will be working with; train with
them.
 Know what kinds of help are available.
 Do NOT be afraid to call for help if you need it!

29. Conclusion
The challenge is NOT to be innovative in
a crisis.
The challenge is to be well-trained and
well-disciplined enough to
FOLLOW THE RULES!