EMT-Basic Exam: The Basics of Operations - Rescue Operations

As an EMT-Basic, you may respond to calls in which the patient may be trapped. This type of situation is most common in motor vehicle collisions. In these situations, your personal safety is paramount. Remember, you cannot help anyone if you are injured and your injuries may need to be treated by EMS personnel, thereby taking vital resources away from the patients on the scene.
In many cases, rescue operations are handled by firefighters, police officers, or special rescue personnel. Some EMS agencies require EMT-Basics to take a special course in rescue operation techniques so they can assist rescue personnel with certain emergencies.
This guide will review the basics of patient extrication, the safety equipment used in rescue operations, and the techniques used to access and remove patients from dangerous situations.

1. Basics of Extrication
Extrication is the process of removing a patient from a motor vehicle or other dangerous situation. In some situations, you must remove debris or other objects to safely access the patient in a process called disentanglement. This often involves the use of specialized equipment. EMT-Basics with additional education or certifications may utilize this equipment to help extricate the patient, or the extrication process may be handled by firefighters or specialized rescue crewmembers before you arrive. Regardless of your role in the rescue of the patient, all extrication efforts must be coordinated to ensure the safety of the emergency responders and the patient.

Hydraulic extrication tools.

In some areas, an incident commander will coordinate the efforts of the rescue and medical personnel. This person is also often responsible for coordinating transport in incidents involving multiple victims.
Remember, critical care must be provided before and during patient extrication. Because this could put you in a dangerous situation, it is important to ensure that you have all the necessary equipment to protect yourself as you treat the patient. This may include wearing protective gear, such as a helmet or goggles.
Work with the rescue crew to ensure that the patient is removed in a way that doesn’t cause further injury. When you reach the patient, begin immediate care. In trauma situations, this will most likely involve implementing c-spine precautions, managing the airway, controlling bleeding, and supplying the patient with oxygen.

Tip: Critical care precedes extrication in most cases. However, extrication may be necessary if the patient is in immediate danger.

2. Safety and Equipment
In rescue operations, safety should be your primary concern. You also need to ensure the safety of your partner, the patient, and any bystanders. To do this effectively, you need to ensure that you take the proper precautions before attempting to assess or treat any patients.

a. Your Safety
One of the easiest ways to ensure your personal safety is to wear protective gear that is suitable for each emergency. This may include a helmet, protective eyewear, and leather gloves. Some EMT-Basics also wear puncture-resistant clothing and steel-toed boots in certain situations.
Check to make sure that you and your partner are wearing the appropriate protective gear before entering the scene.

b. The Patient’s Safety
After you have considered your safety needs, you must focus on safely removing the patient from harm’s way. In some cases, rescue personnel will use special equipment to remove the patient from the vehicle or structure. The removal process may create sparks or break glass. In this situation, you should protect the patient from glass, metal, and other dangerous debris. Use a blanket or a tarp to cover the patient. This will also protect the patient from the elements.
It is also important to explain the extrication process to the patient. Inform the patient of the sounds that he or she may hear during the process. This will help keep the patient calm.
Remember to keep witnesses and other onlookers away from the scene. This will reduce the risk of additional injuries and allow the rescue workers and medical professionals to focus on helping the patient.

c. Other Safety Concerns
Motor vehicle accidents present rescue workers with a number of challenges. You should always be aware of the risk of fire at the scene of a motor vehicle accident. Ensure that the vehicle’s engine is turned off to reduce the risk of fire. Don’t attempt to extinguish a vehicle fire unless you have the knowledge and equipment to do so. If you are not equipped to deal with this situation, wait for firefighters to secure the scene.
Another hazard when dealing with a patient trapped inside a car is the stability of the motor vehicle. Before entering the vehicle and caring for the patient, work with other rescue responders to secure the vehicle.
The risk of electric shock is another hazard you may encounter on the job. Downed power lines should only be handled by utility or rescue workers who have special training. Don’t attempt to approach or treat a patient if downed power lines are in your way. Wait for the appropriate authorities to secure the scene before attempting to treat the patient.
Hazardous materials also present a unique danger to both rescue workers and patients. 

In some situations, it may be helpful to appoint a safety officer to oversee the entire operation. This person should not be involved in the rescue or treatment of the patient. The safety officer observes the scene and notes any potential hazards that medical and rescue personnel might not notice during the emergency.

3. Accessing the Patient
Simple access of a patient doesn’t require any special equipment or training. However, accessing the patient is sometimes difficult, particularly in motor vehicle accidents. Remember to always wear protective clothing, even when accessing the patient is simple.
Don’t attempt to access the patient on your own when the extrication process is particularly complex. Call dispatch for further assistance if you think that accessing the patient might be difficult or dangerous. Follow the directions of rescue workers to access the patient in a safe and timely manner. If you are unable to assist in the extrication, do your best to reassure the patient during the process.

Tip: Check with your EMS agency to see if additional training is available to become a rescue technician.

4. Removing the Patient
Once you are able to gain access to the patient, you should begin critical care before and during the process of extrication. In cases where a spinal injury is suspected, you should always stabilize the spine before moving the patient. The only instance in which you should move the patient without spinal stabilization is when there is an immediate danger to the patient or rescue workers.
Ensure that you have the proper personnel to safely remove the patient from the vehicle or structure. Choose a pathway that will protect the patient from further injury as you leave the scene of the accident.

Additional Topic to Review
- Recommended minimum personal protective equipment for vehicle rescue