Interior Rescuer

[firefighter26]

A lot of simple, and yet, effective things can be done by the interior rescuer, apart from patient care. What things do you look for, as an interior responder?

For myself, I always check to make sure that feet and legs are not pinned under the dash/pedals (the best I can). I'll give a quick look for ignition keys, and make sure they are turned off, and that the vehicle is in park. Giving the door handle a quick pull is also helpful.

[Bones42]

Our interior person (unfortunately) is usually an EMT that is not very highly rescue trained. They will focus on the patient care. They don't usually remember to try any of the common options, door handles, locks, steering wheel tilts, etc. I would rather they do all this, but it does not happen. We keep trying to train on it.

Along with your items, it would be nice if they also looked for any and all signs of airbags. Roll down whatever windows they can. Can seats be moved manually.

[firefighter26]

That is a good point, Bones.

Here, in my neck of the woods, firefighters end up being the interior responder the majority of the time. This is usually because 1) we are, most often, there first, 2) our gear offers better protection than the nice, white, wool shirt that EHS usually wears 3) we are better trained for "rescue" operations.

Having separate EHS and Fire agencies means that the EHS side isn't as skilled at rescue operations as the Fire side (but the opposite is true for medical calls).

Unfortunately, when there is a division such as this, it can be hard to train the EHS crews to work efficiently with Rescue crews. Don't get me wrong, the job gets done; but if everyone was on the same page, it would get done faster.

Anyhow, back to the original post. There is lots that can be done from the inside.

Once again, for myself, I try to blend my Rescue duties with my Patient Care duties. I find It works out rather well. For example, during my patient RBS (Rapid Body Survey), I will also do a "vehicle interior RBS." Thus, when checking to make sure that the PT is free of the door we are going to remove, I will also check door handles, windows, and locks. When checking to make sure the knees and legs are not pinned, I will un my hand under the dash and try for the hood release, check for keys, and check the seat to see if I can find a handle to move it back. Coming back up the other side of the body I will check to make sure the E-brake is engaged. All the while, of course, talking to the patient. They can, some times, be your best source of information for things like Airbag location, and can sometimes even give you a good idea of their injuries.

Does anyone else have a 'system' that they use to make sure all the little things get done?

[JorgHeck]

Some time ago I found an article on defrace.org (extrication medical station) about the inside rescuer but this page seems to be not available any more.

Lets try to make a list of tasks an interior rescuer could/should do:

• Get access to the interior of the car and the patient
• Unlock/Open doors
• Open windows
• Look (smell) for special hazards (fuel)
• Airbag-Scanning
• Patient survey
• Cut seatbelts
• Shut off the motor if running
• Set the brake, Automatic in "Park"
• Use elektrical systems for own advantage
• Shut of the ignition. Leave the key where it is
• Turn on the "warning-lights" to show that there is electricity
• Cover the patient
• Talk to the patient

What else could/should he do?

[SANDSTROMJM]

Bones,
I feel for you, but as you know, my squad overcame that problem.
All our Extrication Team members are EMT's, Patient care & Extrication capable. It's a great concept, and has expidited(sp)pt removal. All members are on the same page, so to speak.
Joe

[Firescueguy]

Besides the other things posted here such as checking the extent of entrapment & such, I make it a point to put the car in park, apply the emrgency brake & REMOVE the keys from the ignition. Some people may disagree with this but I have had a pt. (very uncooperative, not a head injury, just plain uncooperative - must have been that "I have a Mercedes, I don't have to listen to you" mentality) who in the middle of the extrication team setting up their tools decided to not only turn the key but also rev the engine so she could get her cell phone on faster!!! The prompt removal (and subsequent "relocation" into the woods) of her keys eliminated that problem mighty quick.

Just my 2 cents....Stay Safe.

[firefighter26]

It is nice that we are all on the same page for what to look for (I can see your point on key removal, and I have had this happen to us in the passed. Someone had a little to much to drink one night, and ended up parking their car up on three wheels on the cement barrier. Shortly after we got there he tried to start up his car to drive it away. Our DC, at the time, reached in and took his keys before he could get the car into gear).

So, on to the next question (if we missed anything from the first question, feel free to add your thoughts):

As an Interior Responder, what equipment do you like to take with you? and does your department provide you with any IR specific equipment?

For example, we have "rescue helmets" on our rescue for the IR to wear. They are supposed to be lower profile so they don't hang up on things (supposed to, but they usually get hung up anyway.. and I still like my helmet because it has a visor, the IR helmets have goggles, but that will be another question).

[Ohiovolffemtp]

Other tasks for the interior rescuer:

Medical:
- Cervical spine immobilization - manual.
- C-collar application
- O2 therapy
- Insert oral or nasal airway
- Support breathing with BVM
- Intubation if required.
- IV therapy.
- Evaluation of pulse, motion, & sensation in all extremities.

Extrication:
- Watch for displacement of vehicle parts into patient
- Disentanglement of feet (if the patient is critical, just wiggle them loose).
- Cut wire harnesses, plastic components, etc that linger after major cutting done.
- lower glass windows into doors if possible.

[rmoore]

By taking each of the tasks that all of you suggested in this Message Forum, I have compiled the following list. It's a nice list!

Inside Rescuer Functions

Access
-get access to the interior of the car and the patient
Interior Hazard Survey
-look (smell) for special hazards (fuel, gas odor, smell of burning)
Transmission
-place automatic transmission in "Park"
Ignition
-quick look for ignition keys
-shut off the motor if running
-make sure key turned off
-REMOVE key from the ignition
Windows/Doors
-check all reachable door handles, windows, and locks
-give door handle a quick pull
-unlock/open doors
-open windows
-roll down windows if possible
Airbag Scanning
-look for any and all signs of airbags
-report airbag locations and status (deployed/loaded)
Hood Release
-operate hood release
Emergency brake
-set the emergency brake
Patient Protection
-cover/protect patient
Seatbelt System
-cut seatbelts
Electrical System Shutdown
-confirm electrical system shutdown after battery is shutdown
-turn on the parking lights
-check dome light if door is open
Seat
-check the seat to see if I can find a handle to move it back
-can seats be moved manually
Entrapment
-assure PT is free of the door we are going to remove,
-check to make sure the knees and legs are not pinned
-check feet and legs if pinned under the dash/pedals
-if patient is critical, wiggle feet loose
-watch for displacement of vehicle parts into patient
-cut wire harnesses, plastic, etc after major cutting done
Medical
-Patient survey RBS (Rapid Body Survey),
-Cervical spine immobilization
-C-collar application
-O2 therapy
-Insert oral or nasal airway
-Support breathing with BVM
-Intubation if required
-IV therapy
-Evaluation of pulse, motion, & sensation in all extremities
-Talk to the patient

[firefighter26]

Ron, I have to agree, that is a very nice list! It pretty much touches on a little of everything that the interior responder should/could do.

We all know that there usually isn't a lot of room inside. So, what equipment does everyone, as the interior, like to take with them, and why?

Has your department invested in any specific Interior Rescuer Equipment to help make things easier on you, your patient, or the extrication?

[RyanEMVFD]

on scanning for hazards be sure to look for weapons, meth labs, animals, etc also.

we remove the key and throw it on the dashboard. that way everyone sees it and knows the igition is off.

also the interior rescuer should be in command of the vehicle. if the vehicle is shaking too much or if moving the patient this way or another is hurting then they yell freeze and make corrections as the operation proceeds. granted everyone should do this as well and work and communicate together.